Spinezone Medical Fitness, San Diego, CA, United States.
Department of Orthopaedic Surgery, University of California San Diego, San Diego, CA, United States.
J Med Internet Res. 2021 Mar 18;23(3):e22548. doi: 10.2196/22548.
The recent onset of the COVID-19 pandemic has highlighted the need to reduce barriers to access physical therapy and associated care through the use of web-based programs and telehealth for those seeking treatment for low back pain (LBP). Despite this need, few studies have compared the effectiveness of clinic-based versus web-based or telehealth services.
This study aims to compare the clinical outcomes of clinic-based multidisciplinary therapy in an integrated practice unit (C-IPU) model with online integrated multidisciplinary therapy (O-IPU) in individuals undergoing conservative care for LBP.
A total of 1090 participants were prospectively recruited to participate in a clinical trial registry (NCT04081896) through the SpineZone rehabilitation IPU program. All participants provided informed consent. Participants were allocated to the C-IPU (N=988) or O-IPU (N=102) groups based on their personal preferences. The C-IPU program consisted of a high-intensity machine-based core muscle resistance training program, whereas the O-IPU program consisted of therapist-directed home core strengthening exercises through a web-based platform. Changes in LBP symptom severity (Numeric Pain Rating Scale), disability (Oswestry Disability Index), goal achievement (Patient-Specific Functional Scale), and frequency of opioid use were compared between the C-IPU and O-IPU groups using multivariate linear regression modeling adjusted for age, gender, treatment number, program duration, and baseline pain and disability.
Approximately 93.03% (1014/1090) of the participants completed their recommended programs, with no group differences in dropout rates (P=.78). The C-IPU group showed greater pain relief (P<.001) and reductions in disability (P=.002) than the O-IPU group, whereas the O-IPU group reported greater improvements in goal achievement (P<.001). Both programs resulted in reduced opioid use frequency, with 19.0% (188/988) and 21.5% (22/102) of participants reporting cessation of opioid use for C-IPU and O-IPU programs, respectively, leaving only 5.59% (61/1090) of participants reporting opioid use at the end of their treatment.
Both in-clinic and web-based multidisciplinary programs are beneficial in reducing pain, disability, and opioid use and in improving goal achievement. The differences between these self-selected groups shed light on patient characteristics, which require further investigation and could help clinicians optimize these programs.
ClinicalTrials.gov NCT04081896; https://clinicaltrials.gov/ct2/show/NCT04081896.
新冠疫情的爆发凸显了通过使用基于网络的程序和远程医疗为寻求低腰痛（LBP）治疗的患者提供物理治疗和相关护理的机会，以减少获取障碍。尽管有这种需求，但很少有研究比较基于诊所的与基于网络或远程医疗服务的有效性。
本研究旨在比较综合实践单元（C-IPU）模型中基于诊所的多学科治疗与在线综合多学科治疗（O-IPU）在接受保守治疗的 LBP 患者中的临床结果。
通过 SpineZone 康复 IPU 计划，共有 1090 名参与者前瞻性地被招募参加临床试验注册（NCT04081896）。所有参与者均提供了知情同意。参与者根据个人喜好被分配到 C-IPU（N=988）或 O-IPU（N=102）组。C-IPU 计划包括高强度基于机器的核心肌肉阻力训练计划，而 O-IPU 计划则通过基于网络的平台提供治疗师指导的家庭核心强化锻炼。使用多元线性回归模型，根据年龄、性别、治疗次数、计划持续时间以及基线疼痛和残疾情况，对 C-IPU 和 O-IPU 组之间的 LBP 症状严重程度（数字疼痛评分量表）、残疾（Oswestry 残疾指数）、目标实现（患者特定功能量表）和阿片类药物使用频率的变化进行比较。
约 93.03%（1014/1090）的参与者完成了他们推荐的计划，两组的辍学率没有差异（P=.78）。C-IPU 组在疼痛缓解方面表现出更大的改善（P<.001）和残疾程度的降低（P=.002），而 O-IPU 组在目标实现方面的改善更大（P<.001）。两个计划都导致阿片类药物使用频率降低，C-IPU 和 O-IPU 计划分别有 19.0%（188/988）和 21.5%（22/102）的参与者报告停止使用阿片类药物，只有 5.59%（61/1090）的参与者在治疗结束时报告使用阿片类药物。
基于诊所和基于网络的多学科计划都有利于减轻疼痛、残疾和阿片类药物的使用，并改善目标的实现。这些自我选择的组之间的差异揭示了患者特征，这需要进一步研究，并可能有助于临床医生优化这些计划。
ClinicalTrials.gov NCT04081896；https://clinicaltrials.gov/ct2/show/NCT04081896。
