M. Correale1, S. Mian-Valiante2, S. Groe2, K. Lane3, D.R. Rampersaud2
1University Health Network - Toronto Western Hospital, Low Back Rapid Access Clinics - ISAEC, Toronto, Canada, 2University Health Network - Toronto Western Hospital, Division of Orthopaedics - Arthritis Program, Toronto, Canada, 3University Health Network, Techna Institute, Toronto, Canada
Background: COVID-19 significantly disrupted all outpatient services and reduced available resources for patients with low back pain (LBP). More than 1000 new referrals were on hold as a direct consequence of closures. Without access to care, patients with LBP may present to emergency departments unnecessarily, increase opioid use, become increasingly debilitated with functional limitations, and be at increased risk of developing chronic pain pathways and behaviours. In response, a Virtual Assessment and Education Toolkit (VAET) was developed to enable virtual care and minimize the anticipated collateral damage to patients with LBP from this global pandemic.
Purpose: To develop a Toolkit that supports and enables the delivery of a standardized approach to virtual care for LBP across the province of Ontario.
Methods: A multi-methods approach was utilized. A needs assessment was conducted via webinar with 103 advanced practice ISAEC clinicians to understand the barriers and enablers of virtual care. This webinar was recorded, transcribed, and analyzed to ascertain a deeper understanding of emergent issues. For barriers, solutions were explored with key stakeholders including government funding agencies, regulatory colleges, professional associations, senior administrative hospital leads, advanced practice clinicians, and spine surgeon sponsors, through further conferencing. Identified enablers, and solutions to barriers were compiled into a framework and a consensus validation process was undertaken. Based on the final agreed upon components, the Virtual Care Toolkit was developed.
Results: The VAET was developed and acts as a resource for the delivery of virtual care across the province of Ontario. Fifteen out of seventeen regional hospitals utilize the toolkit to understand the processes and procedures surrounding virtual care and modify the resources to support local policies. As virtual low back assessments are a novel approach to care, online resources and videos were created to improve the experience for both patients and providers. Preliminary feedback is positive and a formal patient satisfaction survey has been implemented. The framework for virtual care also involved consultation with the provincial spine surgeon to ensure there was a pathway for escalation for more urgent clinical cases and to ease some of the clinician anxieties associated with virtual care for the low back.
Conclusion(s): The development and implementation of a Toolkit for Virtual Care for patients with LBP in a geographically diverse region of Canada enabled minimal disruption of care, thereby reducing risk of chronicity and opioid dependence; and allowed clinicians to maintain their clinical practice, and identify urgent cases, requiring emergent surgical attention, during this COVID-19 pandemic. Physiotherapists with advanced training were integral to the successful development and implementation of this provincial initiative that can be used as a model for other musculoskeletal conditions.
Implications: Virtual Care was initiated in response to COVID-19, however it is anticipated this method of care delivery will continue after the global pandemic resolves, as virtual care improves access to services in more remote areas, can be a preferred method of receiving care for some patients, and may be a more convenient alternative in situations where travelling to an appointment is difficult
Funding, acknowledgements: Ontario Ministry of Health - Low Back Rapid Access Clinics (ISAEC Operations)
Keywords: Virtual Care, Virtual Low Back Assessment, Models of Care
Topic: COVID-19
Did this work require ethics approval? No
Institution: N/A
Committee: N/A
Reason: Development of a Toolkit to enable virtual care for low back pain in response to COVID closures
All authors, affiliations and abstracts have been published as submitted.
