Accepted for/Published in: JMIR Rehabilitation and Assistive Technologies
Date Submitted: Mar 18, 2022
Date Accepted: May 29, 2022
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
A digitally delivered exercise and education treatment program for low back pain: an observational prospective 3-month follow-up
ABSTRACT
Background:
Exercise and education is recommended as first-line treatment by evidence-based, international guidelines for low back pain (LBP). Despite consensus regarding treatment, there is a gap between guidelines and what is offered to patients. Digital LBP treatments are emerging as a new way of delivering first line treatment but research is still at an early stage.
Objective:
To report outcomes after participation in a 3-month digitally delivered treatment program for LBP, and to identify baseline, health-related and treatment-related factors associated with outcomes.
Methods:
We analyzed data from 2593 consecutively recruited participants in a digitally delivered treatment program, available via the national healthcare system in Sweden. The program consists of video-instructed and progressive adaptable exercises, education through text lessons, and a chat/video function connecting patients with a personal physiotherapist. Primary outcome was mean change and proportion reaching a Minimal Clinically Important Change (MCIC) in pain (either 2 points or 30% decrease), assessed with the Numerical Rating Scale (NRS, discreet boxes, 0-10, best to worst). Secondary outcomes were disability, assessed with the Oswestry Disability Index (ODI), and a question on patient acceptable symptom state (PASS).
Results:
Mean participant age was 63 years, 74% were women, 55 % had higher education, 51% were retired and mean BMI was 26.5. Participants completed on average 84% of the daily exercises and lessons, with an adherence of ≥80% in 69% and ≥90% in 50% of the patients. The median reduction in lumbar pain from baseline to 3 months was NRS -2 points and the mean change was -1.7 (95% CI -1.8, -1.6), corresponding to a 35% relative change. MCIC was reached by 58% of participants. Those with ≥90% adherence had a greater mean pain reduction (-1.9, 95% CI -2.0, -1.8). Secondary outcome ODI decreased with 4 points (95% CI -4.5, -3.7), and 36% reached MCIC. Reaching MCIC in pain at 3 months was associated with being of female sex, having higher education, age >65 years and being retired. It was also associated with worse baseline health: high bmi, high baseline pain, radiating pain, pain in other joints, reporting depression/anxiety and with high engagement in the treatment.
Conclusions:
The clinically important reduction in pain for more than 50% of participants after a 3-month digital treatment program for individuals with subacute or chronic LBP may be explained by high adherence related to the digital delivery. Clinical Trial: NCT05226156
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