Occupational Therapists Reveal Why Telehealth Cannot Fully Replace In-Person Care

A quiet revolution is sweeping through Sweden’s primary care clinics, driven by a national reform known as the Transition to Integrated and Person-Centred Care, or TIPCC, which places telehealth at the heart of how services will be delivered in the decades ahead. Yet the therapists who deliver much of the hands-on rehabilitation in this system have remained largely unheard in the debate. Now, a qualitative interview study published in the Scandinavian Journal of Occupational Therapy offers the first systematic look at how occupational therapists working in Swedish regional primary care actually reason about delivering their profession through video technology, and their answers complicate the prevailing narrative that digital care can simply scale to every clinical task.

The research team, led by Johanna Johansson together with Caroline Fischl and Susanne Gustafsson at Jönköping University, conducted semi-structured interviews with fourteen occupational therapists recruited through purposive and network sampling designed to capture geographic variation across the country. Each interview lasted between 24 and 55 minutes, averaging 46 minutes, and followed an interview guide built around the Occupational Therapy Intervention Process Model, a framework that structures the therapist’s work into phases emphasizing the therapeutic relationship and collaboration with the patient. The transcribed material ran to 117 A4 pages and was analyzed using systematic text condensation, a qualitative strategy in which meaning units are identified, coded, grouped, condensed into artificial quotations, and then recontextualized against the original transcripts to ensure the participants’ voices remain intact.

The analysis converged on three overlapping domains through which the therapists organized their thinking: telehealth considered through the lens of the patient, through the lens of their own profession, and in relation to the surrounding context. Within the patient-centered domain, a striking ambivalence emerged around energy. For patients with stress-related illness or fatigue, telehealth conserves resources by eliminating travel and preparatory effort, allowing rehabilitation to begin earlier than an in-person visit would allow. Yet the therapists also described video meetings as potentially draining in their own right, noting that the blue light of screens, the association of computers with workplace performance pressure, and the sheer cognitive load of mediated communication can tax patients in ways a quiet clinic room does not.

Accessibility was the strongest argument in favor of the technology. Therapists reported that telehealth allowed patients to connect from home or even their workplace, saved time for relatives, reduced cancellations, and made group interventions feasible for so-called highly sensitive patients who otherwise spend energy reading the moods of others in a shared room. But preferences told a more complicated story. Most patients, the therapists observed, still prefer to meet in person, and few ever ask for a digital appointment, a pattern one participant called quite odd given the assumed demand for remote services. The therapists admitted their own preconceptions had been overturned: older patients, whom they expected to resist technology, often accepted telehealth willingly, while some patients in their thirties insisted on physical meetings, and patients with neuropsychiatric problems generally did not choose the digital route despite expectations to the contrary.

The professional lens exposed the deepest tensions. Occupational therapy rests on two pillars that telehealth strains: the therapeutic relationship and the performance analysis, the structured observation of a patient doing real activities in a real environment. Building trust through a screen proved slower, and for some therapists impossible, because body language is harder to read, eye contact is compromised, the reassuring gesture of a hand on a shoulder vanishes, and the small talk that lubricates human connection simply disappears in sessions that feel permanently on and off. Observation fared somewhat better. The therapists saw genuine opportunity in virtual home visits, which let them glimpse the patient’s actual living environment, something organizational structures had long prevented. Still, they worried that patients control what the camera shows, act less naturally when they know they are being watched, and that the crucial interplay between person, environment, and activity can be invisible in a framed video feed.

Hands-on elements of the profession proved the hardest to translate. Cognitive assessments, joint walks, ergonomic demonstrations, and hand evaluations that require the therapist to feel and grasp the patient’s hand resist digitization entirely. Some therapists managed to mail assistive devices such as orthoses to patients’ homes, but they described the risk of rehabilitation delays and the difficulty of teaching device use remotely, and others judged remote prescription impossible without direct demonstration. Even the creative scaffolding of therapy, writing with pen and paper, drawing schedules, sorting needs on a whiteboard, loses something on screen; as one therapist explained, writing by hand forces both patient and therapist to slow down in ways that benefit the work. The therapists also recognized that their own attitudes, from self-described pioneers to self-described reactionaries, shaped whether they experienced telehealth as liberation or loss.

The contextual domain revealed that the barriers are not merely technical but structural and political. All participants reported good access to equipment on their side, yet patients often had to use smartphones with small screens, lacked the electronic identification some platforms demand, or suffered unstable internet connections. Platforms showed inconsistent screen displays, made document sharing insecure or impossible for paper-based self-assessments, and forced therapists to guard against other patients’ data appearing on screen. Regionally, management actively promoted telehealth, and some therapists felt real pressure to match private digital providers, even as their immediate supervisors insisted that patient needs must guide practice. This dissonance matters because person-centred care, by definition, requires adapting services to individual needs, preferences, and resources, and a top-down push toward digital delivery risks overlooking exactly those individual differences.

The workload question cut against the efficiency narrative that often justifies digitalization. Therapists described double booking systems, more administration, fewer pauses, and heavier concentration demands during screen-based sessions, with one noting bluntly that although she could save time, she did not take on two patients instead of one. Those who used telehealth heavily found themselves teaching colleagues, adding further burden, while others lacked adequate training altogether. The study’s authors are careful to note that they did not set out to measure whether performance analysis through telehealth is clinically inferior; rather, they mapped how therapists justify their choices. Even so, the findings expose a clear knowledge gap about how the quality of observation-based assessment can be maintained across different modes of service delivery, a question the authors flag as a priority for future research.

The significance of the study extends well beyond Sweden. Most prior telehealth research in occupational therapy has been conducted outside Europe, much of it spurred by the pandemic-era scramble to keep services running, and this investigation is the first to document therapists’ reasoning within Swedish primary care specifically. Its central conclusion is measured rather than polemical: conventional occupational therapy is not always feasible through telehealth, so realizing its full potential will require genuinely new ways of working, not merely transplanting old routines onto new platforms. The therapists uniformly insisted on retaining in-person meetings while embracing further developed telehealth as a valuable complement, one that can extend access, enable environmental observation, and support continuity for patients who cannot travel. For policymakers racing toward integrated, person-centred care, the message is that the digital transition will succeed only if it bends to the grain of the profession’s craft, and to the very human preferences of the patients it serves.

Subject of Research: Occupational therapists' reasoning about telehealth use in Swedish primary care

Article Title: Telehealth within occupational therapy in primary care settings – an interview study

Article References: Johansson, J., Fischl, C., & Gustafsson, S. (2025). Telehealth within occupational therapy in primary care settings – an interview study. Scandinavian Journal of Occupational Therapy, 32(1), Article 2611542. https://doi.org/10.1080/11038128.2025.2611542

Image Credits: AI Generated

DOI: 10.1080/11038128.2025.2611542

Keywords: telehealth, occupational therapy, primary care, digitalization, person-centred care, telerehabilitation, integrated care, Sweden, qualitative interviews, therapeutic relationship, remote OT, within