Is Online Exercise at Home More Effective Than Hydrotherapy and Physiotherapy in Patients With Non-specific Chronic Low Back Pain? A Randomized Clinical Trial

Abstract

Purpose: Many non-pharmaceutical methods have been proposed for the treatment of non-specific chronic low back pain (NCLBP), including Online Exercise at Home (OEH), Hydrotherapy, and Physiotherapy approaches that have shown significant effects. Nevertheless, there are ambiguities in choosing the best option. Therefore, the present study was designed to compare these methods. Methods: This randomized clinical trial included 60 patients with NCLBP (25-45 yrs). After selection, they were randomly divided into three groups (20 patients in each) of OEH (including core stability exercises and education), Hydrotherapy, and Physiotherapy (including hot pack, ultrasound, and TENS), then received interventions for 12 weeks. Visual Analog Scale (VAS) was used to evaluate pain before and after treatment. ANOCOVA and paired t-test were used to analyze the data and a significant level of P <0.05. Results: The results showed that all three treatments used in this study had a significant effect (p <0.05) on reducing the pain intensity for the patients after the intervention. There was no significant difference between the three treatments in reducing pain; however, OEH method could reduce the pain to a greater extent (32.79%). Conclusion: Although the present study reaffirms the effectiveness of all three-treatment approaches, no significant differences were found in the selection of the best option. However, depending on the patient's condition, one of these methods can be selected. Therefore, we introduce hydrotherapy, and Physiotherapy methods for the elderly, severe pain and disability, and OEH as an available method to save money, time and, most importantly, prevent Covid-19 disease.

Isometric vs Isotonic Core Stabilization Exercises to Improve Pain and Disability in Patients with Non-specific Chronic Low Back Pain: A Randomized Controlled Trial

“…Additionally, participants needed to be between the ages of 20 and 60 and have a body mass index or BMI of 30 or less. Patients who had undergone any other treatments, such as acupuncture or physical therapy, in the last 3 months were not eligible for the study ( 5 ).…”

“…Each experimental group of patients underwent an 8-week therapeutic exercise program, with 3 sessions per week. Each session lasted between 40 and 60 minutes, including a warm-up period of 5 - 7 minutes, the main exercise period of 40 - 50 minutes, and a cool-down period of 3 - 5 minutes ( 5 ). The control group did not receive any intervention except for education.…”

“…However, 90% of these patients are diagnosed without specific symptoms, known as non-specific chronic low back pain (NSCLBP), where the cause of the disease cannot be identified clinically ( 4 ). Non-specific chronic low back pain (NSCLBP) persists for at least three months, and its occurrence area is beneath the costal margin and above the inferior gluteal folds without leg pain ( 5 ).…”

“…The most crucial non-surgical methods for treating patients with NSCLBP include pharmacotherapy (NSAID, muscle relaxants, opioids, glucocorticoids, etc.) ( 6 ), physical therapy (TENS, ultrasound, and hot packs), and exercise therapy ( 5 ). However, pharmacotherapy may lead to side effects such as constipation, nausea, and fatigue, and prolonged use of these drugs may result in a resurgence of pain upon discontinuation ( 7 ).…”

“…On the other hand, physiotherapy without the incorporation of therapeutic exercise is not suitable for alleviating long-term pain and enhancing performance because it is relatively expensive and lacks active muscle contraction ( 8 ). Therefore, exercise therapy emerges as a more effective and affordable option for therapists and specialists in treating patients with NSCLBP, given its minimal harm and ease of implementation ( 5 ).…”