Chronic Low Back Pain
Conditions
Keywords
low back pain, telehealth, videoconferencing, access to physical therapy, interprofessional care, rural health
Brief summary
The purpose of this project is to compare usual care for chronic low back disorders in a rural setting (nurse practitioner/NP) to two different means of integrating Physical Therapy (PT) into a rural health care team: 1. in-person PT assessment, where the PT travels from an urban center 2. interprofessional Telehealth assessment where the local NP is joined by a PT via Telehealth. The project will evaluate health, systems and process outcomes, comparative effectiveness and costs of the three methods of assessment. The hypothesis is that an interprofessional Telehealth assessment with be as effective as an in-person PT assessment, but more effective than usual care.
Detailed description
The study design will include two intervention groups and a control group with 20 participants in each group: 1. interprofessional videoconferencing intervention, 2. in-person PT and, 3. usual-care provided by a NP. Due to the interprofessional nature of the intervention, the NP involved in the telehealth-based intervention group may alter their usual care practice; therefore, the control group participants will be drawn from the practices of 2 NPs not involved in the Telehealth intervention providing services out of a different clinic. Each PT and the NP alone will complete a standardized online diagnostic classification tool.Participants will be randomly assigned to one of the three groups.
Interventions
usual NP management of chronic low back disorder
Includes manual therapy, education, exercise
Includes manual therapy, education, exercise.
Sponsors
Study design
Eligibility
Inclusion criteria
* adult 18-80 * low back pain and/or related leg pain affecting function, \>3 months duration
Exclusion criteria
* clients within a third party payer insurance coverage system * clients with primarily neck or thoracic pain * clients with language or comprehension difficulties that would limit completion of paperwork
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Medium impact on patient function | 3 months | Modified Oswestry Disability Index questionnaire |
| Short term impact of patient function | up to 2 weeks after assessment | Modified Oswestry Disability questionnaire |
| Short term impact on pain | up to 2 weeks after assessment | Numeric Pain Rating Scale - questionnaire |
| Short term impact of patient/provider satisfaction | up to 2 weeks after assessment | questionnaire |
| Short term outcome of patient experience with Telehealth | up to 2 weeks | qualitative questionnaire |
| Short term impact on quality of life | up to 2 weeks after assessment | Euro-Qol health survey instrument (EQ-5D) |
| Medium term impact on pain | 3 months | Numeric Pain Rating Scale - questionnaire |
| Medium term outcome of patient and provider satisfaction | 3 months | questionnaire |
| Medium term impact on quality of life | 3 months | Euro-Qol health survey instrument (EQ-5D) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Long term impact on pain | 6 months | Numeric Pain Rating Scale |
| Cost effectiveness of each of 3 arms of study | 6 months | patient diaries |
| Long term outcome on patient/provider satisfaction | 6 months | questionnaire |
| Long term impact on quality of life | 6 months | Euro-Qol health survey instrument (EQ-5D) |
| Long term impact on function | 6 months | Modified Oswestry Disability Index questionnaire |
Other
| Measure | Time frame | Description |
|---|---|---|
| Barriers and facilitators to use of Telehealth | 2 weeks | questionnaire |
Countries
Canada