Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Jul 15, 2020
Date Accepted: Jan 31, 2021
In-clinic versus online multidisciplinary exercise-based rehabilitation for treatment of low back pain: a prospective clinical trial in an integrated practice unit model
ABSTRACT
Background:
The onset of the recent COVID-19 pandemic has highlighted a need to reduce barriers to access for physical therapy and associated care through the use of online programs and telehealth for those seeking treatment for low back pain (LBP). Despite this need, few studies have compared effectiveness of clinic-based versus online or telehealth services.
Objective:
The purpose of this study was to compare clinical outcomes of clinic-based multidisciplinary therapy in an integrated practice unit model (C-IPU) to online integrated multidisciplinary therapy (O-IPU) in individuals undergoing conservative care for LBP.
Methods:
A total of 1,090 participants were prospectively recruited into a clinical trial registry (NCT04081896) through the SpineZone rehabilitation integrated practice unit program. All participants provided informed consent. Participants were allocated to the C-IPU(N=988) or O-IPU(N=102) groups based on personal preference. The C-IPU program consisted of a high-intensity machine-based core muscle resistance training program, whereas the O-IPU program consisted of therapist directed home core strengthening exercises through an online platform. Changes in LBP symptom severity (Numeric Pain Rating Scale), disability (Oswestry Disability Index), goal achievement (Patient Specific Functional Scale), and frequency of opioid use were compared between C-IPU and O-IPU groups using multivariate linear regression modeling adjusting for age, gender, treatment number, program duration, and baseline pain and disability.
Results:
Over 93% of participants completed their recommended program with no group differences in drop-outs (P =.78). The C-IPU group showed greater pain relief (P < .001) and reductions in disability (P=0.002) as compared to the O-IPU group, whereas the O-IPU group reported larger improvements in goal achievement (P< .001). Both programs resulted in reduced opioid use frequency, with 19 and 22% of participants reporting cessation of opioid use for C-IPU and O-IPU programs respectively, leaving only 5.6% of participants reporting opioid use at the end of their treatment.
Conclusions:
Both in-clinic and online multidisciplinary programs are beneficial in reducing pain, disability, opioid use and improving goal achievement. Differences between these self-selected groups shed light on patient characteristics, which require further investigation and could help clinicians optimize these programs. Clinical Trial: Nct04081896
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