Effectiveness of an internet-based self-management program based on exercise and pain education for chronic spinal pain: a subanalysis of the REABILITADOR trial

Introduction: Internet-based self-management programs and telerehabilitation initiatives have grown with thedevelopment of new technologies and have been extensively used for delivering healthcare in many areas . These programs overcome common barriers that patients face with traditional face-to-face healthcare, such as travel, lack oftime, and high demand of the public health system
. In the past years, during the emergence of the COVID-19 pandemicthis mode of delivery has become even more popular. However, there is still a lack of studies testing this mode of delivery,especially in low- and middle-income countries.
Objective: To test the effectiveness of an internet-based self-management program based on pain education and exercisefor people with chronic spinal pain compared to an online booklet.
Methods: This is a subset of patients with chronic spinal pain from a prospectively registered randomized controlled trial. We included patients aged 18-60 years, with chronic spinal pain (back, neck, or thoracic pain), and internet access. The baseline assessment was performed via videoconference and follow-up by telephone or online questionnaire. Patients received a login/password to the study website and were automatically randomized at first access to the intervention orcontrol group. The intervention included asynchronous videos and animations based on pain education, physical activitypromotion and exercises videos. They also received weekly text messages and health coaching. Patients allocated to thecontrol group received an online booklet. Pain (NRS 0-10) and Function (PSFS 0-30) were assessed after treatment (8 weeks). We used ITT for all analyses.
Results: A total of 122 patients with chronic non-specific LBP (91 women and 31 men) were randomised to either internet-based self-management program based on exercise and pain education (n = 62) or online booklet (n = 59). The follow-up pain score was 4.3 points (SD 2.6) for the intervention group and 5.4 points (SD 2.2) for the control group (Mean difference of -1.10, 95% CI -1.96 to -0.24).The follow-up function score was 15.3 (SD 9.2) for the intervention group and 16.6 (SD 7.8) for the control group (Mean difference of -1.30, 95% CI -4.33 to 1.73). Patients did not report any adverse events.
Conclusion: The internet-based self-management program was superior to online booklet for reducing pain intensity;however, the uncertainty of the effect may not include meaningful differences.