Effectiveness of telerehabilitation in managing chronic low back pain: a pragmatic randomized controlled non-inferiority trial.

BACKGROUND

For patients with chronic low back pain (CLBP), telerehabilitation (TR) has been suggested as an alternative to conventional rehabilitation. However, evidence from pragmatic trials comparing TR with routine clinical rehabilitation is still limited.

OBJECTIVES

To investigate whether TR is non-inferior to conventional in-person rehabilitation for pain intensity in individuals with CLBP. Secondary objectives included disability, pain catastrophizing, quality of life, and kinesiophobia.

METHODS

A pragmatic non-inferiority randomized controlled trial was conducted with 50 adults with CLBP who were randomly assigned to TR or in-person rehabilitation. The TR program included individualized exercise, education, and self-management delivered remotely, while the control group received usual clinic-based care. The primary outcome was pain intensity assessed using the Numeric Rating Scale (NRS), with disability and other patient-reported outcomes assessed as secondary measures. Between-group comparisons were performed using analysis of covariance, with adjustments made for baseline values, and non-inferiority was evaluated using a pre-specified margin.

RESULTS

Both groups showed comparable improvements across outcomes, with no meaningful between-group differences. Non-inferiority was not demonstrated for pain intensity within the pre-specified margin. However, TR demonstrated non-inferiority to conventional rehabilitation for disability measured by the Oswestry Disability Index (adjusted mean difference -0.82 points; 95% CI -5.13 to 3.49). For other outcomes, no clear between-group differences were observed.

CONCLUSIONS

These findings indicate that telerehabilitation can be considered a clinically acceptable alternative option to in-person rehabilitation for individuals with CLBP, particularly when the primary goal is functional improvement. Careful patient selection may be required when pain reduction is the main treatment objective.