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Advancing Interprofessional Primary Health Care Services in Rural Settings for People with Chronic Low Back Disorders: Protocol of a Community-Based Randomized Controlled Trial

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ABSTRACT

Background: Chronic low back disorders (CLBDs) are a substantial burden on individuals and societies, and impact up to 20% of Canadians. Rural and remote residents are approximately 30% more likely to have CLBDs. Reduced access to appropriate team-based health services, including physical therapy, is a key factor that may magnify the impact of CLBD on pain, physical function, overall quality of life, health-related system costs, and individual costs.

Objective: The purpose of this project is to evaluate the validity, comparative effectiveness, costs, barriers, and facilitators of an interprofessional management approach for people with CLBDs, delivered via telehealth.

Methods: This project will examine 3 different health care delivery options: (1) in-person nurse practitioner (NP); (2) in-person physical therapist (PT); and (3) a team approach utilizing an NP (in-person) and a PT joining via telehealth. Validity of the telehealth team care model will be explored by comparing the diagnostic categorization and management recommendations arising from participants with CLBD who undergo a team telehealth, in-person NP, and in-person PT assessment. Comparative effectiveness and costs will be examined using a community-based randomized controlled trial in a rural Saskatchewan community with limited PT services. The 3 arms of the trial are: (1) usual care delivered by a local rural NP; (2) a local NP and an urban-based PT joining via telehealth; and (3) face-to-face services by a PT traveling to the community. Patient-reported outcomes of pain, physical function, quality of life, satisfaction, and CLBD care-related costs will be evaluated up to 6 months after the intervention. Patient and provider experiences with the team telehealth approach will be explored through qualitative interviews.

Results: The study was funded in July 2013 and the University of Saskatchewan Biomedical Research Ethics Board approved the study in November 2013. Participant recruitment began in September 2014 and data collection was completed in December 2015. Analysis is in progress and results are anticipated in 2017.

Conclusions: CLBD is a widespread public health problem, particularly in rural and remote areas, which requires new innovative approaches to deliver appropriate health care. The results of this project will inform the development of evidence-informed approaches and community-based implementation strategies to improve access to PT services in primary health care settings in other rural and remote underserved areas. Findings might also provide a framework for cost-effective and patient-centered models of service delivery for the management of other chronic conditions.

Clinicaltrial: ClinicalTrials.gov NCT02225535; https://clinicaltrials.gov/ct2/show/NCT02225535 (Archived by WebCite at http://www.webcitation.org/6lqLTCNF7)

No MeSH data available.


Related in: MedlinePlus

Design of rural community-based trial part of the study. CLBD: chronic low back disorder; NP: nurse practitioner; PT: physical therapist.
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figure1: Design of rural community-based trial part of the study. CLBD: chronic low back disorder; NP: nurse practitioner; PT: physical therapist.

Mentions: The study design for Objectives 2 and 3 included two intervention groups and a control group, with 20 participants in each group: (1) interprofessional telehealth intervention; (2) in-person PT (travelling from Saskatoon, SK to provide services); and (3) usual care provided by an NP (see Figure 1). Due to the interprofessional nature of the intervention, the NP involved in the telehealth-based intervention group may have altered their usual care practice; therefore, the control group participants were drawn from the practices of 2 NPs that were not involved in the telehealth intervention, who provided services out of Carrot River. Participants were randomly assigned to 1 of the 3 groups using simple block randomization to ensure equal group sizes [40]. Participants allocated to either of the in-person PT group or the team telehealth intervention groups were eligible to receive up to 4 in-person PT treatment sessions delivered by an urban-based PT who travelled to the community (if recommended by the assessing health care providers).


Advancing Interprofessional Primary Health Care Services in Rural Settings for People with Chronic Low Back Disorders: Protocol of a Community-Based Randomized Controlled Trial
Design of rural community-based trial part of the study. CLBD: chronic low back disorder; NP: nurse practitioner; PT: physical therapist.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5121529&req=5

figure1: Design of rural community-based trial part of the study. CLBD: chronic low back disorder; NP: nurse practitioner; PT: physical therapist.
Mentions: The study design for Objectives 2 and 3 included two intervention groups and a control group, with 20 participants in each group: (1) interprofessional telehealth intervention; (2) in-person PT (travelling from Saskatoon, SK to provide services); and (3) usual care provided by an NP (see Figure 1). Due to the interprofessional nature of the intervention, the NP involved in the telehealth-based intervention group may have altered their usual care practice; therefore, the control group participants were drawn from the practices of 2 NPs that were not involved in the telehealth intervention, who provided services out of Carrot River. Participants were randomly assigned to 1 of the 3 groups using simple block randomization to ensure equal group sizes [40]. Participants allocated to either of the in-person PT group or the team telehealth intervention groups were eligible to receive up to 4 in-person PT treatment sessions delivered by an urban-based PT who travelled to the community (if recommended by the assessing health care providers).

View Article: PubMed Central - HTML - PubMed

ABSTRACT

Background: Chronic low back disorders (CLBDs) are a substantial burden on individuals and societies, and impact up to 20% of Canadians. Rural and remote residents are approximately 30% more likely to have CLBDs. Reduced access to appropriate team-based health services, including physical therapy, is a key factor that may magnify the impact of CLBD on pain, physical function, overall quality of life, health-related system costs, and individual costs.

Objective: The purpose of this project is to evaluate the validity, comparative effectiveness, costs, barriers, and facilitators of an interprofessional management approach for people with CLBDs, delivered via telehealth.

Methods: This project will examine 3 different health care delivery options: (1) in-person nurse practitioner (NP); (2) in-person physical therapist (PT); and (3) a team approach utilizing an NP (in-person) and a PT joining via telehealth. Validity of the telehealth team care model will be explored by comparing the diagnostic categorization and management recommendations arising from participants with CLBD who undergo a team telehealth, in-person NP, and in-person PT assessment. Comparative effectiveness and costs will be examined using a community-based randomized controlled trial in a rural Saskatchewan community with limited PT services. The 3 arms of the trial are: (1) usual care delivered by a local rural NP; (2) a local NP and an urban-based PT joining via telehealth; and (3) face-to-face services by a PT traveling to the community. Patient-reported outcomes of pain, physical function, quality of life, satisfaction, and CLBD care-related costs will be evaluated up to 6 months after the intervention. Patient and provider experiences with the team telehealth approach will be explored through qualitative interviews.

Results: The study was funded in July 2013 and the University of Saskatchewan Biomedical Research Ethics Board approved the study in November 2013. Participant recruitment began in September 2014 and data collection was completed in December 2015. Analysis is in progress and results are anticipated in 2017.

Conclusions: CLBD is a widespread public health problem, particularly in rural and remote areas, which requires new innovative approaches to deliver appropriate health care. The results of this project will inform the development of evidence-informed approaches and community-based implementation strategies to improve access to PT services in primary health care settings in other rural and remote underserved areas. Findings might also provide a framework for cost-effective and patient-centered models of service delivery for the management of other chronic conditions.

Clinicaltrial: ClinicalTrials.gov NCT02225535; https://clinicaltrials.gov/ct2/show/NCT02225535 (Archived by WebCite at http://www.webcitation.org/6lqLTCNF7)

No MeSH data available.


Related in: MedlinePlus