Low back pain (LBP) is a major health problem1, considered the
 leading cause of years lived with disability1 and of absenteeism.
 Although the impact on productivity varies in the literature2, one
 systematic review estimated the direct medical costs as $300
 billion in the United States (U.S.) alone3. Unsatisfactory LBP
 management may lead to overutilization of imaging4, surgeries5,6,
 and medication, including opioids7,8.
 Current guidelines for chronic LBP (CLBP) management
 recommend physiotherapy as a first-line intervention, alongside
 education and behavioral interventions9,10. Moderate-certainty
 evidence from randomized controlled trials (RCTs) supports the
 effectiveness of exercise-based physiotherapy in reducing pain
 and disability in LBP treatment11, and these interventions have
 often yielded better outcomes for disability and return to work
 than surgical interventions2,12.
 However, access to in-person physiotherapy faces several
 barriers: a scarcity of healthcare resources (including therapists
 and facilities), time-, travel-, and costs-constraints (work time off,
 childcare costs), insufficient health literacy, and, more recently, the
 perceived risk of contracting infections13. All these also affect
 engagement, resulting in high percentages of unattended or
 incomplete treatments14.
 Digital interventions have great potential in overcoming such
 challenges, being more accessible and affordable than in-person
 physiotherapy15,16, and increasing patient adherence and empow
erment17. Within LBP management, research has focused on the
 effectiveness and safety of digital interventions, both as adjuncts
 to in-person care18,19 and as stand-alone through video
 conference-based19 or asynchronous telerehabilitation20,21. The
 latter has the potential to scale care delivery, addressing the
 growing prevalence of CLBP1. However, the few trials comparing
 exercise-based asynchronous interventions with standard in
person physiotherapy considered cohorts with diverse acuity
 levels20,21 or were non-randomized studies20, compromising the
 certainty of evidence on the subject. Thus, further research is
 needed on the effectiveness of these solutions as an alternative to
 in-person physiotherapy for CLBP.
 Previously, we demonstrated the effectiveness of tailored digital
 care programs (DCP) integrating exercise, education, and cogni
tive behavioral therapy (CBT) in several musculoskeletal condi
tions22,23, including acute and chronic LBP24,25. The present RCT
 aims to compare the clinical outcomes of patients with CLBP
 following a DCP versus conventional in-person physiotherapy. We
 hypothesize that outcomes are comparable to those obtained
 with conventional physiotherapy.