If you Build it, Will they Come? Patient and Provider Use of a Novel Hybrid Telehealth Care Pathway for Low Back Pain

Author:

Lentz Trevor A123,Coffman Cynthia J45,Cope Tyler1,Stearns Zachary2,Simon Corey B2,Choate Ashley4,Gladney Micaela4,France Courtni4,Hastings S Nicole467,George Steven Z12

Affiliation:

1. Duke Clinical Research Institute , Durham, NC , USA

2. Department of Orthopaedic Surgery , Duke University School of Medicine, Durham, NC , USA

3. Duke-Margolis Center for Health Policy , Duke University, Durham, NC , USA

4. Center of Innovation to Accelerate Discovery and Practice Transformation , Durham VA Health Care System, Durham, NC , USA

5. Department of Biostatistics and Bioinformatics , Duke University Medical Center, Durham, NC , USA

6. Department of Population Health Sciences , Duke University School of Medicine, Durham, NC , USA

7. Division of Geriatrics , Duke University School of Medicine, Durham, NC , USA

Abstract

Abstract Objective The purpose of this study was to describe the referrals and use of a hybrid care model for low back pain that includes on-site care by physical therapists, physical activity training, and psychologically informed practice (PiP) delivered by telehealth in the Improving Veteran Access to Integrated Management of Low Back Pain (AIM-Back) trial. Methods Data were collected from November 2020 through February 2023 from 5 Veteran Health Administration clinics participating in AIM-Back, a multisite, cluster-randomized embedded pragmatic trial. The authors extracted data from the Veteran Health Administration Corporate Data Warehouse to describe referral and enrollment metrics, telehealth use (eg, distribution of physical activity and PiP calls), and treatments used by physical therapists and telehealth providers. Results 701 veterans were referred to the AIM-Back trial with 422 enrolling in the program (consult-to-enrollment rate = 60.2%). After travel restrictions were lifted, site visits resulted in a significant increase in referrals and a number of new referring providers. At initial evaluation by on-site physical therapists, 92.2% of veterans received pain modulation (eg, transcutaneous electrical nerve stimulation, manual therapy). Over 81% of enrollees completed at least 1 telehealth physical activity call, with a mean of 2.8 (SD = 2.0) calls out of 6. Of the 167 veterans who screened as medium to high risk of persistent disability, 74.9% completed at least 1 PiP call, with a mean of 2.5 (SD = 2.0) calls out of 6. Of those who completed at least 1 PiP call (n = 125), 100% received communication strategies, 97.6% received pain coping skills training, 89.6% received activity-based treatments, and 99.2% received education in a home program. Conclusion In implementing a hybrid care pathway for low back pain, the authors observed consistency in the delivery of core components (ie, pain modulation, use of physical activity training, and risk stratification to PiP), notable variability in telehealth calls, high use of PiP components, and increased referrals with tailored provider engagement. Impact These findings describe variability occurring within a hybrid care pathway and can inform future implementation efforts.

Publisher

Oxford University Press (OUP)

Subject

Physical Therapy, Sports Therapy and Rehabilitation

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