Identifying Perceptions, Experiences, and Recommendations of Telehealth Physical Therapy for Patients with Chronic Low Back Pain: A Mixed Methods Survey



      Describe concerns, advantages, and disadvantages encountered in an evidence-based PT program for persons with chronic low back pain (cLBP) delivered by telehealth.


      Mixed methods survey and semi-structured interview of persons with cLBP.


      Prospective observational cohort study of persons with cLBP from three healthcare systems receiving 8-sessions of evidence-based telehealth physical therapy (PT).


      Participants were selected after completing Week 10 (from baseline) assessment from an ongoing cohort study. We enrolled 31 of 126 participants (mean age = 42.4 years, 71.0% female) from the cohort study.


      Participants had completed 8 sessions of evidence-based telehealth PT and participated in semi-structured interviews.

      Main Outcome Measures

      Baseline and Week 10 and 26 assessments assessed psychosocial risk (StarTBack Screening Tool), working alliance (Working Alliance Inventory-Short Form), pain (Oswestry Disability Index) and health-related quality of life (PROMIS-29 profile, version 2). Semi-structured interviews were conducted by telephone and consisted of open-ended questions assessing perception, satisfaction, and likelihood of recommending telehealth PT. Participants identified advantages and disadvantages to telehealth PT. Interviews were recorded, transcribed, and coded using an iterative qualitative process. Statistical comparisons by experience were made using analysis of variance (continuous) and Fisher's exact test (categorical).


      Compared to negative experience group (n=5), participants in positive (n=16) and neutral (n=10) experience groups endorsed higher bond working alliance with their therapist. Participants with a positive experience were more likely to view telehealth PT as cost-savings (n=10, 62.5%) compared to those with a neutral (n=1, 10.0%) or negative (n=1, 20.0%) experience; and less likely to view telehealth PT as lower quality (n=0, 0.0%; n=1, 10.0%; n=2, 40.0%, respectively).Prior to starting telehealth, based on semi-structured interviews, 18 (58.1%) of participants had concerns and these persisted after starting in half of this group. Concerns regarded telehealth being different from or inferior to in-person PT, lack of physical correction, and worries of not using technology appropriately. Convenience, time savings, and personalization were seen as advantages. Difficulty making a personal connection with the therapist, lack of physical correction, and problems with technology were seen as disadvantages.
      Many participants endorsed a hybrid approach that included in-person and telehealth PT. Providing necessary equipment and technology assistance was seen as ways to improve telehealth PT experience.


      Telehealth is an acceptable modality to deliver PT for patients with cLBP with most having a positive experience and reporting advantages. Improvements could include offering a hybrid approach (in-person and telehealth combined) and providing necessary equipment and technical support. More research is needed to optimize the most effective strategies for providing telehealth PT for patients with cLBP.

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