TeleBACK - Clinical Trial

Why are we conducting this study?

Low back pain is a major problem in the United States and the rest of the world. A few important facts about low back pain:

  1. Low back pain is the top cause of disability globally, including the United States.
  2. Low back is the most expensive health condition in the United States, accounting for over $135 billion in spending per year.
  3. Low back is the most common reason that opioids are prescribed and used in the United States

Physical therapy has been found to be effective in reducing pain and disability related to low back pain. Patients who are treated with physical therapy for their low back pain experience decreases in pain and disability. These patients are less likely to receive advanced imaging, injections, or surgery. They are less likely to need opioid medication. Despite these benefits, roughly 1 in 6 patients with low back pain receive physical therapy. This may be due to to barriers, such as wait time, missed work time, and transportation.

The COVID-19 pandemic has facilitated the rapid emergence of remotely-delivered physical therapy. Before the pandemic, physical therapy was delivered in-person in outpatient clinics. However, as the pandemic began, policy changes expanded the way that physical therapy is delivered. Our team studied patients with low back pain who received remotely-delivered physical therapy (i.e., telehealth physical therapy). These patients experienced significant reductions in disability, pain intensity, and pain interference. The had improved physical function and fewer problems with their sleep.

Telehealth physical therapy is relatively new and there is a lack of research examining how well this approach works. When we spoke with patients and healthcare providers, they wanted to know whether telehealth physical therapy was as good as in-clinic physical therapy. They also wanted to know if there were certain patients who could benefit from telehealth physical therapy.

We are conducting this study to see if telehealth physical therapy is as good as in-clinic physical therapy for patients with low back pain. This study will be one of the first studies conducted comparing the use of telehealth physical therapy to in-clinic physical therapy for patients with low back pain. The results of the study will provide important information on how telehealth physical therapy effects pain, disability, and use of other health care services.

Study Overview

Study Design

This study will be a partnership between Johns Hopkins Medicine, University of Utah, and Intermountain Healthcare.

We will enroll individuals with chronic low back pain receiving care from a primary care provider at one of the three health systems. Enrolled participants will be randomly assigned to receive either telehealth physical therapy or in-clinic physical therapy.

Patients in telehealth and in-clinic physical therapy will receive 8 weekly telehealth visits with a trained physical therapist. Those in telehealth physical therapy will attend their visits from their computer. Those in in-clinic physical therapy will attend their visits at an outpatient clinic.

Outcomes

All patients will be contacted at 3 months, 6 months, and 12 months after study enrollment to complete questionnaires that will allow our study team to examine the effects of telehealth physical therapy and in-clinic physical therapy.

We will use a combination of surveys and data from the electronic medical record to measure the following key outcomes: