The effects of in-person-supervised, tele-supervised, and unsupervised stabilization exercises on pain, functionality, and kinesiophobia in patients with chronic low back pain: a randomized, single-blind trial

Abstract

Background: The efficacy of various supervision methods for stabilization exercises in patients with chronic low back pain (CLBP) remains uncertain. Objective: To evaluate the impact of supervised and unsupervised stabilization exercises in patients with CLBP. Methods: Sixty-six participants were assigned to the in-person-supervised, tele-supervised, or unsupervised groups. All participants received a 20–30-minute exercise program three times a week for 4 weeks. We assessed functionality (Oswestry Disability Index), pain intensity (Numeric Rating Scale), and kinesiophobia (Tampa Scale of Kinesiophobia) before and after the 4 weeks. The outcomes were analyzed using effect size, minimum clinically important difference (MCID), minimal detectable change (MDC), Wilcoxon test, and post hoc analyses. Results: While the unsupervised group improved in all measures (p <.05) both the tele-supervised (p =.001) and in-person-supervised (p <.001) groups achieved superior functionality exceeding MDC. The in-person-supervised group demonstrated greater functionality (p <.001) than the tele-supervised group, exceeding MCID. Pain intensity decreased in the tele-supervised (p =.011) and in-person-supervised groups (p <.001) compared to the unsupervised group, exceeding MCID and MDC. No significant difference was found in post-treatment NRS score changes between the supervised groups (p =.071). The in-person-supervised group displayed a greater reduction in kinesiophobia than the tele-supervised (p <.001) and unsupervised groups (p <.001) but not exceeding MCID or MDC. Effect sizes were large within and between groups except for a small effect size between the tele-supervised and unsupervised groups in kinesiophobia. Conclusion: While tele-supervised stabilization exercises alleviate pain and enhance functionality, in-person-supervised exercises may be more effective in improving functionality and reducing kinesiophobia in patients with CLBP. © 2024 Elsevier B.V., All rights reserved.