Associations Between Telerehabilitation and Outcomes for Patients with Low Back Pain During the COVID-19 Pandemic

Research Objectives To examine associations between frequency of telerehabilitation i.e., any few, most or all, and outcomes of functional status, number of visits, and patient satisfaction during COVID-19 and to compare functional status outcomes by telerehabilitation delivery mode i.e., synchronous, asynchronous, mixed, for patients with low back pain. Design Retrospective observational cohort. Setting Outpatient rehabilitation. Participants Sample consisted of 91,117 episodes of care (58% women;mean age = 55 [SD = 18]). Interventions Not applicable. Main Outcome Measures Lumbar Computer Adaptive Test (LCAT) patient-reported outcome measure was administered to assess functional status. LCAT has been shown to be reliable, valid, and responsive. Number of visits during the episode of care were documented at discharge. Data on patient satisfaction with treatment results were collected: “How satisfied were you with overall results of your treatment at this facility?” Results Telerehabilitation was administered in 5013 care episodes (5.5%). Propensity score matching was used to match episodes of care with or without telerehabilitation exposure by the probability of receiving telerehabilitation. Standardized differences were used to compare samples before and after matching. All standardized differences between matched samples were < 0.1. There was no significant difference in functional status points (range = 0–100, with higher representing better functional status) between matched samples, except for episodes that had few (−1.7) and all (+2.0) telerehabilitation frequencies or that involved the asynchronous (−2.6) telerehabilitation mode. These point differences suggest limited clinical importance. Episodes with any telerehabilitation frequency involved significantly fewer visits (0.7 to 1.3) than episodes with no telerehabilitation, except that those with the most telerehabilitation frequencies had nonsignificantly fewer visits (0.6). A smaller proportion of patients with telerehabilitation than of patients with no telerehabilitation (−4.0% to −5.0%, respectively) reported being very satisfied with treatment results, except for those with the ‘all’ telerehabilitation frequency. Conclusions A positive association between telerehabilitation and outcomes was observed, with a trend for better functional status outcomes and fewer visits when all care was delivered through telerehabilitation. Satisfaction tended to be lower with telerehabilitation use. Author(s) Disclosures No conflicts to declare.

Is Telerehabilitation a Viable Option for People With Low Back Pain? Associations Between Telerehabilitation and Outcomes During the COVID-19 Pandemic.

OBJECTIVE: The aims of this study were to examine associations between frequency of telerehabilitation (TR) and outcomes of functional status (FS), number of visits, and patient satisfaction during COVID-19 and to compare FS outcomes by TR delivery mode for individuals with low back pain. METHODS: Propensity score matching was used to match episodes of care with or without TR exposure by the probability of receiving TR. FS, visits, and satisfaction were compared for individuals without TR and those who received care by TR for "any," "few," "most," or "all" frequencies (4 matched samples), and FS was compared for individuals receiving synchronous, asynchronous, and mixed TR modes (3 matched samples). Standardized differences were used to compare samples before and after matching. Outcomes between matched samples were compared using z tests with 95% CI. RESULTS: The sample consisted of 91,117 episodes of care from 1398 clinics located in 46 states (58% women; mean age = 55 [SD = 18]). Of those, only 5013 episodes (5.5%) involved any amount of TR. All standardized differences between matched samples were <0.1. There was no significant difference in FS points (range = 0-100, with higher representing better FS) between matched samples, except for episodes that had ``few'' (-1.7) and ``all'' (+2.0) TR frequencies or that involved the asynchronous (-2.6) TR mode. These point differences suggest limited clinical importance. Episodes with any TR frequency involved significantly fewer visits (0.7-1.3) than episodes with no TR, except that those with the "most" TR frequency had non-significantly fewer visits (0.6). A smaller proportion of individuals with TR (-4.0% to -5.0%) than of individuals with no telerehabilitation reported being very satisfied with treatment results, except for those with the "all" TR frequency. CONCLUSIONS: A positive association between TR and rehabilitation outcomes was observed, with a trend for better FS outcomes and fewer visits when all care was delivered through TR. Satisfaction tended to be lower with TR use. Overall, this observational study showed that for people with low back pain, physical therapy delivered through TR was equally effective as and more efficient than in-person care, with a trend of higher effectiveness when used for all visits during the episode of care. No differences in FS outcomes were observed between care delivered with synchronous and mixed TR delivery modes and care delivered with no TR. However, the asynchronous mode of TR was associated with worse functional outcomes than no TR. Although the majority of people were very satisfied with their treatment results with and without TR, very high satisfaction rates were reported by a slightly smaller proportion of individuals with TR versus those without TR. Our results suggest that TR is a viable option for rehabilitation care for individuals with low back pain and should also be considered in the post-COVID-19 era.

Telerehabilitation During the COVID-19 Pandemic in Outpatient Rehabilitation Settings: A Descriptive Study.

OBJECTIVE: COVID-19 has widely affected delivery of health care. In response, telerehabilitation (TR) has emerged as alternative care model. Aims were: (1) to describe baseline patient characteristics and available unadjusted outcomes for episodes of care administered during COVID-19 using TR versus traditional in-person care, and (2) to describe TR frequency levels by condition and telecommunication modes. METHODS: A descriptive retrospective observational design was used to report patient variables and outcomes including physical function, number of visits, and patient satisfaction, by TR frequency (few, most, or all visits) and telecommunication modes. Standardized differences were used to compare baseline characteristics between episodes with and without TR. RESULTS: Sample consisted of 222,680 patients (59% female; mean [SD] age = 55 [18] years). Overall TR rate was 6% decreasing from 10% to 5% between second and third quarters of 2020. Outcome measures were available for 90% to 100% of episodes. Thirty-seven percent of clinicians administered care via TR. Patients treated using TR compared with in-person care were more likely to be younger and live in large metropolitan areas. From those with TR, 55%, 20%, and 25% had TR during few, most, or all visits, respectively. TR care was administered equally across orthopedic body parts, with lower use for nonorthopedic conditions such as stroke, edema, and vestibular dysfunction. TR was primarily administered using synchronous (video or audio) modes. The rate of patients reported being very satisfied with their treatment results was 3% higher for no TR compared with TR. CONCLUSIONS: These results provide new knowledge about to whom and how TR is being administered during the pandemic in outpatient rehabilitation practices throughout the United States. The database assessed was found to be suitable for conducting studies on associations between TR and diverse outcome measures, controlling for a comprehensive set of patient characteristics, to advance best TR care models, and promote high-quality care. IMPACT: This study provided detailed and robust descriptive information using an existing national patient database containing patient health and demographic characteristics, outcome measures, and telerehabilitation (TR) administration data. Findings support the feasibility to conduct future studies on associations between TR care and patient outcomes, adjusting for a wide range of patient characteristics and clinical setting factors that may be associated with the probability of receiving TR. The finding of limited and decreasing use of TR over the study period calls for studies aimed to better understand facilitators and inhibitors of TR use by rehabilitation therapists during everyday practice to promote its use when clinically appropriate.