TELEREHABILITATION FOR ACUTE, SUBACUTE AND CHRONIC LOW BACK PAIN

J. Fandim¹, L. Almeida², L. Costa¹, C. Maher³, T. Yamato¹, B. Dear⁴, A. Traeger³, S. Kamper⁵, B. Saragiotto¹

¹Universidade Cidade de São Paulo, Masters and Doctoral Program in Physical Therapy, São Paulo, Brazil, ²McMaster University, Ontário, Canada, ³Sydney School of Public Health, University of Sydney, Sydney, Australia, ⁴Macquarie University, Department of Psychology, Sydney, Australia, ⁵Institute for Musculoskeletal Health, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia

Background: Low back pain (LBP) is the leading cause of disability worldwide¹. During the last two years, the COVID-19 pandemic has widely affected the delivery of health care globally. In response to that, telerehabilitation has emerged as an alternative care model for adults with LBP. Telerehabilitation can be broadly defined as the delivery of rehabilitation services over telecommunication technologies such as websites, smartphone apps, videoconferencing systems, and telephone. The number of studies on telerehabilitation for LBP has increased exponentially and, therefore, it is urgent to conduct a Cochrane systematic review to summarize the evidence available on this topic and guide clinical practice.

Purpose: To evaluate the effectiveness of telerehabilitation interventions for individuals with non-specific LBP compared to usual care, minimal interventions (e.g., no treatment, waiting-list, advice), or a similar face-to-face intervention on pain intensity and disability at short-, intermediate-, and long-term follow-ups.

Methods: We searched the major databases up to May 2021. We considered any health intervention delivered remotely through telecommunication networks or the Internet (e.g., telephone, website, videoconference, apps) for adults with acute, subacute, and chronic non-specific low back pain. We included pain intensity and disability as primary outcomes, and as secondary outcomes, we included return to work, self-efficacy, fear-avoidance, psychological-related outcomes, and intervention adherence. Two independent reviewers screened the studies, extracted data, assessed the risk of bias and quality of the evidence (GRADE).

Results: We included 34 studies (40 records) (n= 6,012 participants) and 14 study protocols. The most frequent methodological limitation was the lack of blinding of assessor and allocation concealment. We found low certainty evidence that telerehabilitation exercise interventions seem to be superior to minimal intervention for chronic LBP on pain intensity and disability at intermediate-term follow-up. Additionally, there is very low certainty evidence that telerehabilitation psychological interventions seem not to be superior to minimal interventions for chronic LBP on pain intensity short-term follow-up.

Conclusions: The quality of evidence in this review varied from very low to low. For most comparisons, it is very likely that further studies will have a meaningful impact on our confidence in estimating effects. However, we believe that the small benefit provided by telerehabilitation interventions can be beneficial in the public health context, especially during the COVID-19 pandemic.

Implications: Telerehabilitation interventions have been used as a potential alternative to increase access to healthcare services for adults with LBP. However, although the exponential increase in the number of randomized controlled trials on telerehabilitation interventions for LBP, no other robust systematic review has been recently conducted to evaluate its effectiveness appropriately. Therefore, this systematic review has shown the most updated evidence on this topic to guide researchers, clinicians, and patients in the decision-making process of managing LBP symptoms.

Funding acknowledgements: None

Keywords:
Systematic review
Low back pain
Telerehabilitation

Topics:
Musculoskeletal: spine
Pain & pain management
Research methodology, knowledge translation & implementation science

Did this work require ethics approval? No

Reason: This is a systematic review study which not involve direct or indirect contact with any participant.