Six-month follow-up of a telehealth intervention for chronic back pain

Abstract

Telehealth interventions show promise for management of chronic conditions, including chronic pain, but the durability of treatment effects is unclear. We report results on 45 participants completing six-month follow-up of a randomized clinical trial assessing the efficacy of a telephone-delivered, minimal therapist contact, home-based intervention for chronic back pain in primary care. Participants were randomized to either Behavioral Medicine Rehabilitation Self-Management Skills Training (n =20) or a Supportive Care condition (n=25). The sample is predominantly male (67%), middle-aged (mean age= 49.7 + 12.3 yrs), Caucasian (71%), with longstanding pain (mean duration14.0+ 11.6 years), of moderate intensity (mean Numerical Pain Rating Scale = 4.9 + 1.6/10), moderate functional impairment (Roland & Morris Disability = 11.0+ 4.4), and mild distress (Beck Depression Inventory-II = 10.9+ 6.5). Sixty percent of subjects in the self-management training condition reported 50% or greater improvement at six-month follow-up, as compared to 32% of those in the supportive care condition (Fisher's exact p=.057). Mean percent improvement ratings also significantly favored the self-management group (53.2 + 38.4) over the supportive care group (28.5 + 39.0); t(43)=2.1, p=.039. Results suggest that a minimal therapist contact, telephone delivered, behavioral medicine rehabilitation self-management intervention may be a beneficial component of a “stepped-care” program for moderately impaired patients with back pain in primary care.