BeatPain Utah: study protocol for a pragmatic randomised trial examining telehealth strategies to provide non-pharmacologic pain care for persons with chronic low back pain receiving care in federally qualified health centers

Fritz, Julie M.; Fiol, Guilherme Del; Gibson, Bryan; Wetter, David W.; Solis, Victor; Bennett, Emily; Thackeray, Anne; Goode, Adam P.; Lundberg, Kelly; Romero, Adrianna; Ford, Isaac; Stevens, Leticia; Siaperas, Tracey; Morales, Jennyfer; Yack, Melissa; Greene, Tom

doi:10.1136/bmjopen-2022-067732

Cited by 7 publications

(5 citation statements)

References 88 publications

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“…Physical therapist training focused on the intervention core components and integration of MAPS for English and Spanish-speaking patients. 35 Training in culturally competent care used Hays ADDRESSING framework as a structured self-exploration method of how the PT’s cultural background may interact with their patient’s background and influence care. 55 We also used Betancourt’s framework for cross-cultural communication to help PTs consider major cultural issues they may encounter and provide person-centered care characterized by empathy and respect for patients’ values and preferences.…”

Section: Resultsmentioning

confidence: 99%

“…BeatPain Utah 35 ( Clinicaltrials.gov Identifier: NCT04923334 ) is a pragmatic clinical trial examining two PT-led telehealth EBIs; a brief consult and an extended PT program; delivered across two treatment phases. Further details are published.…”

Section: Methodsmentioning

confidence: 99%

“…Further details are published. 35 BeatPain is a hybrid type 1 trial, primarily focusing on effectiveness and secondarily on implementation outcomes. 36 Implementation mapping occurred during a planning year before enrollment.…”

Section: Methodsmentioning

confidence: 99%

“…Step 5-Evaluate Implementation Outcomes Implementation outcomes for the BeatPain trial 35 were selected to evaluate the success of the IM process across groups. Because BeatPain adapted nonpharmacologic pain EBIs for underrepresented populations using novel delivery strategies, we identi ed important implementation outcomes as adoption, acceptability, feasibility, and delity as de ned in Table 3.…”

Section: Regular Team Meetings For Problemsolving and Skills Practicementioning

confidence: 99%

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Use of implementation mapping in the planning of a hybrid type 1 pragmatic clinical trial: the BeatPain Utah study

Fritz,

Gibson,

Wetter

et al. 2023

Preprint

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Background Considerable disparities in chronic pain management have been identified. Persons in rural, lower income and minoritized communities are less likely to receive evidence-based, nonpharmacologic care. Telehealth delivery of nonpharmacologic, evidence-based interventions for persons with chronic pain is a promising strategy to lessen disparities, but implementation comes with many challenges. The BeatPain Utah study is a hybrid type I effectiveness-implementation pragmatic clinical trial investigating telehealth strategies to provide nonpharmacologic care from physical therapists to persons with chronic back pain receiving care in Community Health Centers (CHCs). CHCs provide primary care to all persons regardless of ability to pay. This paper outlines the use of implementation mapping to develop a multifaceted implementation plan for the BeatPain study. Methods During a planning year for the BeatPain trial we developed a comprehensive logic model including the 5-step implementation mapping process informed by additional frameworks and theories. The five iterative implementation mapping steps were addressed in the planning year; 1) conduct needs assessments for involved groups; 2) identify implementation outcomes, performance objectives and determinants; 3) select implementation strategies; 4) produce implementation protocols and materials; and 5) evaluate implementation outcomes. Results CHC leadership/providers, patients and physical therapists were identified as involved groups. Barriers and assets were identified across groups which informed identification of performance objectives necessary to implement two key processes; 1) electronic referral of patients with back pain in CHC clinics to the BeatPain team; and 2) connecting patients with physical therapists providing telehealth. Determinants of the performance objectives for each group informed our choice of implementation strategies which focused on training, education, clinician support and tailoring physical therapy interventions for telehealth delivery and cultural competency. We selected implementation outcomes for the BeatPain trial to evaluate the success of our implementation strategies. Conclusions Implementation mapping provided a comprehensive and systematic approach to develop an implementation plan during the planning phase for our ongoing hybrid effectiveness-implementation trial. We will be able to evaluate the implementation strategies used in the BeatPain Utah study to inform future efforts to implement telehealth delivery of evidence-based pain care in CHCs and other settings. Trial Registration Clinicaltrials.gov Identifier: NCT04923334. Registered June 11, 2021 (https://clinicaltrials.gov/study/NCT04923334

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Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Regular Team Meetings For Problemsolving and Skills Practicementioning

confidence: 99%

See 2 more Smart Citations

Use of implementation mapping in the planning of a hybrid type 1 pragmatic clinical trial: the BeatPain Utah study

Fritz,

Gibson,

Wetter

et al. 2023

Preprint

Self Cite

View full text Add to dashboard Cite

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“…BeatPain Utah is evaluating two strategies to provide telehealth PT for adults with cLBP who receive care in Community Health Centers (CHCs) in Utah (25). CHCs are federally-funded, nonprofit organizations providing primary care in areas with high prevalence of medically underserved individuals (26).…”

Section: Pragmatic Clinical Trials Being Conducted In Underserved Com...mentioning

confidence: 99%

Telehealth delivery of physical therapist-led interventions for persons with chronic low back pain in underserved communities: lessons from pragmatic clinical trials

Fritz,

Ford,

George

et al. 2024

Front. Pain Res.

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In this perspective, we present our experience developing and conducting two pragmatic clinical trials investigating physical therapist-led telehealth strategies for persons with chronic low back pain. Both trials, the BeatPain Utah and AIM-Back trials, are part of pragmatic clinical trial collaboratories and are being conducted with persons from communities that experience pain management disparities. Practice guidelines recommend nonpharmacologic care, and advise against opioid therapy, for the primary care management of persons with chronic low back pain. Gaps between these recommendations and actual practice patterns are pervasive, particularly for persons from racial or ethnic minoritized communities, those with fewer economic resources, and those living in rural areas including Veterans. Access barriers to evidence-based nonpharmacologic care, which is often provided by physical therapists, have contributed to these evidence-practice gaps. Telehealth delivery has created new opportunities to overcome access barriers for nonpharmacologic pain care. As a relatively new delivery mode however, telehealth delivery of physical therapy comes with additional challenges related to technology, intervention adaptations and cultural competence. The purpose of this article is to describe the challenges encountered when implementing telehealth physical therapy programs for persons with chronic low back pain in historically underserved communities. We also discuss strategies developed to overcome barriers in an effort to improve access to telehealth physical therapy and reduce pain management disparities. Inclusion of diverse and under-represented communities in pragmatic clinical trials is a critical consideration for improving disparities, but the unique circumstances present in these communities must be considered when developing implementation strategies.

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Ensuring Virtual Vigilance in Decentralized Clinical Trials

Hernandez,

Lindsell

2024

JAMA

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BeatPain Utah: study protocol for a pragmatic randomised trial examining telehealth strategies to provide non-pharmacologic pain care for persons with chronic low back pain receiving care in federally qualified health centers

Cited by 7 publications

References 88 publications

Use of implementation mapping in the planning of a hybrid type 1 pragmatic clinical trial: the BeatPain Utah study

Use of implementation mapping in the planning of a hybrid type 1 pragmatic clinical trial: the BeatPain Utah study

Telehealth delivery of physical therapist-led interventions for persons with chronic low back pain in underserved communities: lessons from pragmatic clinical trials

Ensuring Virtual Vigilance in Decentralized Clinical Trials

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