Effectiveness of telehealth-based interventions in the management of non-specific low back pain: a systematic review with meta-analysis

BACKGROUND: Telehealth has emerged as a potential alternative to deliver interventions for low back pain (LBP); however, its effectiveness has not been investigated. PURPOSE: The aim of this review was to evaluate whether interventions delivered by telehealth improve pain, disability, function, and quality of life in non-specific LBP. STUDY DESIGN: This is a systematic review with meta-analysis. METHODS: Seven databases were searched from the earliest records to August 2015. Eligible studies were randomized controlled trials that investigated the effectiveness of telehealth-based interventions, solo or in combination with other interventions, for non-specific LBP compared with a control group. Trials deemed clinically homogeneous were grouped in meta-analyses. RESULTS: Eleven studies were included (n = 2,280). In chronic LBP, telehealth interventions had no significant effect on pain at short-term follow-up (four trials: 1,089 participants, weighted mean difference [WMD]: -2.61 points, 95% confidence interval [CI]: -5.23 to 0.01) or medium-term follow-up (two trials: 441 participants, WMD: -0.94 points, 95% CI: -6.71 to 4.84) compared with a control group. Similarly, there was no significant effect for disability. Results from three individual trials showed that telehealth was superior to a control intervention for improving quality of life. Interventions combining telehealth and usual care were more beneficial than usual care alone in people with recent onset of LBP symptoms. CONCLUSION: There is moderate-quality evidence that current telehealth interventions, alone, are not more effective than minimal interventions for reducing pain and disability in chronic LBP. To date, modern telehealth media (eg, apps) and telehealth as an adjunct to usual care remain understudied. (C) 2017 Elsevier Inc. All rights reserved.