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.

http://www.medgadget.com/telemedicine/page/

2

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

A New Model of Care is

Needed

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

RP-7 Remote Presence

Robot

• 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

stacey.lovogrona@usask.ca