Telehealth for Musculoskeletal Rehabilitation & Pain Care: Applying Qualitative Methods and the Six-Forces Innovation Framework to Assess and Address a Prevalent US Healthcare Need

Abstract

Musculoskeletal Disorders are the leading cause of pain and disorder in the United States and globally. Of all musculoskeletal disorders, back pain is the most prevalent, with a lifetime prevalence of 84% for any form of back pain and a prevalence of 23% for chronic low back pain. This burden of pain has led to calls for a cultural shift in how pain is diagnosed and treated in the United States by the Institute of Medicine and National Institute of Health, and other Federal and State agencies. The IOM and the NIH's central recommendation is to design new pain care models that rely on individualized, multimodal, multidisciplinary care, centered on establishing a patient-clinician therapeutic alliance and shared-decision making. The doctoral project involved 15 semi-structured patient interviews and 10 physical therapist interviews to assess therapeutic alliance and patient experience in the MSK rehab and pain care context to inform a startup organization looking to remodel MSK pain care through telehealth. Themes identified under the therapeutic alliance fell under a Goal, Task, and Bond conception. Themes identified for patient experience fell under the categories of Barriers, Adherence Determinants, and Patient Pleasers. Finally, the thesis presents recommendations to the startup on translating the learning on the therapeutic alliance and patient experience into a consumer-focused strategy. The recommendations aim to guide the startup on strengthening the alliance and improving the patient experience through telehealth. Furthermore, it addresses relevant considerations regarding the forces of structure, financing, public policy, technology, consumers, and accountability that healthcare innovators are bound to experience.