At home clinic visits for LBP: Is it really effective?

Vanessa Denny

COVID-19 exhibits many debilitating symptoms. However, among the ones that the scientific community is well familiar with, back pain has been one of the most under-discussed [1]. Although back pain as a symptom of COVID can be a murky area for discussion, it is still very concerning for the general population. In fact, the data suggests that people have become even more familiar with Lower Back Pain (LBP) over the past eighteen months. COVID-19 back pain generally emanates from two sources. First, the virus causes muscle aches and pains (myalgia) as the infection progresses, and the quarantine requirements have many people sitting at home for longer periods of the day.

Hence, there has been a recent increase of interest in how to best care for yourself when experiencing LBP. Some clinics have answered this by providing at-home tests. In 2020, UT Southwestern announced they were expanding their telehealth visits to provide a path for patients to have their back pain questions answered while remaining at home or in quarantine [2]. Using a video exam template, they are able to successfully assess their patients’ mobility and needs, without a trip to the clinic.

How effective are these methods? A study on home-based telemedicine (HBT) found significantly more improvements in the at-home patients than the control group. 87.2% of the HBT patients were performing their home exercises, as compared to the 65.9% of the control participants. [3] A study on in-clinic versus online rehabilitation programs found that the group working in their own homes were better able to achieve their goals [4]. However, that same study also found greater pain relief amongst the in-clinic group.

A major factor in one’s ability to be successful with home rehabilitation is their own self-efficacy. Self-efficacy is a broad term, but within the context of medicine it refers to the cognitive process an individual learns when integrating new behaviors that will improve their future. Holly Farley’s literature review of the subject says, “From this, the concept of self-efficacy and one’s ability to meet the challenges of self-management and succeed directly impacts Telehealth. Within low back pain patients, self-management is particularly essential. Barriers to self-efficacy include health literacy access and support, which Telehealth directly provides solutions for, thus increasing the patient’s belief and motivation to work towards a successful recovery.” [5]

However, telemedicine is only as good as the technology that is available to the patients. The methods that are most common such as phone-apps or text messages; have not been researched enough to say for certain if they can improve LBP. Regardless, the current research does look promising, and some don’t want to wait before getting started.

If you are eager to get to work on helping ease the back pain in your own life, a few physical therapy clinics have put out easy exercises that can be done at home. The Kansas-based clinic, Advanced Physical Therapy, recommended lower trunk rotations, pelvic tilts, ball squeezes, and the piriformis stretch [6]. Dr. Parikh at Hackensack Meridian Health recommends some life-adjustment tips; limiting your time in bed or sitting down, exercising as much as possible, heat and ice therapy, stretches, and a healthy diet [7].

Whatever path forward you choose, one of the clear impacts from covid-19 is a nationwide increase in the use of telehealth [8]. It’s important for all patients to know what their resources are and what options they have in order to be successful. A driving force in this increase needs to be additional longitudinal studies in order for patients to understand what path forward they should choose. This means understanding the potential drawbacks of telemedicine, such as limited technology or equipment, needs to be weighed into decision making. A study on the socioeconomic disparities during the telehealth surge disproportionately impacted patients with the most limited access to in-person clinics. The study found that, “Increasing age and being in the lowest median household income quartile were associated with lower odds of completing a virtual visit overall.” [9] However, despites the minor shortcomings, at home clinic visits for LBP is certainly effective.

This article has been approved and reviewed by the Scientific Writing Team Lead of Esurgi: Ishtiak Ahmed Chowdhury

Sources:

1. https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html?utm_campaign=AC_CRNA
2. https://utswmed.org/medblog/back-neck-pain-relief-telehealth/
3. https://pubmed.ncbi.nlm.nih.gov/27584139/
4. https://www.researchgate.net/publication/350169862_In-Clinic_Versus_Web-Based_Multidisciplinary_Exercise-Based_Rehabilitation_for_Treatment_of_Low_Back_Pain_Prospective_Clinical_Trial_in_an_Integrated_Practice_Unit_Model
5. https://onlinelibrary.wiley.com/doi/full/10.1002/nop2.382
6. https://aptclinics.com/2021/01/back-pain-in-quarantine-let-us-help/
7. ics.com/2021/01/back-pain-in-quarantine-let-us-help/
8. https://www.hackensackmeridianhealth.org/HealthU/2020/04/27/6-ways-to-alleviate-lower-back-pain-during-lockdown/
9. https://jamanetwork.com/journals/jamaotolaryngology/fullarticle/2775067