Effectiveness of an interprofessional assessment and management approach for people with chronic low back disorders delivered via virtual care: A randomized controlled trial pilot intervention.

Objective: Virtual care for chronic conditions has seen uptake due to COVID-19. Evaluation of virtual models is important to ensure evidence-based practice. There is a paucity of research in the use of virtual care for management of chronic back disorders. The objective of this study was to evaluate effectiveness of a team-based virtual care model for back disorder assessment where a physical therapist uses virtual care to join a nurse practitioner and patient in a rural Saskatchewan, Canada community. Methods: Sixty-four rural adults with chronic back disorders were randomly allocated to receive either: (1) team-based virtual care (n = 24); (2) care from an urban physical therapist travelling to community (n = 20); or (3) care from a rural nurse practitioner (n = 20). The team-based care group involved a nurse practitioner located with a rural patient, and a physical therapist joining using virtual care. The physical therapist alone and the nurse practitioner alone groups received in-person assessments. Groups with a physical therapist involved had follow-up treatments by in-person physical therapy. Outcomes over six months included pain, disability, back beliefs, satisfaction, quality-adjusted health status and management-related costs. Results: There were no significant differences for pain, disability, back beliefs and satisfaction between groups. The average cost per patient for implementing in-person physical therapist assessment ($135) was higher compared with the team over virtual care ($118) and NP care ($59). Conclusion: Primary outcomes were not different by group. Physical therapist alone was more costly than other groups. Future research should include more participants, longer follow-up time and refined cost parameters. Trial Registration: ClinicalTrials.gov NCT02225535; https://clinicaltrials.gov/ct2/show/NCT02225535 (Archived by WebCite at http://www.webcitation.org/6lqLTCNF7).

Construct validity of RT3 accelerometer: a comparison of level-ground and treadmill walking at self-selected speeds.

This study examined differences in accelerometer output when subjects walked on level ground and on a treadmill. We asked 25 nondisabled participants to wear an RT3 triaxial accelerometer (StayHealthy, Inc; Monrovia, California) and walk at their "normal" and "brisk" walking speeds for 10 minutes. These activities were repeated on a treadmill using the individual speeds from level-ground walking on two occasions 1 week apart. Paired t-tests found a difference in RT3 accelerometer vector magnitude (VM) counts/min between the two walking speeds on both surfaces on days 1 and 2 (p < 0.001). Although we found no significant differences between VM counts/min on the two surfaces at normal and brisk speeds on days 1 and 2 (p > 0.05), we found wide limits of agreement between level ground and treadmill walking at both speeds. Measurement and discrimination of walking intensity employing RT3 accelerometer VM counts/min on the treadmill demonstrated reasonable validity and stability over two time points compared with level-ground walking.