Objective: To compare the effectiveness of supervised physical therapy program versus non-supervised on pain, functionality, fear of movement and quality of life in patients with non-specific chronic low back pain. Design: A randomized double-blind clinical trial. Setting: Clinical outpatient unit; home. Subjects: A total of 64 participants with non-specific chronic low back pain were randomized into either supervised exercise group ( n = 32) or non-supervised home exercise group ( n = 32). Interventions: The supervised group was treated with therapy exercises (strengthen lumbopelvic musculature), while the non-supervised received an informative session of the exercises, which were performed un-supervised at home. Both groups received three weekly sessions for eight weeks. Main Measures: Pain, disability, fear of movement, quality of life, trunk muscle endurance and trunk anteflexion motion were assessed at baseline, two, and six months of follow-up. Results: Although analysis of variance (ANOVA) test showed statistically significant differences between groups for pain ( P = 0.028; supervised: 2.5 ± 2.1; non-supervised: 3.5 ± 1.5) and disability for Roland–Morris Disability Questionnaire ( P = 0.004; supervised: 3.1 ± 2.2; non-supervised: 5.1 ± 3.0) and for Oswestry Disability Index ( P = 0.034; supervised: 14.5 ± 7.1; non-supervised: 19.2 ± 10.0) at 8 weeks immediately posttreatment, there were no differences between the groups in patient-rated pain, functionality, fear of movement and quality of life at six months of follow-up. Conclusion: Patients with chronic low back pain who received supervised exercise showed more improvement in both the short and long term in all patient-rated outcomes over the non-supervised group, but the differences were small and not clinically significant.
Background: Most patients who experience chronic low back pain are managed in primary care services, the international clinical guidelines endorse like first line of treatment the self-management and recommendations for the management of their ailment. The treatment of low back pain an individual self-maintenance program through a web application could mean maintaining of the symptoms, reducing costs in terms of medical care and time work absence. There is little evidence on the reliability of the via Internet-based rehabilitation systems to treat low back pain, the implementation of a clinical and efficient self-maintenance web program is a key priority for the health service in Andalusia.Methods: This protocol describes a double-blind, randomized controlled feasibility trial of a telemedicine program (e-Health intervention) developed to support the self-management of people with chronic low back pain in primary care physiotherapy. Three Hospital with primary care for outpatients will be the units of randomisation, in each Hospital the participants will be randomized to one of two groups, a pragmatic control group receiving either the usual home program based on electrostimulation and McKenzie Therapy and e-Health intervention. Patients are followed up at 2 and 6 months. The primary outcomes are (1) acceptability and demand of the intervention by general practitioners, physiotherapists and patients and (2) feasibility and optimal study design/ methods for a definitive trial. Secondary outcomes will include exploratory analysis and variation in clinical outcomes of pain, disability, fear of movement, quality of life, isometric resistance of the trunk flexors, lumbar mobility in flexion and lumbar segmental range of motion; and the effect of the intervention.Discussion: Through the specific e-Health programs at home, could increase adherence to treatment, patients could learn to control and self-manage the evolution of their low back pain, preventing its evolution to stages of greater pain and disability. If the painful symptomatology improves could be cost-effective healthcare tool that can reach a large number of people living in rural or remote areas.Trial Registration: PC-0185-2017/ NCT04283370. Registered 20 February 2020, https://clinicaltrials.gov/ct2/show/NCT04283370. Recruiting.
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