Study examines rural services for back pain

Rural residents are 30 percent more likely than their urban neighbours to have back pain, a condition that affects 20 percent of the Canadian population.


Brenna Bath, associate professor in the University of Saskatchewan’s School of Physiotherapy, said farmers are a high risk group because of the physical nature of their jobs. 


She said they also may not have access to health-care plans and workers compensation programs because they are self-employed. As well, wait times for publicly funded physical therapy clinics can be long. 


Bath said 90 percent of Saskatchewan physiotherapists practice in urban centres, with the majority in Saskatoon and area.


Researchers hope to bridge the service gap between rural residents with chronic back pain and their access to physical therapy.


Bath is leading a team studying three care options in the Kelsey Trail Health Region in northeastern Sask-atchewan: traditional care with a nurse practitioner, urban physiotherapists delivering care in person in rural regions and access to physiotherapists and nurse practitioners via a Telehealth conference.


Telehealth can be used for clinical appointments, consultations, followups, meetings and continuing education programs, which allow rural and remote patients to remain in their own communities.


“Video conferencing is an exciting technology. It’s not new, but it’s underutilized,” she said.


Bath said the research could affect patient care well beyond provincial borders by creating new primary health-care models.


She said most people with back pain seek help from family doctors, but there are other options. 


“They don’t necessarily have the same level of training in musculoskeletal assessment as physiotherapists,” she said. “Rather than look at the doctor, we might look to multi-disciplinary teams.”


Her own clinical experience outside Saskatoon showed that the majority of those referred to orthopedic specialists did not require surgery, and many had difficulties in accessing physiotherapy in rural areas.


“They go back to communities that don’t have access to services considered as ideal management,” said Bath.


The Kelsey Trail Health Region was selected because of its distance from urban centres and the low number of physiotherapists.


Colleen Naber, director of therapies for the health region, said there is a nationwide shortage of physiotherapists. She said her region operates at 60 percent of normal staffing levels because of people going on leave and competition with city jobs.


“Today I’m being three people,” Naber said. “We cannot provide the services to that heath region the way that we would like to. As soon as you have a person going on leave, we can’t backfill.”


Bath said video conferencing is a new concept for Saskatchewan, but a similar system is in place in Ontario following hip and knee replacement surgery.


This spring, the study will seek volunteer participants for whom back pain has impaired their daily life and function for at least three months or more.


The Kelsey Trail Health Region, with a population of 40,000, has 32.2 physical therapists per 100,000 population compared to 83.2 physical therapists per 100,000 in the Sask-atoon Health Region.


The study, which includes re-searchers in psychology, physiotherapy and economics disciplines at the U of S, will look at what type of care works best in different situations, patient satisfaction, costs of delivering care and costs for patients who must commute for therapy. 


The Saskatchewan Health Re-search Foundation has funded the project, which also received $30,000 from the Ralston Brothers Medical Research Fund Competition. 


Funding will buy a teleconferencing unit, which will remain in the Arborfield and District Health Care Centre after the study is completed in 2016.