Woznica David N, Milligan Mark, Krymis Holly, Peters Kaitlyn C, O'Connor Mary I, Grant Ryan A
Vori Health Medical Group, Nashville, TN.
Arch Rehabil Res Clin Transl. 2023 May 26;5(3):100269. doi: 10.1016/j.arrct.2023.100269. eCollection 2023 Sep.
To evaluate the effects of an interdisciplinary care team (ICT) model delivered by telemedicine on patients with low back pain (LBP).
Retrospective analysis of deidentified pre-existing data.
Retrospective observational study of patients presenting with LBP to a nationwide telemedicine practice using an ICT model.
Over a 9-month period all patients with a diagnosis related to LBP and who had an ICT evaluation (medical doctor, advanced practice provider, health coach, and physical therapist) were included in the study (n=36). A minimum of 2 follow-up physical therapy visits were required for inclusion.
Patients were evaluated for LBP, received a diagnosis, and were offered a multidisciplinary treatment plan. Additional real-time audio visual medical, health coaching, registered dietician, and physical therapy services were received as deemed clinically appropriate.
Baseline, 30 day, and final pain (mean 81 day) measurements via numerical pain rating scale (NPRS). Baseline and final Patient-Reported Outcomes Measurement Information System (PROMIS)-10 Global Mental/Physical domains.
Use of prescription medication, referral for imaging, need for injections, or surgery.
36 patients met criteria. Pain levels included mild (n=6, 16.7%), moderate (n=19, 52.8%), and severe (n=11, 30.6%). Clinically significant pain improvements were noted in 83.3% (n=25) of those with moderate or severe pain. PROMIS Mental and Physical Health categorization from Fair/Poor to Good/Excellent significantly improved over time. The initial 20% (n=7) in Fair/Poor Mental Health improved to 6.3% (n=2) at finish, while the 80% (n=28) in Good/Excellent Mental Health at start improved to 93.8% (n=30) at finish. Regarding Physical Health, 51.4% (n=18) rated Fair/Poor at start and 31.3% (n=10) at finish, while the 48.6% (n=17) rated Good/Excellent at start improved to 68.8% (n=22) at finish. The need for prescription medication was low (n=6, 16.7%) and spinal imaging orders were negligible (n=1, 2.8%). Injections were warranted in 11.4% (n=4) of patients and surgical referral with operative treatment in 2.8% (n=1).
Interdisciplinary care delivered through telemedicine can significantly improve pain and support improved health-related quality of life in patients with LBP, with low rates of imaging, prescription, and interventional use.
评估通过远程医疗提供的跨学科护理团队（ICT）模式对腰痛（LBP）患者的影响。
对去识别化的已有数据进行回顾性分析。
对使用ICT模式向全国远程医疗机构就诊的LBP患者进行回顾性观察研究。
在9个月的时间里，所有诊断与LBP相关且接受过ICT评估（包括医生、高级执业提供者、健康教练和物理治疗师）的患者被纳入研究（n = 36）。纳入研究要求至少进行2次随访物理治疗。
对患者进行LBP评估，做出诊断，并提供多学科治疗方案。根据临床判断，提供额外的实时视听医疗、健康指导、注册营养师和物理治疗服务。
通过数字疼痛评分量表（NPRS）进行基线、30天和最终疼痛（平均81天）测量。基线和最终的患者报告结局测量信息系统（PROMIS）-10全球心理/身体领域评分。
处方药的使用、影像检查转诊、注射需求或手术需求。
36名患者符合标准。疼痛程度包括轻度（n = 6，16.7%）、中度（n = 19，52.8%）和重度（n = 11，30.6%）。在中度或重度疼痛患者中，83.3%（n = 25）的患者疼痛有临床显著改善。随着时间推移，PROMIS心理健康和身体健康分类从“一般/较差”显著改善为“良好/优秀”。初始心理健康“一般/较差”的20%（n = 7）在结束时改善为6.3%（n = 2），而初始心理健康“良好/优秀”的80%（n = 28）在结束时改善为93.8%（n = 30）。关于身体健康，开始时51.4%（n = 18）评为“一般/较差”，结束时为31.3%（n = 10），而开始时48.6%（n = 17）评为“良好/优秀”，结束时改善为68.8%（n = 22）。处方药需求较低（n = 6，16.7%），脊柱影像检查医嘱可忽略不计（n = 1，2.8%）。11.4%（n = 4）的患者需要注射治疗，2.8%（n = 1）的患者需要手术转诊并接受手术治疗。
通过远程医疗提供的跨学科护理可显著改善LBP患者的疼痛，并有助于提高与健康相关的生活质量，影像检查、处方和介入治疗的使用率较低。
