Combining telehealth and physical activity improves physical function for veterans

April 16, 2018 – A pilot study testing the effects of a home-based telephone-supported physical activity program for chronic low back pain provides a foundation for a larger trial to study the effectiveness of these interventions in older veterans.

A pilot randomized clinical trial on older veterans with chronic low back pain was recently published by DCRI researchers in Physical Therapy Journal, the official journal of the American Physical Therapy Association, for their special issue on pain management.

“The prevalence of chronic pain in the American veteran population is very high and among those who have chronic pain, musculoskeletal pain such as chronic back pain is very common,” said the DCRI’s Adam Goode, DPT, PhD, first author of the study. “Considering that in the general population, about 50 percent of all older adults have chronic low back pain and up to 60 percent of all veterans complain of chronic pain, the condition is extremely common and understudied.”

Adam GoodeChronic low back pain is a persistent pain in the lower back region that lasts for at least three months. It represents the second leading cause of disability worldwide and is a major economic problem resulting in approximately 100 to 200 billion dollars per year in costs for the United States. The prevalence of chronic low back pain in adults has increased more than 100 per cent in the last decade and continues to increase dramatically in the aging population in the country affecting both men and women in all ethnic groups with a significant impact on functional capacity and occupational activities.

Set in the Durham Veterans Affairs Healthcare System and funded by the Veterans Health Administration, one of the largest integrated healthcare systems in the United States, the pilot study demonstrated that home-based telephone-supported physical activity interventions are feasible, acceptable and safe for older veterans.

“To improve physical function among older adults was our primary outcome,” said Goode. “Improving function is very important for the population with chronic low back pain, for low back pain in older adults leads to functional decline, which is associated with many deleterious effects such as changes in cognitive function and mortality.”

According to the study, despite current guidelines indicating that individuals with chronic low back pain should participate in regular exercise, less than 40 percent of veterans with chronic pain, including chronic low back pain, use exercise to treat their pain.

“As far as back pain in general is concerned, there are not a lot of interventions that have a large impact on improving outcomes,” said Goode. “One simple intervention is exercise or physical therapy that can considerably improve physical function among older adults and can be successfully delivered in the home setting.”

According to Goode, this study found that a single in-person visit with a physical therapist and a home-based exercise program with telephone support can produce meaningful improvements in multiple outcomes among older adult veterans with chronic low back pain.

“Studies that involve older adults that have greater sample sizes and are of longer duration are the next step, which could be generalizable to the population at large,” said Goode

In addition to Goode, other researchers included Shannon Stark Taylor, S. Nicole Hastings, Catherine Stanwyck, Cynthia Coffman, and Kelli D. Allen.