The Physical and Psychological Effects of Telerehabilitation-Based Exercise for Patients With Nonspecific Low Back Pain: Prospective Randomized Controlled Trial

Abstract

Background: Physical therapy has demonstrated efficacy in managing nonspecific low back pain (NLBP) among patients. Nevertheless, the prevalence of NLBP poses a challenge, as the existing medical infrastructure may be insufficient to care for the large patient population, particularly in geographically remote regions. Telerehabilitation emerges as a promising method to address this concern by offering a method to deliver superior medical care to a greater number of patients with NLBP.

Objective: The purpose of this study is to demonstrate the physical and psychological effectiveness of a user-centered telerehabilitation program, consisting of a smartphone app and integrated sensors, for patients with NLBP.

Methods: This was a single-center, prospective, randomized controlled trial for individuals with NLBP for a duration exceeding 3 months. All participants were assigned randomly to either the telerehabilitation-based exercise group (TBEG) or the outpatient-based exercise group (OBEG). All participants completed a 30-minute regimen of strength and stretching exercises 3 times per week, for a total of 8 weeks, and were required to complete assessment questionnaires at 0, 2, 4, and 8 weeks. The TBEG completed home-based exercises and questionnaires using a telerehabilitation program, while the OBEG completed them in outpatient rehabilitation. The Oswestry Disability Index (ODI) served as the primary outcome measure, assessing physical disability. Secondary outcomes included the Numeric Pain Rating Scale, Fear-Avoidance Beliefs Questionnaire, and 36-item Short-Form Health Survey.

Results: In total, 54 of 129 eligible patients were enrolled and randomly assigned to the study. The completion of all the interventions and assessments in the TBEG and OBEG was 89% (24/27) and 81% (22/27). The findings indicate that no statistical significance was found in the difference of ODI scores between the TBEG and the OBEG at 2 weeks (mean difference -0.91; odds ratio [OR] 0.78, 95% CI -5.96 to 4.14; P=.72), 4 weeks (mean difference -3.80; OR 1.33, 95% CI -9.86 to -2.25; P=.21), and 8 weeks (mean difference -3.24; OR 0.92, 95% CI -8.65 to 2.17; P=.24). The improvement of the ODI in the TBEG (mean -16.42, SD 7.30) and OBEG (mean -13.18, SD 8.48) was higher than 10 after an 8-week intervention. No statistically significant differences were observed between the 2 groups at the 8-week mark regarding the Fear-Avoidance Beliefs Questionnaire (mean difference 8.88; OR 1.04, 95% CI -2.29 to 20.06; P=.12) and Numeric Pain Rating Scale (mean difference -0.39; OR 0.44, 95% CI -2.10 to 1.31; P=.64). In the subgroup analysis, there was no statistically significant difference in outcomes between the 2 groups.

Conclusions: Telerehabilitation interventions demonstrate comparable therapeutic efficacy for individuals with NLBP when compared to conventional outpatient-based physical therapy, yielding comparable outcomes in pain reduction and improvement in functional limitations.

Keywords: back pain; efficacy; exercise; health survey; low back pain; medical infrastructure; mobile phone; nonspecific low back pain; pain intensity; physical therapy; psychological; quality of life; randomized controlled trial; telerehabilitation; therapeutic.

Figure 1.. The 3 different parts of the Healbone Intelligent Rehabilitation System. The doctor’s portal could be used to create and modify exercises, monitor training progress, and view patient data. The patients could use the user’s portal to complete the prescribed exercises, view educational materials, and provide feedback to the physical therapists. Finally, the transmitter portal encrypts and transmits the data collected, ensuring the overall system’s integrity.

Figure 2.. Participant flowchart.

Figure 3.. The primary and secondary outcomes Oswestry Disability Index, Numeric Pain Rating Scale, and Fear-Avoidance Beliefs Questionnaire at baseline and 2, 4, and 8 weeks; error bars represent 95% CIs.