Telehealth to empower rural patients with musculoskeletal pain

  • Woman with hands on her back
The University of Sydney
Carlos Ivan Mesa Castrillon, PhD student, Faculty of Medicine and Health

Low back pain and knee osteoarthritis affects more than 7.2 million people in Australia. Although patients in rural communities suffer from more severe levels of these conditions compared to those in urban areas, their access to health services is significantly limited. Recommended by all clinical guidelines, physical activity and exercise improve physical function in patients with low back pain and knee osteoarthritis. Research from our group has shown that these interventions can be delivered effectively with the use of telehealth, such as videoconferencing and web-based applications.

The Empower study is an innovative solution to help provide equitable access to treatment for people with musculoskeletal pain in rural Australia through a telehealth physical activity approach. Investigators from the University of Sydney led by Professor Paulo Ferreira are conducting a randomised controlled trial of 156 people with low back pain or knee osteoarthritis from remote Australia, recruited from our established health partners. Funding from the Medibank Foundation allowed our research team to establish strong partnerships with consumers groups, healthcare providers, and Western NSW LHD that enabled the successful implementation of the pilot study to ascertain the feasibility of the telehealth approach. The study attracted considerable interest from the general community in rural Australia, and the full trial is now underway.

The primary aim of this study is to investigate the effectiveness of an telehealht-supported intervention comprised of a tailored physical activity plan and progressive resistance exercise program, to improve physical function in people living in rural Australia with chronic non-specific low back pain or knee osteoarthritis in comparison to usual care. The secondary aim is to evaluate the efficacy of the intervention to improve pain intensity, activity limitations, quality of life, physical activity, pain coping and measures of feasibility such as recruitment rate, attendance and adherence, follow-up rate, participant’s opinions and any difficulties or barriers encountered throughout the trial.

The innovation in the trial is the use of procedures that allow online recruitment, screening and follow-up through quick and straightforward questionnaires to confirm the eligibility of the participants. Additionally, telehealth technology, through smartphones or laptops, allows effective communication between physiotherapist and participants through web-based apps. The intervention involves a tailored physical activity and progressive resistance exercise program; or usual care which involves a wide range of care practices provided in a community. Outcomes are measured at baseline, three and six months post-randomisation.

The research is expected to be completed in the middle of 2021, with a total duration of 36 months. If the intervention is found to be effective, specific recommendations about its widespread implementation will be developed by our partners and made available to Local Health Districts. Ultimately, this innovative approach could allow all Australians to have fair access to evidence-based healthcare.

Finally, the Empower study team wants to acknowledge the collaborating team and institutions that have been working to help the communities and perform the research study: Medibank private, Musculoskeletal Australia (formerly MOVE organisation), Western NSW Local Health District– Orange Health Service and Dubbo Base Hospital, University of Sydney – Musculoskeletal Health; Discipline of Physiotherapy; The Institute of Bone and Joint Research; School of Public Health, Implementation Science and eHealth; School of Rural Health; Charles Perkins Centre, University of Melbourne – Centre for Health, Exercise and Sports Medicine, La Trobe University – La Trobe Rural Health School.

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