Poster Presentation Sydney Spinal Symposium 2025

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 (#14)

Andrew R Robert 1 2 , Christopher Needs 3 , Christopher G. Maher 1 , Marnee J McKay 2 , David B Anderson 2 , Joshua M Hutton 1 3 , Tarcisio F Folly de Campos 1 , Nadine E Foster 4 , David Martens 3 , Danielle M Coombs 1 , Gustavo C Machado 1 , Christopher S Han 1 , Joshua R Zadro 1
  1. Institute for Musculoskeletal Health, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
  2. Discipline of Physiotherapy, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
  3. Royal Prince Alfred Hospital, Sydney Local Health District, Sydney, New South Wales, Australia
  4. Surgical, Treatment and Rehabilitation Service (STARS) Research and Education Alliance, The University of Queensland and Metro North Health, Brisbane, Queensland, Australia

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 in the Australian public hospital system.

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 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 or 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 (26 in intervention, 14 in control). Feasibility targets were met for acceptability, fidelity (80%), adherence (88-100%) and missing data (5%). Intervention participants waited a median of 13 days less for their first appointment compared the usual care participants (16 days vs. 29 days) but additional outcomes should be interpreted with caution. Feasibility targets were not met for recruitment and consent rates, largely owing to clinic disruptions due to COVID-19.

Conclusion: This study provides important information to guide modifications to our Rapid Stratified Telehealth model of care and planning of a large multi-site RCT across hospital outpatient clinics.