High-Intensity Training Telerehabilitation for Persons with Chronic Low Back Pain: A Pilot Clinical Trial

Abstract

Background/Objectives: High-intensity training (HIT) has been shown to enhance physical fitness and reduce functional impairments in persons with moderately disabling chronic nonspecific low back pain (CNSLBP). However, sustaining these improvements post-rehabilitation remains a challenge. To address this, a home-based, technology-supported HIT program utilizing telerehabilitation can be implemented at home. This study assesses the feasibility and clinical effectiveness of a telerehabilitation HIT program for persons with CNSLBP. Methods: The pilot clinical trial (NCT05234008) recruited 15 persons with CNSLBP. Participants completed a 6-week multimodal HIT intervention with 12 bi-weekly sessions. The first four sessions were organized at REVAL Research Center, followed by eight home-based sessions using the Physitrack^® platform. Assessments were conducted at baseline (PRE), two weeks into the intervention (MID), and immediately post-intervention (POST). Outcome measures included maximal oxygen uptake (VO2max) testing, disease-related outcomes, feasibility, motivation assessed via questionnaires, and system usability and adherence tracked through Physitrack^® technology. Results: Fourteen participants (seven females; age: 45.9 years) successfully completed the program without adverse events. Based on PRE-POST comparisons, motivation levels remained high (Motivation Visual Analog Scale: -1.2 ± 0.9, p = 0.043) despite reduced motivation at POST. Improvements were also observed in pain (Numeric Pain Rating Scale: -1.8 ± 0.2, p = 0.026), disability (Modified Oswestry Disability Index: -12.1 ± 10.2, p = 0.002), fear-avoidance (Fear-Avoidance Components Scale: -10.1 ± 5.8, p = 0.005), and exercise capacity (VO2max: 4.4 ± 1.6, p = 0.048). Conclusions: The HITHOME study is the first to investigate the feasibility and effectiveness of a telerehabilitation HIT program for persons with CNSLBP. The results underscore the feasibility of implementing a home-based HIT program to support adherence to vigorous exercise programs and improve clinical outcomes in this population. Additionally, the findings emphasize technology's potential importance in enhancing home-based exercise therapy and lay the groundwork for future studies on blended care and telerehabilitation using HIT in CNSLBP.

Keywords: blended care; chronic nonspecific low back pain; high-intensity training; telerehabilitation.

Figure 1

Study design.

Figure 2

Visualization of the HIT program in the Physitrack mobile application consisting of trunk strength exercises (1) and cardiorespiratory interval training (2). Exercises were displayed with a video/picture guide and written instructions (3). The therapist could follow the participant’s adherence through a clear progression graph (4).