Comparison of hybrid guided home-based and outpatient rehabilitation in patients with chronic low back pain: A randomized controlled trial

Background

Chronic low back pain (CLBP) is a leading cause of disability globally, often requiring multidisciplinary management. Hybrid rehabilitation models, combining home-based exercises with telemonitoring and periodic check-ins, may offer improved outcomes and adherence compared to standard outpatient care.

Objective

To evaluate the effectiveness of a hybrid guided home-based rehabilitation (HGHR) compared to standard outpatient rehabilitation (SOR) in patients with CLBP.

Methods

A randomized controlled trial was conducted with 56 participants assigned to a HGHR or a SOR group. Both groups completed an 18-week intervention with seven scheduled physiotherapy sessions. The HGHR group performed structured home-based exercises supported by weekly phone monitoring and in-person check-ins, while the SOR group attended traditional supervised outpatient sessions. Outcomes were assessed at baseline, after the 18-week intervention, and at the end of a 24-week follow-up period (week 42 in total).

Results

At 42 weeks, the HGHR group demonstrated significantly greater improvements in trunk extensor endurance (mean difference: +34.3 s; p = 0.009; Hedges' g = 0.688) and pain reduction (mean difference: 1.67 points; p = 0.001; Hedges’ g = 0.910) compared to the SOR group. No significant between-group differences were found in disability or most SF-36 quality of life domains. Adherence exceeded 89 % in both groups, with no serious adverse events reported.

Conclusions

Hybrid guided home-based rehabilitation is effective in improving trunk endurance and reducing pain in patients with CLBP. These benefits were maintained up to 24 weeks post-intervention. Future research should explore long-term cost-effectiveness and integration of psychological support to further enhance outcomes.