*3.5. Barriers*

### 3.5.1. Physical Barriers

Using digital care visits for treatment sometimes poses barriers, such as the inability to apply certain treatment techniques that could otherwise be used in a face-to-face visit. Cioffi et al. showed that 50.69% of responding therapists felt digital care visits restrict or prevent applying certain techniques [54], and surgeons from Kirby et al. had similar experiences [43]. Allied health specialists reported that the medical interventions were limited to those who did not require a trained occupational therapist's presence. Therefore, patients were less successful in reaching motor goals [36].

A similar problem occurred to healthcare professionals trying to examine the patients. In 13 studies, clinicians reported that lack of physical examination was problematic [36,38,39,43,44,46,48,50,51,55,58,59,61]. Surgeons in Kirby et al. pointed out that they had difficulty measuring sensation and tenderness [43]. In addition, occupational therapists sometimes struggle to evaluate motor skills [36]. Mammen et al. found occasional technical problems and the inability to touch sometimes hindered the physician's ability to conduct the examination [58]. Physical therapists experienced discomfort without hands-on assessment [59]. Other studies showed that clinicians thought not having a physical examination was a loss, and digital care visits cannot replace hands-on examination [38,39,44,46,48,50,51,55,61]. Mental health workers [45,49,52,57] and physicians [48,50] considered the inability to see non-verbal cues as a disadvantage.
