Use of a modified treatment-based classification system for subgrouping patients with low back pain: Agreement between telerehabilitation and face-to-face assessments

ABSTRACT

Objective: To examine the agreement between telerehabilitation and face-to-face assessments of patients with acute and subacute low back pain (LBP) using a modified treatment-based classification (TBC) system. A secondary aim was to evaluate patient satisfaction with the telerehabilitation assessment. Methods: Patients with LBP of less than 90 days’ duration underwent both telerehabilitation and face-to-face assessments. After physical examination, patients were classified into one of three intervention groups (mobilization/manipulation, specific exercise, and stabilization). The assessment order and clinicians were randomized, and the clinicians were blinded to each other’s classification decision. Results: Forty-seven patients participated (mean [SD] age, 48.6 [15.0] years; 70% female). The overall rate of percentage agreement was 68.1% (κ = 0.52; 95% confidence interval, 0.32–0.72). There was no difference in classification distributions between assessments (χ² = 2.14, p = 0.54). The percentage agreement was 48.9%–59.6% for the modified TBC algorithm variables except for straight leg raise greater than 91°, which was markedly lower at 35.1%. This was the only variable that was significantly different between the telerehabilitation and face-to-face scenarios. The overall satisfaction with the telerehabilitation assessment was good. Conclusions: The results suggest that a telerehabilitation assessment using the modified TBC system may be able to direct treatment of patients with acute and subacute LBP. However, challenges still remain in applying this approach to clinical practice.

KEYWORDS:

• e-health
• telemedicine
• telehealth
• virtual
• internet
• spine
• lumbar
• assessment
• reliability
• diagnosis

Declaration of Interest

The authors report no conflicts of interest.