JMIR Publications

ABSTRACT

Background:

Patient education, advice on returning to normal activities and (home-based) exercise therapy are established physiotherapeutic treatment options for patients with non-specific low back pain (LBP). However, the effectiveness of physiotherapy interventions on health-related outcomes largely depends on patient self-management and adherence to exercise and physical activity recommendations. E-Exercise LBP is a recently developed blended care intervention, consisting of face-to-face physiotherapy treatment in which eCoaching is integrated using a smartphone application. Following the promising effects of online applications on patients’ self-management skills and adherence to exercise and physical activity recommendations, it is hypothesized that e-Exercise LBP will improve patients’ physical functioning.

Objective:

To investigate the short-term (3 months) effectiveness of e-Exercise LBP on physical functioning in comparison to face-to-face physiotherapy in patients with non-specific LBP.

Methods:

The design was a multicentre cluster randomized controlled trial with intention-to-treat analysis. Patients with non-specific LBP aged 18 years and older were asked to participate in the study. The patients were treated with either e-Exercise LBP or face-to-face physiotherapy. E-Exercise LBP was stratified according to the risk for developing persistent LBP. Face-to-face physiotherapy was conducted according to the Dutch physiotherapy guideline for non-specific LBP. The primary outcome was physical functioning (Oswestry Disability Index, range 0-100). Secondary outcomes included pain intensity, fear avoidance beliefs, and self-reported adherence. Measures were taken at baseline and 3-months follow-up.

Results:

Both the e-Exercise LBP group (n=104) and the face-to-face physiotherapy group (n=104) improved clinically relevant and statistically significant in physical functioning, but there was no statistically significant or clinically relevant between group difference (Mean Difference -1.96; 95%CI -4.47 to 0.55). For the secondary outcomes, e-Exercise LBP showed statistically significant between group differences on fear avoidance beliefs and self-reported adherence. In patients with a high risk of developing persistent LBP (n=13), e-Exercise LBP showed statistically significant between group differences on physical functioning (Mean Difference -16.39; 95%CI -27.98 to -4.79) and several secondary outcomes.

Conclusions:

e-Exercise LBP is not more effective than face-to-face physiotherapy in patients with non-specific LBP to improve physical functioning on the short-term. Within-group improvements for both e-Exercise LBP and face-to-face physiotherapy are comparable. However, e-Exercise LBP seems to be the preferential treatment strategy in patients with a high risk of developing persistent LBP. Clinical Trial: ISRCTN 94074203; https://doi.org/10.1186/ISRCTN94074203