Trial Summary

For patients with chronic low back pain, physical therapy is a cost-effective method for improving pain and disability. Physical therapy also reduces the need for advanced imaging, injections, surgery, and opioid medications. Yet only 7% to 13% of patients with low back pain, including those with chronic low back pain, receive physical therapy. Patients report significant barriers to accessing physical therapy, including transportation, provider availability, and missed work time. Access is especially limited in rural communities, where there are approximately 40% fewer physical therapists per capita than in metropolitan areas. Patients in rural communities typically must travel longer distances to receive physical therapy, which can impose higher transportation costs and require more time away from work. Access barriers in rural communities likely contribute to the greater rates of low back pain–related disability and opioid consumption in these communities compared with metropolitan areas. Policy changes during the COVID-19 public health emergency allowed physical therapists to begin providing care remotely, referred to as “telerehabilitation.” Telerehabilitation has the potential to improve access to physical therapy in rural communities and may serve as a means of improving outcomes for patients with chronic low back pain. ARBOR-Telehealth is a randomized clinical trial of the effectiveness of a risk-informed telerehabilitation strategy to reduce opioid use and low back pain–related disability and improve physical function and health-related quality of life among patients with chronic low back pain. The trial will enroll patients with chronic low back pain who present to primary care clinics that serve rural communities. Eligible patients will be randomly assigned to either an educational control group or to 1 of 3 risk-informed telerehabilitation interventions: a low-risk group receiving remote therapeutic monitoring; a medium-risk group receiving physical therapy telehealth visits; or a high-risk group receiving psychologically informed physical therapy telehealth visits. The primary effectiveness outcomes are the differences in change in low back pain–related disability and opioid use after 8 weeks. The study team will explore implementation outcomes using a mixed-methods approach consisting of electronic surveys and semistructured interviews with patients, physical therapists, practice managers, and outpatient services administrators focused on the perceived quality and impact of the intervention on barriers to care.

NIH Project Information