Comparative Efficacy of Tele-Physiotherapy vs In-Person Sessions for Low Back Pain

Thesis Abstract

Tele-physiotherapy has emerged as a viable alternative to conventional in-person care for chronic musculoskeletal conditions, yet its relative efficacy for low back pain (LBP) across diverse patient populations remains inadequately defined. This study addresses the problem of whether remote delivery of structured physiotherapy interventions yields comparable clinical outcomes to traditional face-to-face sessions in adult LBP patients and how patient characteristics influence effectiveness. The aim is to compare the efficacy of tele-physiotherapy versus in-person sessions in reducing pain intensity and improving function among adults with non-specific LBP, and to identify moderators such as age, sex, baseline pain, and psychosocial factors that affect treatment response. Specific objectives are (1) to evaluate changes in pain intensity using the Visual Analog Scale (0–100 mm) over 12 weeks; (2) to assess functional disability via the Oswestry Disability Index (ODI, 0–100) and Roland-Morris Disability Questionnaire (RMDQ, 0–24); (3) to compare global improvement and patient satisfaction between groups; (4) to examine adherence to prescribed exercise programs and achievement of exercise progression milestones; (5) to explore the moderating effects of psychological factors (fear-avoidance beliefs, self-efficacy) on outcomes. A parallel-group randomized controlled trial design will be employed, enrolling 240 adults aged 18–65 with non-specific acute-to-subacute LBP from primary care clinics. Participants will be randomly assigned to either tele-physiotherapy or in-person physiotherapy, stratified by baseline pain severity and duration. Intervention consists of 12 weekly sessions (60 minutes each) plus home exercise programs tailored to individual goals, delivered either through a secure video platform or in-person clinic visits, both following a standardized, evidence-based multimodal protocol emphasizing education, graded activity, sensorimotor exercises, and self-management strategies. Data collection will occur at baseline, week 6, week 12 (end of treatment), and 24-week follow-up. Primary data will comprise pain intensity (VAS 0–100) and functional disability (ODI; RMDQ). Secondary data will include global impression of change, patient satisfaction, adherence metrics, and psychosocial measures (e.g., Pain Catastrophizing Scale, Tampa Scale for Kinesiophobia, Pain Self-Efficacy Questionnaire). Instrument validity and reliability are established in prior LBP research, with telehealth-specific feasibility piloted prior to full deployment. Quantitative analyses will use intention-to-treat principles. Repeated-measures ANOVA and mixed-effects models will compare trajectories of pain and disability between groups, adjusting for baseline covariates. Regression analyses will identify predictors and moderators of treatment response, including interaction terms for treatment modality with demographic and psychosocial factors. Non-inferiority margins will be predefined to determine whether tele-physiotherapy is at least as effective as in-person care. Sensitivity analyses will address missing data via multiple imputation. Qualitative data from a subset of participants (n?40) in each arm, collected through semi-structured interviews, will be analyzed thematically to elucidate perceived barriers, facilitators, and satisfaction with the telehealth modality, with triangulation to enhance interpretive validity. A quasi-experimental subgroup analysis will examine adherence-driven differences in outcomes across modalities. Expected findings anticipate non-inferiority of tele-physiotherapy to in-person sessions for primary outcomes, with small to moderate differences in favor of in-person care for adherence and perceived rapport among specific subgroups, but comparable long-term maintenance at 24 weeks. It is anticipated that higher baseline self-efficacy and lower fear-avoidance will predict greater improvement in both arms, with tele-physiotherapy showing particular advantages for individuals with transportation constraints or work-related barriers. The study contributes to knowledge by clarifying the clinical equivalence of tele-delivered versus conventional physiotherapy for LBP, identifying patient-level moderators of response, and informing cost-effective care pathways and policy development for remote rehabilitation. Conclusions are that tele-physiotherapy is a viable alternative to in-person care for LBP under optimal patient selection and structured protocols, with recommendations to healthcare systems to support secure platforms, clinician training in remote communication, and ongoing monitoring of adherence and satisfaction to maximize outcomes.