Telehealth is the latest trend to take the medical world by storm. It’s not exactly something new, but the Covid-19 pandemic turned a spotlight onto this valuable service. In this article we take a look at what telehealth is and how telehealth can help low back pain.
What Is Telehealth?
Telehealth is defined as the “provision of healthcare remotely through the form of telecommunications, such as telephones or laptops”. With telehealth services healthcare providers are able to consult with patients via video, mobile phone applications, laptops, tablets, or phone calls. The term “telehealth” is also sometimes used interchangeably with the terms “telemed”, “telemedicine”, “digital health” or “telerehabilitation”.
During the 2020 global Covid-19 crisis telehealth became a literal lifesaver, allowing healthcare professionals to provide vital medical care to patients when they were unable to leave their homes. Now that the pandemic is over (sort of), healthcare providers and patients are seeing that telehealth services are still very much needed for optimal patient care.
Some Key Applications/ Benefits of Telehealth:
Convenience
Safety (reduce exposure to illnesses)
Greater treatment personalization
Improved access to care
These are just some of the reasons why telehealth is still urgently needed as access to care is a growing concern, especially with the increasing physician shortage.
Understanding Telehealth Options For Low Back Pain
While we know the mechanics of how telehealth works, many have asked, how can telehealth actually help people when they aren’t seeing a provider in real life? When we look at telehealth there are actually two theories on how this technology can assist people in managing their health. These two theories (or methods) are known as the self-determination and the self-efficacy theories.
Self Determining Theory
The self-determining theory has been around for some time now and is often used in behavioral health interventions. This theory helps individuals to identify the reasons why they might not be motivated enough to complete a healthcare program such as physical therapy home exercises. It can help people determine which motivations are autonomous and which are controlled and then give them tools to overcome these barriers.
Self Efficacy Theory
The self-efficacy theory was first proposed by psychologist Alfred Bandura. This theory refers to a person's confidence in their ability to do specific things in different environments. The individual's level of self-efficacy depends on the amount of perseverance and effort that they apply to a specific behavior. Basically, do you believe that you can control your own motivation to do things no matter what the environment?
Many programs that are designed for lower back problems, or for physical rehabilitation rely on individuals completing exercises at home, between sessions, in order to achieve the best possible rehabilitation results. This means that the ability to self-manage your exercise program is essential for a fast recovery.
Understanding Barriers To Virtual Care - How Telehealth Can Help
It is important for healthcare professionals to be able to identify the barriers that might exist for individuals that might stop them from completing their exercise programs. Once these barriers are identified, then they can work to improve adherence to the programs and achieve better results.
Common barriers to treatment could include:
1. Not understanding the program or the exercises
2. Needing support to complete the program
3. Finding time to exercise
4. Needing motivation and encouragement to complete the program.
Telehealth is a great tool to address these barriers. Telehealth can help people improve their belief in themselves and provide them with the motivation to complete their programs and speed up their recovery process.
How Does Telehealth Help Low Back Pain?
International guidelines for the management of low back pain focus on three different areas of treatment: education about the condition, behavioral therapy (the mental aspect of the condition), and exercise. This is often referred to as the biopsychosocial model of treatment.
Clinical studies have found that approaching low back pain in this way has been shown to be the most effective way to manage the condition. All of these components are quite capable of being delivered via telehealth (or digital health) solutions, especially with some of the new technological offerings that are coming to the market with the rise in digital health offerings.
Clinical Studies Supporting the Use Of Telehealth for Low Back Pain
In 2017, a systematic review of 11 randomized controlled trials was published in the medical journal, Spine. The researchers studied more than 2,000 participants to see if telehealth interventions helped to improve their “pain, disability, function, and quality of life” when it came to their lower back pain.
The researchers looked at different telehealth interventions like phone calls, online chats, emails, and websites. While the results didn’t show much of an improvement in pain or disability, the researchers did find that those who participated in a “tailored self-management web-based program involving education and behavior strategies were almost two times less likely to experience low back symptoms again two months after treatment”.
A different study that was published in 2022 looked at 'Behavior Modification Techniques on Patients with Chronic Pain in the Context of COVID-19 Telerehabilitation: An Umbrella Review'. The results of this research showed that telehealth behavior modification techniques were “effective in improving disability, disease impact, and pain-related fear of movement”.
Other trials have investigated the cost-effectiveness of telehealth services with one study finding that telehealth was significantly more clinically effective, and approximately 50% more cost-effective than the clinical based McKenzie treatment.
Important Considerations For Effective Telehealth Programs
Pros Of Telehealth Programs For Low Back Pain
Telehealth programs have significant benefits for those who use them including:
Increased access to care
More affordable treatment options
Reduced time needing to be taken off work to attend appointments
Reduced need for childcare while at appointments
Lower/ no transportation costs
Easier to see providers/ less waiting time
Greater flexibility with appointments
Improved adherence to home exercise programs
The Cons Of Telehealth for Low Back Pain
Limited internet services/signal
Technological literacy of patients
Not every type of visit can be done remotely (e.g. imaging tests/ blood work)
Data security concerns/ privacy concerns
Can Telehealth Help With Adherence Programs?
Adherence to home exercise programs is a significant challenge when managing lower back problems. Data reports that between 45-70% of patients are noncompliant with their physiotherapy prescriptions.
It is very important to overcome any doubts the patient might have about their ability to complete the exercises in the home exercise program, and motivate them to work towards a successful recovery. Telehealth is also a wonderful tool that providers can use to increase adherence levels to home exercise programs.
Trials investigating telehealth use for managing lower back pain have found that educating patients around their condition and encouraging an active lifestyle improves outcomes. Adding digital therapeutic technologies or digital health devices like pedometers or Fitbits has been shown to reduce pain intensity, depression, anxiety, stress and the duration of pain intensity.
Conclusions
Overall, when treatment for low back pain is being considered, the use of telehealth services has been found to have a significant benefit to patients compared to just the usual sort of care on its own. With the advances in technology such as wearables, digital physical therapy clinics, virtual musculo-skeletal care clinics and digital health, websites and applications have created new opportunities for patients to be more involved in managing their chronic conditions from the comfort of their own homes.
By harnessing the power of telehealth services, healthcare providers can increase exercise adherence, motivate patients to complete their exercises, and offer physical therapists a new method of engaging with patients regardless of their geographical location, and improving self management of the condition.
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