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Telehealth Therapy Effects of Nurses and Mental Health Professionals From 2 Randomized Controlled Trials for Chronic Back Pain

Gannon, Jamie, PhD*,†; Atkinson, Joseph H., MD*,†; Chircop-Rollick, Tatiana, PhD; D’Andrea, John, MD*,†; Garfin, Steven, MD; Patel, Shetal, PhD*; Penzien, Donald B., PhD; Wallace, Mark, MD; Weickgenant, Anne L., PhD*; Slater, Mark, PhD§; Holloway, Rachael, PsyD*; Rutledge, Thomas, PhD, ABPP*,†

doi: 10.1097/AJP.0000000000000678
Original Articles

Objective: To compare the efficacy of mental health professional versus primary care nurse-delivered telehealth cognitive-behavioral therapy (CBT) and supportive care (SC) treatments for chronic low back pain, using data from 2 separate randomized controlled trials. Both trials were completed in the same hospital and used the same study design, research team, and outcome measures.

Materials and Methods: Participants from Study 1 (Mental Health Professional Study) (N=66; 2007 to 2011) and Study 2 (Nursing Study) (N=61; 2012 to 2016) were patients with chronic low back pain (≥4/10 intensity) randomized to either an 8-week CBT or an SC telehealth condition matched for contact frequency, format, and time. Participants completed validated measures of improvement in back pain disability (Roland Morris Disability Questionnaire [RMDQ]), pain intensity (Numeric Rating Scale [NRS]), depressive symptoms (Beck Depression Inventory 2 [BDI-2]), pain catastrophizing (Pain Catastrophizing Scale [PCS]), and overall improvement (Global Clinical Impressions [GCI]).

Results: Intent-to-treat analyses at posttreatment showed that scores on the RMDQ (Cohen d=0.33 to 0.55), NRS (d=0.45 to 0.90), PCS (d=0.21 to 0.41), and GCI (18.5% to 39.1%) improved significantly in both studies and in both treatments from pretreatment to posttreatment. Changes in BDI scores were inconsistent (d=−0.06 to 0.51). The analyses revealed no significant differences in treatment efficacy between the trained nurse versus the mental health professionals on the RMDQ, NRS, PCS, or GCI measures (P>0.20).

Discussion: Results from these clinical trials suggest that the benefits of home-based, telehealth-delivered CBT and SC treatments for chronic back pain were comparable when delivered by a primary care nurse or mental health professional.

*VA San Diego Healthcare System

University of California, San Diego, CA

The University of Mississippi Medical Center, Jackson, MS

§Scottsdale Clinical Research Institute at Scottsdale Healthcare, Scottsdale, AZ

T.R., J.G., and M.S.: conducted all study analyses and assembled the tables and figures for the manuscript, Washington, DC.

Supported by the Office of Research and Development, Rehabilitation Research and Development Service, Department of Veterans Affairs, Washington, DC. The authors declare no conflict of interest.

Reprints: Thomas Rutledge, PhD, ABPP, Psychology Service, 116B, VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA 92161 (e-mail:

Received July 26, 2018

Received in revised form November 21, 2018

Accepted November 27, 2018

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