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Improving Health for Patients With Chronic Low Back Pain in Rural Communities Through Telerehabilitation

ARBOR Telehealth: Improving Health for Patients With Chronic Low Back Pain in Rural Communities Through Improved Access to Telerehabilitation

Who can join

Ages 18 and older · All sexes

Inclusion Criteria:

* Primary care visit in the past 90 days with an LBP-related International Classification of Diseases (ICD-10) diagnosis.
* Age 18 years or older.
* At least moderate levels of pain and disability requiring Oswestry score ≥24% and average pain rating ≥ 4/10 points.
* Meets NIH Task Force definition of chronic LBP based on two questions: 1) How long has LBP has been an ongoing problem? and 2) How often has LBP been an ongoing problem over the past 6 months? A response of greater than 3 months to question 1, and "at least half the days in the past 6 months" to question 2 is required to satisfy the NIH definition of chronic LBP.
* Can speak and understand English.
* Access to video-enabled device and Internet.

Exclusion Criteria:

* Recent history (last 6 months) of lumbar spine surgery.
* Possible non-musculoskeletal cause for low back pain symptoms (e.g., pregnancy).
* Evidence of serious pathology as a cause of LBP including neoplasm, inflammatory disease (e.g., ankylosing spondylitis), vertebral osteomyelitis, etc.
* Neurological disorder resulting in severe movement disorder, or schizophrenia or other psychotic disorder.
* Knowingly pregnant.

About the study

Physical therapy is the first line of treatment for patients with low back pain (LBP) and has been shown to be a cost-effective method for improving pain and disability in patients with chronic LBP; however, despite this effectiveness, only 7-13% of patients go on to receive physical therapy services with patients in rural communities being especially limited to do lack of provider availability, transportation, and missed work time leading to greater rates of LBP-related disability and opioid consumption. With the rapid emergence of digital treatment approaches to physical therapy (i.e., telerehabilitation), access could be improved by reducing or eliminating many barriers that patients report; however, it is unclear how to appropriately incorporate digital treatment approaches into existing health care models. The investigators propose a prospective randomized clinical trial conducted at a health system serving rural communities to determine the effectiveness of innovative risk-informed telerehabilitation versus standard educational control for patients with chronic LBP that will match individual patients with specific physical therapy delivery (physical therapy telehealth visits or psychologically informed physical therapy telehealth visits) based on the patient's psychosocial risk of poor outcomes.

What is being tested

• Standardized Education (behavioral)
• Telerehabilitation (behavioral)

Sponsor: Johns Hopkins University · Participants: 434 · Started: Jan 27, 2025

Contact the study team

• Richard L Skolasky, Sc.D. · Phone: 410-502-7975
• Kevin McLaughlin, D.P.T. · Phone: 410-614-3234

Official record on ClinicalTrials.gov — NCT06471920

Locations in the U.S.

From ClinicalTrials.gov, data retrieved Sep 30, 2026. Each study sets its own eligibility; the study team decides who can join.