To establish the feasibility of delivering stratified care integrated with telehealth (‘Rapid Stratified Telehealth’) for patients with LBP and feasibility of evaluating the new model of care for a variety of musculoskeletal conditions in a future multi-site randomised control trial (RCT).
People with LBP newly referred to a multi-disciplinary outpatient clinic in Sydney, Australia were randomised to receive Rapid Stratified Telehealth or usual in-person care. Rapid Stratified Telehealth matched the mode and type of care to participants’ risk of developing persistent disabling pain (using the Keele STarT MSK Tool) and identified the presence of potential radiculopathy. Outcomes included the feasibility of delivering the intervention (fidelity, appointment duration, App useability, adherence) and evaluation for a future multi-centred RCT (participant recruitment rates, loss to follow-up), and patient outcomes (pain, function, quality of life, satisfaction) analysed descriptively. Nested qualitative interviews investigating acceptability were analysed using thematic analysis.
Forty participants were randomised using a 2:1 ratio (Rapid Stratified Telehealth = 26 and usual care = 14). We found 82% of participants were provided care that matched their subgroup and 100% of participants completed the entire online pain education program. The mean number of participants recruited was 2.7 per week from 8.5 eligible. Rapid Stratified Telehealth compared to usual care (median, IQR) resulted in shorter waiting times (days): 17 (7 to 42) vs. 29 (7 to 89). At 6 weeks, both groups had similar pain (0-10 numeric rating scale) 6 (5 to 7) vs. 6 (4 to 7) and satisfaction scores (11-point numerical rating scale 4.5 (2 to 8) vs. 5 (1 to 7) but those who received Rapid Stratified Telehealth had higher disability scores (Roland-Morris Disability Questionnaire) 10.5 (4.5 to 14.5) vs. 8 (5 to 14).
Rapid Stratified Telehealth appears to be feasible to adapt to a larger adequately powered RCT across multiple outpatient hospital settings in metropolitan Sydney, Australia for a variety of musculoskeletal conditions.
Rapid Stratified Telehealth is being adapted for a larger adequately powered RCT across multiple outpatient hospital settings in metropolitan Sydney, Australia for a variety of musculoskeletal conditions. The model of care has potential to reduce treatment waiting times (while not compromising clinical outcomes) and have positive implications for cost-effectiveness compared to usual in-person care.
stratified care
telehealth
