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Using Remote Presence Robots to
Improve Access to Care for People
with Low Back Pain
Stacey Lovo Grona, MSc, Brenna Bath, PhD, Luis Bustamante, MSc, Ivar Mendez, PhD,
Background
• Robots successfully used for medical assessments in a northern Inuit community in Newfoundland (Mendez et al., 2013)
• Now being used clinically in remote Northern Saskatchewan by the Department of Surgery, U of S.
• Innovative and emerging health care trend.
• Not yet used for PT service delivery anywhere in the world despite affordability and flexibility.
Background
• Chronic low back disorders (CLBD) are the leading
cause of morbidity worldwide, compared to 289 other
disease and conditions, considering years lived with
disability! (Vos et al., 2012)
• People with CLBD use more than double the health
system dollars than a comparable population without
back disorders (Mapel et al., 2004).
• 20% of Canadians have chronic back disorders (CBD) for
more than 6 months at a time.
• PT’s are rarely included in primary care teams, yet they
have very much to offer in terms of managing chronic low
back disorders.
PT and Management of
Back Pain
• Experienced PT’s have higher levels of knowledge in
managing back pain than physician interns, residents,
and all physicians except orthopedic surgeons (Childs et
al., 2005).
• Bath et al. (2012) found no significant difference
between PT’s and an orthopedic surgeon regarding
diagnostic categorization of people with chronic low
back disorders.
• People living in rural or remote regions are 30% more
likely to have CBD (Bath et al. 2014), however, access to
physical therapy (PT) services is limited.
• Lack of appropriate health care is thought to be a reason
for the higher rates of chronic health conditions in rural
areas (Allen, 1996 and Grimmer, 1998).
Gabrush, Fritzler, Dickson, Bisaro,
Bryan, Bath 2014
Mamaweetan
Churchill Health
Region 2 PT’s.
Population is 23,500.
Residents of remote Northern areas frequently seek care
for back disorders in urban centers.
• Time away from work, home and family
• Lengthy periods of travel, difficult road conditions
• Barrier to early assessment and appropriate follow-up
RP-7 Remote Presence Robot
• In Touch Health, Santa Barbara, CA
• Class II medical device, US FDA
• Mobility – the PT can move around the patient with the robot to evaluate important aspects such as posture, movement quality and control.
• Realistic head / screen movements
• Excellent camera, audio and visual functionalities
• Functionalities:
• Regular and zoom camera control
• Microphone and speaker volume
• Mirrored screen (operator can demonstrate TO patient what
he/she is looking at by drawing or highlighting on the
screen)
• Approximate size of a person
• Picture and video can
be saved and
encrypted
• Easy monitoring of
internet capacity to
ensure adequate
service available
• Set-up Considerations:
• Pre-clinical testing (light, audio to ensure most pleasing
appearance and sound)
• Earphones for privacy
• Privacy handset
• Printer
Research Question
• What is the feasibility of using remote
presence robots for a distance physical
therapy assessment of chronic low back
pain?
Research Details
• Approved by the University of Saskatchewan Biomedical Ethics Board 15-16. Case study design.
• Preparation and consultation with Indigenous community to ensure respectful research protocol.
• Data: Sociodemographic information, clinical information, depression and fear avoidance questionnaires, patient satisfaction and patient/practitioner experience interviews
Model of Care
• Interprofessional Team and Videoconferencing Pilot
• NP involvement with patient, urban PT joining from a distance
• Interprofessional role clarification and revision of traditional
spinal triage assessment
• Participant Selection:
• 18-80 years
• >3 months bothersome back or leg pain
• Not presently receiving PT, nor covered by WCB/SGI
• Recruitment: via NP appointed in charge of study by
Indigenous community
• NP training
• Interprofessional Assessment:
• Subjective History
• Medical history, medications, imaging results, weight and history of chronic illness
• Special questions: thecal pressure, neurological symptoms, bowel/bladder and sensation, use of steroids, history of RA, coagulation issues.
• Objective Exam
• Active Mobility
• Neurological Tests: key muscles, reflexes, upper motor neuron testing and sensory testing
• Neural Mobility Tests
• Special Tests:
Education Provided
• Use of mirrored screen to display educational
information:
• Back biomechanics and occupational hygiene
• Anatomy and pathology of back injuries
• Exercise examples
• Postural education
• Stages of tissue healing and expectations for recovery
• Next steps
• Findings:
• Subjective: post-surgical discectomy and laminotomy
• Objective: active range of motion limitations, poor control of posture and core musculature, neural mobility restrictions
• Follow-up
• 1 week later via robot
• Review and progression of exercise, explanation of next steps.
• Referral to closest in person PT for hands on treatment.
Results
• Awaiting following up semi structured interview and
questionnaires.
• SLR improved to normal in 1 week
• In one month goal of 10,000 steps per day achieved.
• Client was very pleased with education and ability to
begin exercises, as well as information on back safety and
expectations
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