The physical and psychological effectiveness of mHealth-based physiotherapy for patients with chronic non-specific low back pain: A systematic review and meta-analysis.

BackgroundTo determine (a) the effect of mHealth-based physiotherapy for patients with chronic non-specific low back pain (CNLBP) on fear, anxiety, depression, and self-efficacy; (b) which is the most effective on improving individuals' pain intensity and physical disability through the comparison of the efficacy of mHealth-based physiotherapy with outpatient-based physiotherapy, home-based physiotherapy with simple supervision or unsupervision, and waiting-list group.MethodsThe systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted in PubMed, MEDLINE (via Ovid), Scopus, Embase, the Physiotherapy Evidence Database (PEDro), Web of Science, and the Cochrane Central Register of Controlled Trials (CENTRAL) until September 20, 2024. Two independent reviewers (LQ and CZW) extracted information about origin, characteristics of study participants, eligibility criteria, characteristics of interventions, outcome measures and main results.ResultsA total of 37 RCTs involving 5832 participants were included. The risk of bias was generally low in the included studies. The results indicated that mHealth-based physiotherapy for individuals' CNLBP was more effective in reducing pain intensity (standardized mean difference [SMD] -0.32, 95% CI -0.48 to -0.17; P < 0.001), improving physical disability (SMD -0.30, 95% CI -0.42 to -0.18; P < 0.001), and decreasing fear-avoidance (SMD -0.28, 95% CI -0.47 to -0.09; P = 0.004). However, the mHealth-based physiotherapy was less effective on decreasing anxiety (SMD 0.29, 95% CI 0.06-0.52; P = 0.01) and remained unclear in decreasing depression (SMD 0.13, 95% CI -0.05 to 0.31; P = 0.16) and improving self-efficacy (SMD 0.14, 95% CI -0.06 to 0.34; P = 0.18). In subgroup analyses of pain intensity and physical disability, mHealth-based physiotherapy for individual with CNLBP was more effective than outpatient-based physiotherapy, home-based physiotherapy with simple supervision or unsupervision and waiting-list groups.ConclusionOur meta-analysis suggested that mHealth-based physiotherapy holds significant potential for reducing pain intensity and fear-avoidance, and improving physical disability in individuals with CNLBP compared to traditional physiotherapy model. However, its effect was less on reducing anxiety and depression, and improving self-efficacy.