Effects of Synchronous Versus Asynchronous Telerehabilitation Programs for Chronic Nonspecific Low Back Pain: A Three-Arm Randomized Controlled Trial.

OBJECTIVE

To assess the effectiveness of synchronous and asynchronous telerehabilitation programs in managing chronic nonspecific low back pain (CNLBP).

DESIGN

A three-arm parallel group randomized trial

SETTING

University Hospital, Department of Orthopedics and Traumatology

PARTICIPANTS

This randomized controlled trial was carried out on individuals (N=72) (31 women, 41 men; mean age, 41.26±10.97y) with CNLBP.

INTERVENTIONS: Participants were randomly assigned to 3 groups: (1) a synchronous telerehabilitation group (STG) (n=24), (2) an asynchronous telerehabilitation group (ASTG) (n=24), and (3) a control group (CG) (n=24). A structured exercise program was delivered in real-time to the STG via prerecorded videos to the ASTG and through a digital book to the CG (12wk).

MAIN OUTCOME MEASURES: Pain levels as the prespecified primary outcome were measured using the visual analog scale. Disability was assessed with the Roland Morris Disability Questionnaire and Oswestry Disability Index. Fear of movement was evaluated with the Tampa Scale, and quality of life was determined using the SF-12.

RESULTS

Pain levels, disability status, fear of movement, and quality of life showed improvement at week 12 in all groups (P<0.05). In addition, the STG showed greater improvements than the CG in the visual analog scale (mean difference, 1.28; 95% CI, 0.50-2.05). Moreover, the ASTG obtained more significant results than the CG group only in the subparameters of SF-12 (physical component summary and mental component summary).

CONCLUSIONS

A real-time synchronous telerehabilitation program was superior in improving pain, disability, fear of movement, and quality of life, whereas the asynchronous group was superior compared with an unsupervised home exercise program in improving quality of life only. These results imply that remote therapy could be introduced in clinical practice to improve patient outcomes and resource utilization and eventually be used more broadly.