Lakhasly

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.