Examining the Relationship between Individual Patient Factors and Substantial Clinical Benefit from Telerehabilitation among Patients with Chronic Low Back Pain

Abstract

Abstract Objective The COVID-19 pandemic has facilitated the emergence of telerehabilitation, but it is unclear which patients are most likely to respond to physical therapy provided this way. The purpose of this study was to examine the relationship between individual patient factors and substantial clinical benefit from telerehabilitation among a cohort of patients with chronic low back pain. Methods This is a secondary analysis of data collected during a prospective longitudinal cohort study. Patients with chronic low back pain (N = 98) were provided with a standardized physical therapy protocol adapted for telerehabilitation. We examined the relationship between patient factors and substantial clinical benefit with telerehabilitation, defined as a ≥ 50% improvement in disability at 10 weeks, measured using the Oswestry Disability Index. Results Sixteen (16.3%) patients reported a substantial clinical benefit from telerehabilitation. Patients reporting substantial clinical benefit from telerehabilitation had lower initial pain intensity, lower psychosocial risk per the STarT Back Screening Tool, higher levels of pain self-efficacy, and reported higher therapeutic alliance with their physical therapist compared to other patients. Conclusion Patients with lower psychosocial risk and higher pain-self efficacy experienced substantial clinical benefit from telerehabilitation for chronic low back pain more often than other patients in our cohort. Therapeutic alliance was higher among patients who experienced a substantial clinical benefit compared to those who did not. Impact This study indicates that psychosocial factors play an important role in the outcomes of patients receiving telerehabilitation for chronic low back pain. Baseline psychosocial screening may serve as a method for identifying patients likely to benefit from this approach.