Improving Access to Telerehabilitation for Chronic Low Back Pain in Rural Communities Through Risk-Based Telehealth Physical Therapy Compared to Standard Education

What this Trial Is About

Chronic low back pain LBP is a leading cause of disability worldwide and a major contributor to healthcare costs and opioid use in the United States. This trial evaluates how to improve physical therapy access and effectiveness for patients with chronic LBP living in rural communities, where barriers such as provider availability, transportation, and missed work limit care. The study aims to compare risk-informed telerehabilitation approaches to standard educational methods to better match treatment to patient risk of poor outcomes. Participants will be randomized to either a standardized education group receiving web-based evidence-based information and exercises for self-management or a risk-informed telerehabilitation group receiving tailored video physical therapy visits based on a psychosocial risk screening tool. The telerehabilitation group includes either standard physical therapy telehealth visits or psychologically informed physical therapy telehealth visits depending on risk level. Treatments last 8 weeks, with education delivered via a secure website and telerehabilitation via video visits. Participants will attend primary care clinics serving rural areas and provide informed consent before randomization. Outcomes include changes in disability related to LBP measured by the Oswestry Disability Index and opioid use after 12 weeks. Additional assessments include physical function, quality of life, and healthcare use up to one year. The study also gathers feedback from patients and providers through surveys and interviews to understand implementation and barriers. The total study period extends through 2028.

Improving Health for Patients With Chronic Low Back Pain in Rural Communities Through Telerehabilitation