telehealth

Grand Rounds January 31, 2025: Advancing Rural Back Pain Outcomes Using Rehabilitation Telehealth (ARBOR-Telehealth): Early Progress and Lessons Learned (Richard L. Skolasky, ScD; Kevin H. McLaughlin, DPT)

Posted on by Sophia Ramirez

Speakers

Richard L. Skolasky, ScD
Professor, Johns Hopkins School of Medicine
Department of Orthopaedic Surgery

Kevin H. McLaughlin, DPT
Assistant Professor, Johns Hopkins School of Medicine
Department of Physical Medicine and Rehabilitation

Keywords

Back Pain; Rural Health; Telehealth

Key Points

  • Low back pain (LBP) is the most common cause of disability globally and in the U.S. It’s the largest driver of U.S. healthcare spending growth and a top non-cancer reason for opioid prescriptions.
  • Physical therapy (PT) is a first-line treatment for LBP. It may include exercise, hands-on interventions, and modalities. These methods are cost-effective and decrease the risk of opioid use and surgery. However, due to barriers around the requisite travel, missed work, etc., only 7 – 13% of patients with LBP attend PT.
  • LBP patients in rural areas, where there are higher rates of opioid use and high-impact chronic pain, attend PT less frequently. PT is less accessible than it is in metropolitan areas; there are up to 40% fewer therapists per person; and the travel distance required to get to a clinic is farther.
  • PT was provided virtually (AKA telerehabilitation) during the pandemic, but the effectiveness of telerehabilitation for chronic LBP is unknown. Notably, not all components of PT can be delivered by video visit.
  • The research team’s aims include examining the effectiveness of risk-informed telerehabilitation in reducing LBP-related disability and comparing the prevalence of opioid use among those receiving telerehabilitation and education at 12 weeks.
  • The team is currently in the enrollment phase. They will begin disseminating their results in September 2028.
  • The research team randomized half the group to risk-informed telerehabilitation and the other half to an educational control group. Both groups received best practice advice through the study website, and the control group received eight video visits with a physical therapist over two months.
  • Community engagement strategies include a patient advisory panel and stakeholder advisory committee made up of physical therapists, primary care providers, and rural and public health advocates.

Discussion Themes

One challenge to flag for future studies is that many patients requested virtual appointments outside of office hours. However, the therapists weren’t able to accommodate these requests.

Another challenge is the inconsistent quality of calls between participants. Most folks have access to a smart device; not everyone has access to a desktop, laptop, or tablet, which are preferred for video calls. To address this, the research team is sending participants a phone stand in advance. They also provide basic exercise equipment, including resistance bands and a yoga mat.

While some patients feel a lack of connection with their therapists via telerehabilitation, others have reported that they felt the connection was stronger given the one-on-one nature of the appointments.