JMIR Publications

ABSTRACT

Background:

Chronic nonspecific low back pain (CNSLBP) is a leading cause of disability worldwide. Telerehabilitation (TR) has emerged as a promising strategy to overcome access barriers to conventional face-to-face (FTF) rehabilitation; however, evidence regarding its comparative long-term efficacy and implementation-level outcomes—including system usability, exercise maintenance, and patient enablement—remains limited and methodologically heterogeneous.

Objective:

To compare the short-term clinical outcomes and 3-month maintenance of synchronous TR versus FTF rehabilitation in adults with CNSLBP, and to evaluate system usability, exercise adherence, and patient enablement.

Methods:

We conducted an assessor-blinded, single-center, parallel-group exploratory randomized controlled trial. Thirty-two adults with CNSLBP were randomly allocated (1:1) to an 8-week structured program of progressive exercise and health education delivered via synchronous videoconferencing (TR) or in-clinic (FTF). Primary outcomes were pain intensity (Visual Analog Scale [VAS]) and lumbar disability (Oswestry Disability Index [ODI]). Secondary outcomes included psychological distress (Depression, Anxiety, and Stress Scale-21 [DASS-21]), patient enablement (Patient Enablement Instrument [PEI]), system usability (System Usability Scale [SUS]), and satisfaction. Exercise maintenance and pain recurrence were assessed at 3-month follow-up. Linear mixed models with restricted maximum likelihood were used for repeated-measures analyses under the intention-to-treat principle.

Results:

At 8 weeks, no significant between-group differences were observed (VAS: between-group difference −0.16, 95% CI −0.93 to 0.60, P=.669; ODI: −2.09, 95% CI −5.65 to 1.47, P=.248; DASS-21: −0.10, 95% CI −2.47 to 2.27, P=.933). At 3-month follow-up, the TR group demonstrated significantly better outcomes than the FTF group (VAS: 2.89, 95% CI 2.12–3.66, P<.001; ODI: 3.75, 95% CI 0.21–7.29, P=.038; DASS-21: 6.79, 95% CI 4.42–9.16, P<.001). Exercise maintenance was higher in the TR group 78.6, and pain recurrence was lower (28.6% vs 53.3%). Among TR completers, session attendance was 100%, mean SUS score was 70.54, and 85.7% (12/14) reported high satisfaction. No adverse events were reported.

Conclusions:

Synchronous TR produced comparable short-term clinical outcomes to FTF rehabilitation while demonstrating superior long-term exercise maintenance, lower pain recurrence, and acceptable system usability at 3-month follow-up. Integrating supervised rehabilitation into the home environment may facilitate sustained self-management in CNSLBP. Clinical Trial: Chinese Clinical Trial Registry (ChiCTR2400089449; retrospectively registered on September 9, 2024)