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
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.