# Improving Function and Reducing Opioid Use for Patients with Chronic Low Back Pain in Rural Communities through Improved Access to Physical Therapy using Telerehabilitation

> **NIH NIH UH3** · JOHNS HOPKINS UNIVERSITY · 2024 · $1,240,757

## Abstract

Project Summary
Chronic low back pain (LBP) imposes tremendous burden on affected individuals, healthcare systems, and
society. LBP has been identified as the most common cause of disability globally and in the United States (US).
LBP is also the largest driver of US healthcare spending ($135 billion in 2016) and the most common diagnoses
associated with opioid prescription and consumption. For patients with chronic LBP, physical therapy has been
shown to be a cost-effective method for improving pain and disability. In addition, physical therapy has been
shown to decrease the risk of advanced imaging, injections, surgery, and opioid use in patients with chronic LBP.
Despite available evidence in support, only 7-13% of patients with LBP, including those with chronic LBP, go on
to receive physical therapy services, with patients reporting barriers accessing physical therapy, such as
transportation, provider availability and missed work time. Access is especially limited in rural communities where
there are approximately 40% fewer physical therapists available per capita compared to metropolitan regions. In
addition, patients living in rural communities likely need to travel longer distances to receive physical therapy,
requiring additional missed work time and transportation costs. This lack of access to physical therapy in rural
communities likely contributes to the greater rates of LBP-related disability and opioid consumption that have
been observed in rural communities compared to metropolitan areas. Innovative methods for improving access
to physical therapy are urgently needed to address disparities in outcomes for patients with chronic LBP living
in rural communities in the US. Telehealth has rapidly expanded during the COVID-19 pandemic. This includes
policy changes that have allowed physical therapists to begin providing care remotely, also referred to as
telerehabilitation. Telerehabilitation stands to improve access to physical therapy for patients with chronic LBP
living in rural communities and may serve as a means of improving outcomes of these patients.
We will conduct a single-blind prospective randomized clinical trial addressing key questions to understanding
the effectiveness of a risk-stratified telerehabilitation to reduce opioid use and LBP-related disability and to
improve physical function and health-related quality of life (HRQoL) in patients with chronic LBP. Additionally,
we will explore implementation outcomes using a mixed methods approach consisting of electronic surveys and
semi-structured interviews with patients, physical therapists, practice managers, and outpatient services
administration focusing on perceived quality and impact on barriers to care. We will enroll 434 patients with LBP
presenting to primary care clinics serving rural communities (TidalHealth, Salisbury, MD). Eligible patients will
provide informed consent and be randomized to either an educational control or risk-stratified telerehabilitation
(low...

## Key facts

- **NIH application ID:** 11163083
- **Project number:** 4UH3AR083838-02
- **Recipient organization:** JOHNS HOPKINS UNIVERSITY
- **Principal Investigator:** Kevin McLaughlin
- **Activity code:** UH3 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $1,240,757
- **Award type:** 4N
- **Project period:** 2023-09-25 → 2028-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/11163083

## Citation

> US National Institutes of Health, RePORTER application 11163083, Improving Function and Reducing Opioid Use for Patients with Chronic Low Back Pain in Rural Communities through Improved Access to Physical Therapy using Telerehabilitation (4UH3AR083838-02). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/11163083. Licensed CC0.

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