Comparison of the effectiveness of an e-health program versus a home rehabilitation program in patients with chronic low back pain: A double blind randomized controlled trial

Abstract

Objetive We conducted a randomized double blind clinical trial, to compare the effectiveness of McKenzie exercises and electroanalgesia via an e-Health program versus a home rehabilitation program on functionality, pain, fear of movement and quality of life in patients with non-specific chronic low back pain. Methods Seventy-four participants with non-specific chronic low back pain were randomized to either the e- Health program group (n = 39) or the home rehabilitation program group (n = 35). The interventions consisted of the e-Health program group performing McKenzie exercises and received transcutaneous electrical nerve stimulation, while the home rehabilitation group attended an information session to explain the exercises, which they then performed at home with printed instructions. Both groups performed 3 weekly sessions for 8 weeks. The following were analyzed main measures: pain, disability, fear of movement, quality of life, trunk muscle endurance and trunk anteflexion motion were assessed at baseline and at 2 months. Results Independent samples Student’s t-tests showed that although the patients who followed the e-Health program showed significantly greater improvement than those who followed the home disability rehabilitation program in terms of intensity of pain, lumbar flexion mobility ( P < 0.001), and the following dimensions of quality of life ( P < 0.005), both groups improved significantly in the immediate post-treatment follow up compared with baseline scores. Conclusions Patients with chronic low back pain who followed an unsupervised home intervention supported by an individualized video exercise program showed greater post-treatment improvement than those who followed the same program with printed instructions.

Digital self-care in the management of spine musculoskeletal disorders: A systematic review and meta-analysis

“…The participants were aged 18 years old or more, belonged to the age group from 18 to 65, or were 85 years old with unspecified upper limit. Some considered intermediate ages of 28 to 48 years old ( 15 ) , 30 to 55 ( 16 ) , and 30 to 67 ( 17 ) , and one study included participants aged over 55 years old ( 18 ) . The mean age in the intervention Group was 49.1 (SD: 7.4).…”

“…Regarding the design of the studies, all of them were RCTs, published between 2002 and 2022 with predominance of 2019 with 6 (24%) ( 2 , 6 - 7 , 18 ; 19 - 20 ) and of 2021 with 4 (16%) ( 8 , 21 - 22 ) . Of the 25 studies, 9 (36%) were conducted in the United States of America ( 6 , 21 , 23 ; 24 ; 25 ; 26 ; 27 ; 28 - 29 ) , 5 (20%) in Australia ( 8 , 18 ; 19 ; 20 , 30 ) , 3 (12%) in Germany ( 2 , 14 , 31 ) , 2 (8%) in Spain ( 17 )( 32 ) , and 1 (4%) each in several countries such as India ( 33 ) , Netherlands ( 7 ) , Iran ( 15 ) , Jordan ( 16 ) , Italy ( 34 ) , Denmark and Norway ( 22 ) . The overall total was 5,142 participants, varying from 30 to 779 subjects in each study; 9 (36%) studies had sample sizes smaller than 100 participants ( 2 , 14 ; 15 ; 16 ; 17 ; 18 - 19 , 30 , 33 ) .…”

“…Regarding the digital therapeutic technologies, 9 (36%) used smartphone apps ( 2 , 6 , 15 - 16 , 19 , 22 , 26 , 31 , 33 ) , 9 (36%) resorted to websites and online programs ( 7 - 9 , 17 , 20 , 23 - 24 , 27 - 28 , 32 ) , 2 (8%) employed telephones ( 25 , 30 ) , 1 (4%) chat discussion ( 14 ) , 1 (4%) email ( 29 ) , 1 (4%) virtual reality ( 21 ) , 1 (4%) Telemedicine ( 34 ) , and 1 (4%) video game ( 18 ) . In general, the interventions involved physical exercises ( 2 , 6 - 7 , 15 ; 16 ; 17 ; 18 - 19 , 22 , 27 , 31 ; 32 ; 33 - 34 ) , education ( 2 , 6 ; 7 - 8 , 21 ; 22 - 23 , 26 - 27 , 29 , 32 ) and CBT ( 6 , 20 - 21 , 23 ; 24 ; 25 - 26 , 30 ) . The physical exercises were provided in the form of videos, audios or image-based instructions and could include performance feedback or not.…”

Effectiveness of eHealth therapeutic education interventions in the management of fibromyalgia: protocol for a systematic review and meta-analysis

“… 26 Recently published studies have demonstrated the efficacy of eHealth interventions in managing pain and improving functional status in other chronic pain conditions, such as chronic low back pain. 27 28 Furthermore, a digital-based cognitive–behavioural intervention for insomnia has shown promising results to improve depressive and anxiety symptoms in patients with insomnia. 29 …”

“…In addition, eHealth therapeutic education sessions may be held synchronously where both the patient and healthcare provider engage in real-time interaction and asynchronously as a tool for the subject’s self-management 26. Recently published studies have demonstrated the efficacy of eHealth interventions in managing pain and improving functional status in other chronic pain conditions, such as chronic low back pain 27 28. Furthermore, a digital-based cognitive–behavioural intervention for insomnia has shown promising results to improve depressive and anxiety symptoms in patients with insomnia 29…”