Abstract
BackgroundLow back pain (LBP) and knee osteoarthritis (OA) are major contributors to disability worldwide. These conditions result in a significant burden at both individual and societal levels. Engagement in regular physical activity and exercise programs are known to improve physical function in both chronic LBP and knee OA populations. For people residing in rural areas, musculoskeletal conditions are often more frequent and disabling compared to urban populations, which could be the result of reduced access to appropriate health services and resources in rural settings. EHealth is an innovative solution to help provide equitable access to treatment for people with musculoskeletal pain living in rural settings.Methods/designWe will conduct a randomised clinical trial investigating the effects of an eHealth intervention compared to usual care, for people with chronic non-specific LBP or knee OA in rural Australia. We will recruit 156 participants with non-specific chronic LBP or knee OA. Following the completion of baseline questionnaires, participants will be randomly allocated to either the eHealth intervention group, involving a tailored physical activity and progressive resistance exercise program remotely delivered by a physiotherapist (n = 78), or usual care (n = 78) involving referral to a range of care practices in the community. Outcomes will be measured at baseline, 3 and 6 months post-randomisation. The primary outcome will be physical function assessed by the Patient-Specific Functional Scale (PSFS). Secondary outcomes include pain intensity, physical activity levels, activity limitations, quality of life, pain coping. We will also collect process evaluation data such as recruitment rate, attendance and adherence, follow-up rate, participants’ opinions and any barriers encountered throughout the trial.DiscussionThe findings from this trial will establish the effectiveness of eHealth-delivered interventions that are known to be beneficial for people with LBP and knee OA when delivered in person. As a result, this trial will help to inform health care policy and clinical practice in Australia and beyond for those living in non-urban areas.Trial registrationThis study was prospectively registered on the Australian New Zealand Clinical Trials Registry (ACTRN12618001494224) registered 09.05.2018.
Highlights
Low back pain (LBP) and knee osteoarthritis (OA) are major contributors to disability worldwide
Clinical guidelines commonly recommend the implementation of regular physical activity and exercise programs to improve physical function in people with chronic LBP [13] and knee OA [14]
Aim The primary aim of this study is to investigate the effectiveness of a three-month physiotherapist-delivered eHealth intervention comprised of a tailored physical activity plan and progressive resistance exercise program, to improve physical function in people living in rural Australia with chronic non-specific LBP or knee OA, compared to usual care
Summary
Low back pain (LBP) and knee osteoarthritis (OA) are major contributors to disability worldwide. For people residing in rural areas, musculoskeletal conditions are often more frequent and disabling compared to urban populations, which could be the result of reduced access to appropriate health services and resources in rural settings. People residing in non-urban areas often experience health workforce shortages, especially the availability of musculoskeletal specialists which substantially decline with increasing rurality [12, 18]. This scenario can delay appropriate and timely evidence-based first-line management and prevention of symptom deterioration in rural populations. Innovative models of delivery of health care services are needed, to secure equitable access to recommended treatment for chronic musculoskeletal conditions irrespective of where patients reside
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