Comparative effectiveness of clinic-based and telerehabilitation application of mckenzie therapy among patients with chronic non specific low-back pain
This study evaluated the effect of Telerehabilitation-Based McKenzie Therapy (TBMT) on Pain Intensity (PI), Back Extensors Muscles’ Endurance (BEME), Activity Limitation (AL), Participation Restriction (PR), General Health Status (GHS) and Cost-Utility (CU) in patients with Chronic Non-Specific Low-Back Pain (CNSLBP).Also, the study evaluated the effect of Clinic-Based McKenzie Therapy (CBMT) on PI, BEME, AL, PR, GHSand CU in patients with CNSLBP.In addition, the study compared the effects of TBMT and CBMTon PI, BEME, AL, PR, GHSand CU at 4th and 8th week of the study with a view to providing a validated telerehabilitation platform for management of CNSLBPand to increase cost-effectiveness. This study was a randomized-controlled trial involving 70 patients with CNSLBP. The patients were randomly assigned into either CBMT or TBMT group using block permuted randomization. Participants in both groups received standard McKenzie extension protocol.The protocol involves a course of specific lumbosacral repeated movements in extension that cause the symptoms to centralize, decrease or abolish. TBMT is the mobile-phone application platform of the CBMT. Treatment was applied thrice weekly for eight weeks. Outcomes’ data assessed at the end of 4th and 8th week were used for analysis. Data were analyzed using Independent t-test, Mann Whitney U-test, repeated measure ANOVA, Friedman’s ANOVA, Kruskal-Wallis tests and multiple comparisons post-hoc tests. Alpha level was set at p< 0.05. Participants’ mean age and pain duration was 48.8±11.1 years and 8.96±3.04 months respectively. Within-group comparison across baseline, 4th and 8th week indicate that TBMT had significant effects on PI (4.95±0.92;3.00±0.71vs;0.76±0.94 F=317.377,p=0.001), BEME (25.8±15.2;35.5±15.0; 40.1±13.6 F=97.815, p=0.001), AL (10.2±4.66; 5.38±3.14; 2.29±2.47 F=78.362, p=0.001), PR (23.9 vs.21.4vs. 22.8; p=0.001) and the eight items of GHS (p=0.001). CBMT had significant effect on PI (5.31±1.44; 3.46±1.07; 1.77±0.91 F=139.21, 0.001), BEME (20.4±12.8;29.1±12.8;35.4±11.4 F=101.397 p=0.001), AL (11.8±4.78; 6.38±3.02; 2.50±1.72 F=125.265, p=0.001), PR (24.1 vs. 26.1 vs. 25.0; p=0.001) and the eight items of GHS (p=0.001). However, there were no significant differences (p>0.05)in the treatment effects (mean change) between TBMT and CBMT, except for item ‘energy fatigue’ of the GHS where the TBMT group had significantly higher mean rank than the CBMT (26.7 vs. 21.9; (p=0.010). Estimated treatment cost per patientwas N22, 200.00and N38, 200.00for TBMT and CBMT respectively (cost estimate ratio was 0.58:1). The cost utility values for TBMT per Quality Adjusted Life Years (QALYs) was N75,482.30 for ongoing cost only with a range of N67,934.10 and N83,030.50 for 10% increase and decrease in the QALYs. In conclusion,McKenzie Therapy (MT) conducted via a telerehabilitation platform has comparable outcomes with clinic-based MT. Therefore, telerehabilitation application of MT is effective in management of chronic non-specific low-back pain and has lower cost estimate compared to clinic-based McKenzie therapy(CBMT).