OBJECTIVE: To assess the effectiveness of synchronous and asynchronous telerehabilitation programs in managing chronic nonspecific low back pain (CNLBP).
DESIGN: A three-arm parallel group randomized trial SETTING: University Hospital, Department of Orthopedics and Traumatology PARTICIPANTS: This randomized controlled trial was carried out on individuals (N=72) (31 women, 41 men; mean age, 41.26±10.97y) with CNLBP.
INTERVENTIONS: Participants were randomly assigned to 3 groups: (1) a synchronous telerehabilitation group (STG) (n=24), (2) an asynchronous telerehabilitation group (ASTG) (n=24), and (3) a control group (CG) (n=24). A structured exercise program was delivered in real-time to the STG via prerecorded videos to the ASTG and through a digital book to the CG (12wk).
MAIN OUTCOME MEASURES: Pain levels as the prespecified primary outcome were measured using the visual analog scale. Disability was assessed with the Roland Morris Disability Questionnaire and Oswestry Disability Index. Fear of movement was evaluated with the Tampa Scale, and quality of life was determined using the SF-12.
RESULTS: Pain levels, disability status, fear of movement, and quality of life showed improvement at week 12 in all groups (P<0.05). In addition, the STG showed greater improvements than the CG in the visual analog scale (mean difference, 1.28; 95% CI, 0.50-2.05). Moreover, the ASTG obtained more significant results than the CG group only in the subparameters of SF-12 (physical component summary and mental component summary).
CONCLUSIONS: A real-time synchronous telerehabilitation program was superior in improving pain, disability, fear of movement, and quality of life, whereas the asynchronous group was superior compared with an unsupervised home exercise program in improving quality of life only. These results imply that remote therapy could be introduced in clinical practice to improve patient outcomes and resource utilization and eventually be used more broadly.
| Discipline Area | Score |
|---|---|
| Physician |  |
| Rehab Clinician (OT/PT) |  |
Physician rater
Telerehabilitation may become the main method for patients with non-specific low-back pain.
Rehab Clinician (OT/PT) rater
This study has several methodological limitations. First, the sample size calculation was based on a large effect size (i.e., 0.40). However, since this value was not derived from data reported in the literature, it may not be appropriate. Using a smaller effect size would have been more reasonable; therefore, the sample size may not have been sufficient. Second, the statistical method chosen for the analysis appears to be inappropriate. Using a one-way ANOVA is not suitable for studies with three groups and two follow-up time points when comparing between group differences. In this case, a mixed-effects ANOVA—or preferably, mixed-effects models—would have been more appropriate. Furthermore, considering the number of groups and outcome measures, the likelihood of a Type I error increases. For these reasons, the results should be interpreted with caution.
Rehab Clinician (OT/PT) rater
As an orthopedic and sports physio, the results of this well-conducted RCT add substantial support for the positive role of telerehab in treating highly prevalent conditions such as LBP. These results will help inform not only practice, but also advocacy, policy, and population health outcomes.
, McMaster University