Home›Physical Medicine & Rehab› Telehealth physical therapy for low back pain in rural Maryland faces access and technology barriers, qualitative study finds
Telehealth physical therapy for low back pain in rural Maryland faces access and technology barriers, qualitative study findsTelehealth physical therapy shows promise for rural low back pain
Frontiers in MedicinePublished October 28, 2026DOI ↗Editorial oversight: Dr. Ji-eun Park, MD · Brain, Mind & Pain
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Key Takeaway
Consider telehealth physical therapy for rural low back pain, but anticipate access and technology barriers.
This is a qualitative analysis conducted during the pre-implementation phase of a guideline-based telehealth physical therapy program for low back pain in rural Maryland. The analysis involved 9 participants, including patients, physical therapists, and rural stakeholders, and aimed to assess the feasibility of delivering care via telehealth.
The authors identified 10 overarching themes: access to care, technology, age-related concerns, usefulness, broadband internet, comparison to in-person care, equipment, space, acceptance of telehealth, and therapeutic bonds. These themes highlight both facilitators and challenges to patient engagement.
The analysis also aimed to co-design actionable mitigation strategies for the identified challenges. However, specific strategies are not detailed.
Limitations include the small sample size (n=9). No adverse events or follow-up data were reported. The study does not provide evidence of clinical efficacy or reduction in opioid use; it is intended to inform the design of a future randomized clinical trial.
Practice relevance: The findings offer context-specific insights into the feasibility of telehealth for low back pain in rural communities, which may help clinicians anticipate barriers such as broadband access and technology concerns when implementing similar programs.
How this fits prior evidence
This qualitative analysis extends prior coverage of low back pain interventions by focusing on implementation barriers for telehealth physical therapy in rural settings. Prior coverage has examined telehealth mindfulness (OPTIMUM) and other non-pharmacologic modalities, but this analysis specifically addresses the pre-implementation phase and stakeholder perspectives. It also aligns with the recognized need to reduce opioid use, as prior coverage noted opioids lack long-term efficacy for chronic low back pain. However, unlike prior studies that reported clinical outcomes, this analysis does not provide efficacy data and is limited by a small sample (n=9).
Living in a rural area often means facing long travel times and limited access to specialists. For people struggling with chronic low back pain, these barriers can make it harder to get the physical therapy they need to manage pain without relying on opioid medications.
Researchers looked at how telehealth could bridge this gap. They spoke with patients, physical therapists, and local stakeholders in rural Maryland to see if delivering guided physical therapy through video calls was feasible. They identified ten key themes, including the importance of broadband internet, the role of technology, and how patients feel about the bond they form with their therapists online.
While the study involved a small group of nine people, it provided important insights into the hurdles of remote care, such as age-related concerns and the need for proper space and equipment. This work is an early step to help design future trials aimed at reducing opioid use in rural communities.
What this means for you:
Telehealth can help rural patients manage low back pain, but success depends on technology access and patient comfort.
Common questions
Is telehealth physical therapy feasible for rural patients?
Yes, the study explored the feasibility of using telehealth to deliver physical therapy for low back pain in rural Maryland. Researchers identified ten themes to help understand how this works, including technology use, broadband internet access, and the importance of the bond between the patient and the therapist.
What challenges do patients face with remote physical therapy?
Patients and therapists identified several hurdles, including concerns about technology, age-related issues, and the need for proper space and equipment. These factors are important to consider when moving from in-person care to a telehealth model for managing low back pain.
Can telehealth help reduce opioid use for back pain?
The study was designed to inform a future trial specifically aimed at reducing opioid use. While this initial research did not prove a reduction in medication, it helped identify how to better design future programs for rural communities.
BackgroundLow back pain (LBP), the most expensive health condition in the United States, accounts for over $134.5 billion in federal spending. As a leading cause of disability worldwide, LBP is a common reason for initiating prescription opioid therapy and often requires ongoing multidisciplinary care. In rural settings, where provider shortages, transportation barriers, and geographic constraints limit access to preventive and specialty healthcare for approximately 60 million Americans, telehealth can bring access to nonpharmacologic treatments of LBP, such as physical therapy, to patients. A qualitative analysis was conducted as part of the ARBOR-Telehealth study, a type 1 hybrid effectiveness-implementation of a pragmatic clinical trial, to evaluate a telehealth-delivered physical therapy intervention for adults with chronic LBP in rural Maryland.MethodsIn partnership with TidalHealth, a rural health system, nine individuals (patients, physical therapists, rural stakeholders) participated in pre-implementation, semi-structured, baseline video interviews. For methodological rigor, qualitative data were analyzed adhering to the trustworthiness parallel to quantitative data.ResultsTen overarching themes (access to care, technology, age-related concerns, usefulness, broadband internet, comparison to in-person care, equipment, space, acceptance of telehealth, therapeutic bonds) illuminated challenges that could affect patient engagement and facilitated the co-design of actionable mitigation strategies for implementation.ConclusionsThis study revealed context-specific insights on the feasibility of delivering guideline-based LBP physical therapy via telehealth in rural communities. It contributes evidence to ongoing National Institutes of Health efforts focused on improving pain management and reducing reliance on opioids in communities disproportionately affected by the overdose crisis.
