It is half past seven on a weekday evening. The clinic is locked, and a physiotherapist sits at her kitchen table with a laptop, watching a man in another county do a single leg squat in his sitting room. Nothing about that scene is unusual any more, and nothing about it is unregulated.
This page sets out what has to be in place before that call happens. It is written for physiotherapists on the CORU register who are thinking about adding video work, whether that is two hours a week or most of a caseload.
The same Code, in a different room
CORU has not written a separate rulebook for video. The Physiotherapists Registration Board's Code of Professional Conduct and Ethics does not single out telehealth, so every duty in it applies to a video session exactly as it does in a treatment room. Four of them do most of the work in practice:
- Act within the limits of your knowledge, skills, competence and experience, and refer on when a case sits outside them.
- Give the person enough information, in a form they can understand, to decide whether to consent.
- Keep clear, accurate and up to date records, and keep them secure.
- Maintain adequate professional indemnity cover for any assessment, treatment or service you provide.
None of that changes because the patient is on a screen. What changes is how you meet each one.
What ISCP adds
The Irish Society of Chartered Physiotherapists published its Policy and Guidelines on e-Health for Physiotherapists in Private Practice in March 2020. It binds members, and it is useful reading whether or not you are one.
It asks for indemnity cover that is adequate "in respect of the provision of this form of consultation". It asks you to use professional judgement about whether video suits the person in front of you. It also names the situations where the risk of missing something is higher: people who are not fluent in English, people with hearing or learning difficulties, children, acute trauma, progressive or deteriorating neurological conditions, and people in treatment for serious pathology, including active cancer.
On records and data it is brief. Seek explicit consent for processing personal data, and keep patient communications and records secure and compliant with data protection law.
Insurance: get the answer in writing
Both documents point to the same first step. Before your first video session, ask your insurer or broker, in writing, whether your policy covers physiotherapy delivered by video. A policy that covers you in a clinic does not automatically say so.
If you might ever see someone who is physically outside Ireland at the time of the call, ask that as a separate question. CORU registration is Irish registration, and neither document above deals with cross-border sessions. Until you have an answer from your insurer, and from the regulator in the country where the patient is sitting, the cautious position is patients in Ireland only.
What the research found
The evidence for physiotherapy by video is better than many clinicians assume, within limits.
A 2017 systematic review and meta-analysis pooled 13 studies and 1,520 participants across a range of musculoskeletal conditions. It concluded that real-time telerehabilitation "appears to be effective and comparable to conventional methods" for physical function and pain, and that treatment delivered only by video was equivalent to face-to-face treatment for physical function.
The PEAK trial, published in The Lancet in 2024, randomised 394 adults with chronic knee pain to five consultations over three months, either in person or by video, with 15 physiotherapists across 27 Australian clinics. Video was non-inferior to in-person care for both pain and function at three months.
A 2024 systematic review in the Journal of Physiotherapy looked at behaviour instead of outcomes. Attendance was 8 per cent higher and adherence to home exercise 9 per cent higher with video, and satisfaction was similarly high in both groups. The authors rated the certainty of that evidence as low to very low.
Read the limits as carefully as the findings. These studies mostly test exercise, education and advice. They say little about presentations where a hands-on examination is what gets you to the diagnosis.
Where video stops
You cannot palpate, you cannot test passive range or resisted strength with your own hands, and you cannot treat manually. Some assessments adapt well to a camera. Some do not adapt at all.
The professional judgement that both the Code and the ISCP policy ask for comes down to one question, asked patient by patient: is what I can see and hear enough to do this safely and well? When the answer is no, the job is to say so and refer on.
Video suits practice that already rests on exercise, loading and education. If manual treatment is the centre of how you work, video takes that centre away.
The practical layer
Confidentiality applies at your end of the call as well as theirs, so you need a room with a door that closes. Set the camera far enough back that you can demonstrate a movement, and ask the patient to do the same.
At the start of every session, confirm where the patient is and a phone number you can reach them on. If the call drops or they become unwell, you need to know where to send help.
Write your notes the same day, as you would in clinic. Health information is a special category of personal data under GDPR, so the video tool and wherever your notes live both have to meet data protection law. If you work for yourself, that responsibility is yours. If you work through a clinic or a platform, find out in writing who holds the records and who answers for them.
Two ways to do it
You can set up on your own. You choose the tools, set the price and find the patients, and finding the patients is most of the work.
Or you can work through a clinic or a service that brings the bookings to you. You give up some control and take on far less set up. Book a Physio is the second kind, and how working with us is set up has its own page.
Either way this is likely to be self-employed income. Revenue's guidance on registering as self-employed is the place to start on tax, not this page.