The feasibility of delivering and evaluating stratified care integrated with telehealth ('Rapid Stratified Telehealth') for patients with low back pain: a feasibility and pilot randomised controlled trial

Abstract

OBJECTIVES: Establish the feasibility of delivering and evaluating stratified care integrated with telehealth ('Rapid Stratified Telehealth') to reduce waiting times for people with low back pain seeking care at Australian public hospitals. METHODS: We conducted a single-blinded, single site, 2:1 ratio, two-arm parallel feasibility and pilot randomised controlled trial (RCT) with nested qualitative interviews. Usual clinic-based care for low back pain was compared to Rapid Stratified Telehealth which matched the mode and type of care to participant's risk of persistent disabling pain based on the Keele STarT MSK Tool and potential radiculopathy. Key process outcomes include acceptability of the model, intervention fidelity and adherence, appointment details, response, recruitment and consent rates, and missing data. Additional outcomes included waiting time to access care, clinical outcomes, healthcare utilisation, and adverse events. Quantitative outcomes were summarised descriptively. Qualitative data were analysed using thematic analysis. RESULTS: Of 133 people screened, 101 were eligible (76%), and 40 (30%) were randomised (intervention 26, usual care 14). Feasibility targets were met for acceptability, fidelity, and missing data but not met for recruitment, consent, and response rates. Adherence data was uncertain due to poor reporting. Intervention participants waited a median of 13 days less for their first appointment vs. usual care participants (16 days vs. 29 days). Small sample size and differences in baseline characteristics mean additional outcomes should be interpreted with caution. CONCLUSION: This study provides important information to guide modifications to our Rapid Stratified Telehealth model of care and planning of a large multisite RCT across hospital outpatient clinics. Key Points Our new model of care is feasible to deliver and evaluate in a fully powered RCT. No intervention participant was at low risk of persistent disabling pain. More than half of the intervention participants received clinic-based care.