Effect of telemedicine-supported structured exercise program in patients with chronic low back pain: a randomized controlled trial

Abstract

Background Structured exercise programs delivered via telemedicine have the potential to benefit patients with chronic low back pain (CLBP). However, evidence-practice gaps exist, such as low exercise adherence and lack of attention to the mental health of CLBP, so further research is needed to investigate the impact of telemedicine-supported structured exercise program on patients with CLBP. Objectives To compare the clinical outcomes of patients with CLBP following a telemedicine intervention versus usual care therapy. Materials and methods An open label, randomized controlled trial (RCT) was conducted over eight weekly sessions. Participants with CLBP were randomly assigned to either the Experimental Group (EG) or the Control Group (CG) in a 1:1 ratio, using a randomized numeric table. The EG received an intervention consisting of patient education, health coaching, and structured exercise program delivered through mobile health (mHealth) apps. The CG received usual care therapy, including patient education and paper handouts describing home exercises. The outcome measures included disability, pain intensity, mental health status, quality of life, walking ability, and exercise adherence. These were evaluated using the Roland Morris Disability Questionnaire (RMDQ), the Numerical Rating Scale (NRS), Depression-Anxiety-Stress Scale (DASS21), 12-item Short Form Health Survey (SF-12), Time Up and Go (TUG), and Exercise Adherence Rating Scale (EARS), respectively. Linear mixed-effects model analysis was conducted at baseline, after 4 weeks (during treatment), and after 8 weeks (post-treatment), adhering to the principles of intention-to-treat (ITT) analysis. Results The study included a total of 78 participants, with 39 randomly assigned to each group. Changes were significantly different between groups at 8 weeks in disability (estimated value: −3.96, 95% CI: −5.45 to −2.47, P < 0.001), pain (estimated value: −1.69, 95% CI: −2.14 to −1.24, P < 0.001) and the physical health dimensions of quality of life (estimated value: 4.5, 95% CI: 1.29 to 7.71, P = 0.006). However, there were only within-group differences at 8 weeks in mental health status (estimated value: −3.81, 95% CI: −4.99 to −2.63, P < 0.001), mental health dimensions of quality of life (estimated value: 5.01, 95% CI: 2.9 to 7.13, P < 0.001), walking ability (estimated value: −0.92, 95% CI: −1.17 to −0.68, P < 0.001), and exercise adherence (Z: 1.91, P = 0.06) over time. Conclusion This study suggests that a telemedicine-based structured exercise program is more effective than usual care therapy in improving disability, pain, and physical health dimensions of quality of life in patients with CLBP. Furthermore, the telemedicine program is equally effective as usual care therapy in enhancing mental health status, mental health dimensions of quality of life, walking ability, and exercise adherence. These findings indicate that implementing such a program could reduce the burden on patients with CLBP. Trial registration This trial was registered at China Clinical Trial Registration Center with the identifier ChiCTR2300071560.