Background Physical therapists are key players in the management of musculoskeletal conditions, which are common in rural and remote communities. There are few physical therapists in rural regions compared to potential need, so care is either not provided or must be sought in urban centers, requiring travel and time away from work and family to access services. Telerehabilitation strategies, such as real-time videoconferencing, are emerging as possible solutions to address shortages in rural physical therapy services. Objectives This review will: (1) determine the validity and the reliability of secure videoconferencing for physical therapy management of musculoskeletal conditions; (2) determine the health, system, and process outcomes when using secure videoconferencing for physical therapy management of musculoskeletal conditions. Methods A protocol-driven systematic review of four databases was carried out by two independent reviewers. Study criteria included English language articles from January 2003 to December 2016, on physical therapy management using secure videoconferencing, pertaining to adults 18-80 years with chronic musculoskeletal disorders. Randomized controlled trials, pre-experimental studies, and case-control studies were included. Quality analysis was performed utilizing standardized tools specific for the study designs. Results and conclusions Validity and reliability studies were identified as having high risk of bias. Intervention studies were of moderate quality, and found positive impact on health outcomes and satisfaction. Two studies evaluated costs, with evidence of cost savings in one study. More robust research is required to evaluate long-term effects of telerehabilitation for physical therapy management of musculoskeletal disorders, including cost-benefit analyses.

Purpose: To describe the characteristics of participants in a physiotherapist spinal triage programme, compare the profiles of patients for whom surgery was and was not recommended by a surgeon, and determine the surgical yield among those referred to surgeons. Methods: Data were collected retrospectively by reviewing charts of people who used the service over a 3-year period (2003)(2004)(2005)(2006). Data from up to1,096 people were used in the analysis; complete data were available for 299 people. Descriptive statistics were used to summarize demographics, clinical features, and management recommendations. Characteristics of those who were and were not recommended for surgery were examined using Pearson's chi-square or Fisher's Exact tests. Results: The majority of 746 participants were classified as ''mechanical spine'' (92.5%), 2.9% were ''other body part,'' 2.5% were ''medical/other,'' and only 2% were classified as ''surgical spine.'' Recommendations for surgery (by a surgeon) were independent of patients' age, sex, duration of symptoms, residence (urban/rural), source of health care funding, and diagnosis. The surgical yield was 80%. Conclusions: Most people were not considered candidates for surgery. Triage assessment by physiotherapists can increase the efficiency of an orthopaedic surgeon's caseload by reducing the number of non-surgical referrals and can thus help to ensure more timely access to appropriate health care.Key Words: collaborative practice; diagnosis; advanced practice; low back pain; spinal triage programme. RÉ SUMÉObjectif : Dé crire les caracté ristiques des participants à un programme de triage en fonction de leurs problè mes à la colonne verté brale, comparer les profils des patients pour qui une chirurgie é tait ou non recommandé e et dé terminer l'é tendue de la chirurgie parmi les personnes dirigé es vers un professionnel de la chirurgie. Mé thode : Les donné es ont é té recueillies ré trospectivement en procé dant à un examen des dossiers de personnes qui ont utilisé le service pendant trois ans (de 2003 à 2006). Des donné es relatives à 1 096 personnes é taient disponibles et des donné es complè tes é taient disponibles pour 299 personnes. Des statistiques descriptives ont é té utilisé es pour ré sumer les donné es dé mographiques, les caracté ristiques cliniques et les recommandations de gestion. Les caracté ristiques des personnes ayant ou non fait l'objet d'une recommandation pour une chirurgie ont é té examiné es à l'aide du test du Khi-carré de Pearson et du test de Fisher. Ré sultats : La majorité des 746 participants ont é té classé s comme « mé canique verté brale » (92,5 %); 2,9 % comme « autres parties du corps »; 2,5 % l'ont é té dans « mé dical/autres » et 2 % ont é té classé s comme « verté bral chirurgical ». Les recommandations pour une intervention (par un chirurgien) é taient formulé es indé pendamment de l'â ge des patients, de leur sexe, de la duré e des symptô mes, de leur milieu (urbain ou rural), de la source de financement des soins de santé dans l...

Introduction Telehealth may be a viable means to deliver physical therapy services across a range of practice settings and health conditions; however, there is limited uptake of telehealth in clinical practice. The purpose of this study is to examine and describe trends, gaps and opportunities in published and emerging evidence regarding the use of real-time videoconferencing to deliver physical therapy services. Methods Four databases and three trial registries were searched using terms for physical therapy and telehealth. Inclusion criteria were primary studies, systematic reviews and published trial registries that had the following features: physical therapy assessment and/or treatment, real-time videoconferencing and English language. Title/abstract, full text screening and data extraction were completed by pairs of independent reviewers. Descriptive statistics stratified by published research and trial registry records were used to summarize study characteristics. Results A total of 100 studies (80 published and 20 trial registries) were included. Australia, Canada and the US have the highest proportion of published and emerging research (63.0%). The majority of conditions studied were musculoskeletal (42.0%). Computers were the most common videoconferencing technology used (31.0%) and only 14.0% of studies reported using a secure platform. The majority of studies examined health outcomes (64.0%) and process outcomes (65.0%), while only 32.0% reported system outcomes. Discussion Research in the field of telehealth and physical therapy is growing and becoming increasingly diverse with the advancements in technology.

Purpose: To explore which socio-demographic, clinical, and other factors are associated with reduced perceived access to physiotherapy among people with low back disorders. Methods: A cross-sectional study design was used to evaluate perceived access to physiotherapy services in a convenience sample of 111 people with low back disorders presenting to a spinal triage service. Participants were asked whether they felt that they had reduced access to physiotherapy as a result of cost, wait time, or location. Bivariate and multivariate logistic regression were used to explore the association between perceived access to physiotherapy and a range of socio-demographic, clinical, and other factors. Results: Overall reduced perceived access to physiotherapy was reported by 27.9% of the sample; 13.5% reported reduced access resulting from cost, 9.9% from wait time, and 10.8% from location. A variety of socio-demographic and clinical variables were found to be associated with reduced perceived access, including the presence of other health conditions, rural residence, and no prior physiotherapy use. Conclusion: Perceived access to physiotherapy among people with low back disorders may be associated with a diverse range of factors. Further research is required to determine the relationship between these variables and actual use of physiotherapy services.

Purpose: The purpose of this case study was to evaluate the delivery of an inter-professional (IP) spinal triage management approach to chronic back disorders using remote presence robotic technology as an innovative form of telerehabilitation in a northern Saskatchewan community. Methods: The IP team, consisting of a local nurse practitioner (NP) and a physical therapist in an urban centre, completed a comprehensive neuromusculoskeletal assessment of, and one follow-up visit with, a post-surgical spinal patient. Treatment included detailed education regarding self-management after spinal surgery, provision and progression of home exercises, and reassurance. The patient was then referred to regional, in-person physical therapy care to complete her treatment. Results: A semi-structured interview with the NP revealed a high level of satisfaction; qualitative themes included the value of IP practice and the benefit to the patient of telerehabilitation achieved through patient-centred care. In a post-treatment survey, the patient expressed a high level of satisfaction with and appreciation for the patient-centred approach and the IP team. Objective clinical improvements in spinal and straight-leg raise movements were noted at the final telerehabilitation session. Conclusion: This report demonstrates the feasibility of delivering IP spinal triage management using telerehabilitation, specifically remote presence robotics, in a remote setting. Further research should include larger scale studies that investigate health, system, and economic outcomes as well as comparative studies for other forms of telehealth technology.Key Words: inter-professional relations; low back pain; physical therapists; robotics; telerehabilitation. RÉ SUMÉObjectif : l'objectif de cette é tude de cas é tait d'é valuer le recours à une approche interprofessionnelle (IP) de gestion du triage des problè mes rachidiens pour traiter les problè mes chroniques de dos à l'aide d'une technologie robotique de pré sence à distance comme forme novatrice de té lé ré adaptation dans une communauté du nord de la Saskatchewan. Mé thode : l'é quipe IP, formé e d'une infirmiè re praticienne locale et d'un physiothé rapeute d'un centre urbain, a effectué une é valuation neuromusculosquelletique exhaustive d'une patiente ayant subi une chirurgie rachidienne et l'a revue pour une visite de suivi. Le traitement incluait une formation dé taillé e sur l'autogestion à la suite d'une chirurgie rachidienne, des exercices à faire à la maison ainsi que du ré confort. La patiente a ensuite reç u des soins en physiothé rapie à la clinique ré gionale pour complé ter le traitement. Ré sultats : l'entrevue semi-structuré e avec l'infirmiè re praticienne a ré vé lé une grande satisfaction; les thè mes qualitatifs incluaient la valeur de la pratique IP et les avantages pour la patiente de la té lé ré adaptation obtenue grâ ce à des soins axé s sur le patient. Dans un sondage ré alisé aprè s le traitement, la patiente a exprimé une grande satisfaction et appré ciation de ...

BackgroundA spinal triage assessment service may impact a wide range of patient outcomes. Investigating potential predictors of success or improvement may reveal why some people improve and some do not, as well as help to begin to explain potential mechanisms for improvements. The objective of this study was to determine which factors were associated with improved short-term self-reported pain, function, general health status, and satisfaction in people undergoing a spinal triage assessment performed by physiotherapists.MethodsParticipants with low back-related complaints were recruited from people referred to a spinal triage assessment program (N=115). Participants completed baseline questionnaires covering a range of sociodemographic, clinical, and psychological features. Self-reported measures of pain, function, quality of life, and satisfaction were completed at 4 weeks following the assessment. Determination of “success” was based on minimal important change scores of select outcome measures. Multivariate logistic regression was used to explore potential predictors of success for each outcome.ResultsDespite the complex and chronic presentation of most participants, some reported improvements in outcomes at 4 weeks post assessment with the highest proportion of participants demonstrating improvement (according to the minimal important change scores) in the Medical Outcomes Survey 36-item short-form version 2 physical component summary score (48.6%) and the lowest proportion of participants having improvements in the Numeric Pain Rating Scale (11.5%). A variety of different sociodemographic, psychological, clinical, and other variables were associated with success or improvement in each respective outcome.ConclusionThere may be a potential mechanism of reassurance that occurs during the spinal triage assessment process as those with higher psychological distress (measured by the Fear Avoidance Beliefs Questionnaire and the Distress and Risk Assessment Measure) were more likely to improve on certain outcomes. The use of an evaluation framework guided by a biopsychosocial model may help determine potential mechanisms of action for a physiotherapy-delivered triage program.

BackgroundChronic 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.ObjectiveThe 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.MethodsThis 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.ResultsThe 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.ConclusionsCLBD 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.ClinicalTrialClinicalTrials.gov NCT02225535; https://clinicaltrials.gov/ct2/show/NCT02225535 (Archived by WebCite at http://www.webcitation.org/6lqLTCNF7)