THE EFFECTIVENESS OF TELEREHABILITATION IN PATIENTS WITH CHRONIC MUSCULOSKELETAL PAIN DURING THE COVID-19 PANDEMIC LOCKDOWN

E. Kapreli¹, G. Τsatsakos², Z.A. Cheimonidou², C. Alamanos², A. Achtipi², A. Konstantopoulou¹, E.-A. Lignou¹, P. Bilika¹

Background: Covid-19 lockdown had a large influence on various socio-economic factors that are crucial for mental, body health and quality of life and they are correlated with pain. In addition, it is known that exercise is an effective treatment to reduce pain and improve function activities of daily living (ADL) in patients with a variety of pain conditions (Ambrose and Golightly, 2015; Geneen, et al., 2017). Therefore, it was hypothesized that a remote exercise program could be a feasible, cost-effective and safe solution for these patients, especially during lockdown.

Purpose: The purpose of the current study was to examine whether telerehabilitation could be effective during the lockdown period. A secondary objective was to estimate the feasibility of a telerehabilitation exercise program in this population.

Methods: Patients that self-isolated at home, >18 years old, with chronic musculoskeletal pain (>3 months) were recruited from different physiotherapy clinics. The intervention program consisted of warm up exercises combined with breathing techniques, low-impact aerobic exercises, free range of motion exercises of upper and lower limbs and spine, balancing exercises and finally, stretching exercises of major muscles of limbs and trunk. It lasted 6 weeks/ 2 sessions per week, for a total of 12 sessions of 30-45 minutes each, under the supervision of a qualified physiotherapist, via zoom. Demographics and a number of different questionnaires in order to estimate the level of anxiety, depression, sleep, quality of life, pain behavior, illness perceptions and functioning were completed by each participant twice (first and last week of lockdown period). Self-reported questionnaires include Hospital Anxiety and Depression Scale (HADS), Brief Illness Perception Questionnaire (BIPQ), Oswestry Disability Index (ODI) and Pittsburgh Sleep Quality Index (PAQI). 

Results: Forty-two patients (14 men, 28 women) with mean age 42.98 (±11.94) years agreed to participate. The mean duration of their pain was 20.81 (±21.23) months. Although there was a decrease in pain intensity, not a statistically significant change was observed (Painbefore=4.52 [±2.05], Painafter=3.61 [±2.49], p=0.172. No significant differences were found in the scores of HADS, BIPQ, ODI and PSQI. There was a high adherence to the program (71.5%). Patients reported increased satisfaction with telerehabilitation (7.68 ±2.25 using a VAS scale) and a feeling of a relief of their pain due to their participation (7.18 ±2.76 using a VAS scale). Qualitative analysis revealed two main barriers in patients’ adherence to the telerehabilitation program:
(1) no direct contact with the physiotherapist and
(2) lack of proper equipment at home.

Conclusion(s): Although the duration of the exercise program was short to provoke any statistically significant changes in the examined parameters, telerehabilitation was proved to be a feasible and accepted method for treating chronic pain patients, especially during lockdown period.

Implications: A telerehabilitation program especially during self-isolation conditions like the Covid-19 lockdown seems to be a feasible and promising method for chronic pain management. However, further research is needed in order to ensure optimal therapeutic results especially in patients with chronic musculoskeletal conditions.

Funding, acknowledgements: unfunded work

Keywords: Covid-19 lockdown, chronic musculoskeletal pain, telerehabilitation

Topic: COVID-19

Did this work require ethics approval? Yes

Institution: Physiotherapy Department; University of Thessaly

Committee: Ethics Committee of the Physiotherapy Department; University of Thessaly

Ethics number: 335/5-5-2020