The effectiveness of home-based exercise programs for low back pain patients

Short-term effects of exergaming on patients with chronic low back pain: A single-blind randomized controlled trial

BACKGROUND

Exergaming is increasingly popular, but its impact on chronic low back pain (CLBP) remain unclear.

OBJECTIVES

To evaluate the effectiveness of exergaming versus traditional exercise for managing CLBP using the International Classification of Functioning, Disability and Health (ICF) framework.

METHODS

This single-blind, randomized controlled trial included 70 participants with CLBP, who were assigned to either the exergaming or traditional exercise group. Both groups received 2 weeks of treatment with six sessions. Assessments included the Oswestry Disability Index (ODI), range of motion, Hospital Anxiety and Depression Scale (HADS), balance (Biodex Stability System), Fear-Avoidance Beliefs Questionnaire (FABQ), and physical performance tests.

RESULTS

After six sessions over 2 weeks, the exergaming group showed significant improvements over the exercise group in ODI (p < 0.001), chair-rising time (p = 0.001), stair ascent (p = 0.025) and descent times (p < 0.001), flexion (p = 0.005), extension (p = 0.001), balance (p = 0.012), and FABQ subscales (physical activity: p = 0.003; work: p < 0.001) at the 3-month follow-up. Group × time interaction effects favored exergaming for ODI (p = 0.012), chair-rising (p = 0.045), stair ascent (p = 0.010), and descent (p = 0.002) times. While these changes did not meet clinical significance, exergaming was not inferior to traditional exercise in improving spinal motion, physical performance, fear-avoidance beliefs, and disability.

CONCLUSION

Exergaming appears to be a viable supplementary therapy for patients with CLBP, offering benefits across all ICF domains. Future studies with longer intervention durations are needed to assess its long-term effects.

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

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.

Preliminary Validity and Acceptability of Motion Tape for Measuring Low Back Movement: Mixed Methods Study

BACKGROUND

Low back pain (LBP) is a significant public health problem that can result in physical disability and financial burden for the individual and society. Physical therapy is effective for managing LBP and includes evaluation of posture and movement, interventions directed at modifying posture and movement, and prescription of exercises. However, physical therapists have limited tools for objective evaluation of low back posture and movement and monitoring of exercises, and this evaluation is limited to the time frame of a clinical encounter. There is a need for a valid tool that can be used to evaluate low back posture and movement and monitor exercises outside the clinic. To address this need, a fabric-based, wearable sensor, Motion Tape (MT), was developed and adapted for a low back use case. MT is a low-profile, disposable, self-adhesive, skin-strain sensor developed by spray coating piezoresistive graphene nanocomposites directly onto commercial kinesiology tape.

OBJECTIVE

The objectives of this study were to (1) validate MT for measuring low back posture and movement and (2) assess the acceptability of MT for users.

METHODS

A total of 10 participants without LBP were tested. A 3D optical motion capture system was used as a reference standard to measure low back kinematics. Retroreflective markers and a matrix of MTs were placed on the low back to measure kinematics (motion capture) and strain (MT) simultaneously during low back movements in the sagittal, frontal, and axial planes. Cross-correlation coefficients were calculated to evaluate the concurrent validity of MT strain in reference motion capture kinematics during each movement. The acceptability of MT was assessed using semistructured interviews conducted with each participant after laboratory testing. Interview data were analyzed using rapid qualitative analysis to identify themes and subthemes of user acceptability.

RESULTS

Visual inspection of concurrent MT strain and kinematics of the low back indicated that MT can distinguish between different movement directions. Cross-correlation coefficients between MT strain and motion capture kinematics ranged from -0.915 to 0.983, and the strength of the correlations varied across MT placements and low back movement directions. Regarding user acceptability, participants expressed enthusiasm toward MT and believed that it would be helpful for remote interventions for LBP but provided suggestions for improvement.

CONCLUSIONS

MT was able to distinguish between different low back movements, and most MTs demonstrated moderate to high correlation with motion capture kinematics. This preliminary laboratory validation of MT provides a basis for future device improvements, which will also involve testing in a free-living environment. Overall, users found MT acceptable for use in physical therapy for managing LBP.

Physical Therapists' Acceptance of a Wearable, Fabric-Based Sensor System (Motion Tape) for Use in Clinical Practice: Qualitative Focus Group Study

BACKGROUND

Low back pain (LBP) is a costly global health condition that affects individuals of all ages and genders. Physical therapy (PT) is a commonly used and effective intervention for the management of LBP and incorporates movement assessment and therapeutic exercise. A newly developed wearable, fabric-based sensor system, Motion Tape, uses novel sensing and data modeling to measure lumbar spine movements unobtrusively and thus offers potential benefits when used in conjunction with PT. However, physical therapists' acceptance of Motion Tape remains unexplored.

OBJECTIVE

The primary aim of this research study was to evaluate physical therapists' acceptance of Motion Tape to be used for the management of LBP. The secondary aim was to explore physical therapists' recommendations for future device development.

METHODS

Licensed physical therapists from the American Physical Therapy Association Academy of Leadership Technology Special Interest Group participated in this study. Overall, 2 focus groups (FGs; N=8) were conducted, in which participants were presented with Motion Tape samples and examples of app data output on a poster. Informed by the Technology Acceptance Model, we conducted semistructured FGs and explored the wearability, usefulness, and ease of use of and suggestions for improvements in Motion Tape for PT management of LBP. FG data were transcribed and analyzed using rapid qualitative analysis.

RESULTS

Regarding wearability, participants perceived that Motion Tape would be able to adhere for several days, with some variability owing to external factors. Feedback was positive for the low-profile and universal fit, but discomfort owing to wires and potential friction with clothing was of concern. Other concerns included difficulty with self-application and potential skin sensitivity. Regarding usefulness, participants expressed that Motion Tape would enhance the efficiency and specificity of assessments and treatment. Regarding ease of use, participants stated that the app would be easy, but data management and challenges with interpretation were of concern. Physical therapists provided several recommendations for future design improvements including having a wireless system or removable wires, customizable sizes for the tape, and output including range of motion data and summary graphs and adding app features that consider patient input and context.

CONCLUSIONS

Several themes related to Motion Tape's wearability, usefulness, and ease of use were identified. Overall, physical therapists expressed acceptance of Motion Tape's potential for assessing and monitoring low back posture and movement, both within and outside clinical settings. Participants expressed that Motion Tape would be a valuable tool for the personalized treatment of LBP but highlighted several future improvements needed for Motion Tape to be used in practice.

Efficacy of Self-Natural Posture Exercise (SNPE) programs on chronic low back pain: A randomized controlled feasibility trial with waitlist control

BACKGROUND

Low back pain (LBP) is a significant source of disability and decreased quality of life. The Self-Natural Posture Exercise (SNPE) intervention can be used effectively in many cases, but feasibility and impact has not been fully explored.

OBJECTIVE

The current study explores the feasibility and efficacy of face-to-face (FtF) and virtual (Vir) SNPE programs on chronic low back pain.

METHODS

This is a randomized single-blinded waitlist control study with 10 participants in the FtF group (age 45.8 ± 2.89) and 9 in the Vir group (age 52.2 ± 2.3). Participants had low to moderate low back pain for > 3 months. Those who would eventually become the Vir group served initially as a waitlist control (Con) group. The FtF group received 12 weeks of in-person exercise training sessions conducted and the Vir group received weekly recorded training videos created by and featuring the same instructor. Measured outcomes included feasibility assessed by rate of retention and rate of attendance, level of low back pain (Oswestry Disability Index, Visual Analogue Scale), quality of life (36-Item Short Form Health Survey 1.0), muscular pressure pain threshold, and muscle tone. Analysis was done via repeated measures ANOVA and Wilcoxon tests.

RESULTS

Rates of retention were 80% in the FtF group and 78% in the Vir group. Attendance rates were 88% in the FtF group and 60% in the Vir group. ODI, VAS, and some SF-36 domains improved in both the FtF and Vir groups. Overall, the FtF group improved in more domains and by a larger degree than the Vir group and both groups improved relative to Con.

CONCLUSION

A 12-week SNPE program, done virtually or in person, shows promise in improving ODI, VAS, and some SF-36 domains. FtF appears to be more effective. Future studies would benefit from sampling a larger and more diverse population.

A matter of choice: Should students self-select exercise for their nonspecific chronic low back pain? A controlled study

OBJECTIVES

To explore the effect of autonomy to choose exercise-therapy (ET) for nonspecific chronic low back pain (NSCLBP) on treatment adherence and clinical outcomes.

PARTICIPANTS

Forty-six students were recruited from Ariel University.

METHODS

Every two gender-and-age-matched students were allocated to either self-selected exercise group (SSE) or pre-determined exercise group (PDE). Subjects completed 4-weeks exercise and filled a training-log. Oswestry disability-index (ODI) and numerical pain-rating scores (NPRS) were measured, as well as exercise quality-performance.

RESULTS

ODI and NPRS improved in both groups, with no between-group differences. Exercise quality-performance was also similar between groups. A trend for better exercise-adherence was found in the SSE-group (75.3% vs 65.0% adherence, p = 0.08, effect size d = 0.59). Meaningful NPRS improvement was demonstrated in 54.5% of SSE-group participants compared with 33.3% in the PDE-group.

CONCLUSIONS

Autonomy may serve as a factor to enhance treatment adherence and clinical outcomes of ET for NSCLBP among students.

Understanding Characteristics of User Adherence to Optimize the Use of Home Hand Rehabilitation Technology

Home-based rehabilitation can serve as an adjunct to in-clinic rehabilitation, encouraging users to engage in more practice. However, conventional home-based rehabilitation programs suffer from low adherence and high drop-out rates. Wearable movement sensors coupled with computer games can be more engaging, but have highly variable adherence rates. Here we examined characteristics of user adherence by analyzing unsupervised, wearable grip sensor-based home-hand rehabilitation data from 1,587 users. We defined three different classes of users based on activity level: low users (<2 days), medium users (2 - 9 days), and power users (> 9 days). The probability of using the device more than two days was positively correlated with first day game success (p = 0.91, p<. 001), and number of sessions played on the first day (p = 0.87, p<. 001) but negatively correlated with parameter exploration (total number of game adjustments / total number of sessions played) on the first day (p = - 0.31, p= 0.05). Compared to low users, power users on the first day had more game success (65.18 ± 25.76 %vs. 54.94 ± 30.31 %,p <. 001), parameter exploration (25.47 ± 22.78 % vs. 12.05 ± 20.56 %, p <. 001), and game sessions played (7.60 ± 6.59 sessions vs. 4.04 ± 3.56 sessions, p <. 001). These observations support the premise that initial game success which is modulated by strategically adjusting parameters when necessary is a key determinant of adherence to rehabilitation technology.

Improving Home-Based Scoliosis Therapy: Findings From a Web-Based Survey

BACKGROUND

Conservative scoliosis therapy in the form of assisted physiotherapeutic scoliosis exercises is supplemented by self-contained training at home, depending on the approach (eg, Schroth, the Scientific Exercises Approach to Scoliosis). Complex exercises, lack of awareness of the importance of training, and missing supervision by therapists often lead to uncertainty and reduced motivation, which in turn reduces the success of home-based therapy. Increasing digitalization in the health care sector offers opportunities to close this gap. However, research is needed to analyze the requirements and translate the potential of digital tools into concrete solution concepts.

OBJECTIVE

The aim of this study is to evaluate the potential for optimizing home-based scoliosis therapy in terms of motivation, assistive devices, and digital tools.

METHODS

In collaboration with the Institute of Physiotherapy at the Jena University Hospital, a survey was initiated to address patients with scoliosis and physical therapists. A digital questionnaire was created for each target group and distributed via physiotherapies, scoliosis forums, the Bundesverband für Skoliose Selbsthilfe e. V. newsletter via a link, and a quick response code. The survey collected data on demographics, therapy, exercise habits, motivation, assistive devices, and digital tools. Descriptive statistics were used for evaluation.

RESULTS

Of 141 survey participants, 72 (51.1%; n=62, 86.1%, female; n=10, 13.9%, male) patients with scoliosis with an average age of 40 (SD 17.08) years and 30 scoliosis therapists completed the respective questionnaires. The analysis of home-based therapy showed that patients with scoliosis exercise less per week (2 times or less; 45/72, 62.5%) than they are recommended to do by therapists (at least 3 times; 53/72, 73.6%). Patients indicated that their motivation could be increased by practicing together with friends and acquaintances (54/72, 75%), a supporting therapy device (48/72, 66.7%), or a digital profile (46/72, 63.9%). The most important assistive devices, which are comparatively rarely used in home-based therapy, included balance boards (20/72, 27.8%), wall bars (23/72, 31.9%), mirrors (36/72, 50%), and long bars (40/72, 55.6%). Therapists saw the greatest benefit of digital tools for scoliosis therapy in increasing motivation (26/30, 87%), improving home therapy (25/30, 83%), monitoring therapy progress (25/30, 83%), and demonstrating exercise instructions (24/30, 80%).

CONCLUSIONS

In this study, we investigated whether there is any potential for improvement in home-based scoliosis therapy. For this purpose, using online questionnaires, we asked patients with scoliosis and therapists questions about the following topics: exercise habits, outpatient and home-based therapy, motivation, supportive devices, and digital tools. The results showed that a lack of motivation, suitable training equipment, and tools for self-control leads to a low training workload. From the perspective of the patients surveyed, this problem can be addressed through community training with friends or acquaintances, a supportive therapy device, and digital elements, such as apps, with training instructions and user profiles.

Understanding barriers to adherence to home exercise programs in patients with musculoskeletal neck pain

BACKGROUND

Home exercise program (HEP) prescription is commonplace in physical therapy (PT). Adherence to HEPs is generally poor, with non-adherence as high as 70%. Poor adherence may negatively impact outcomes.

OBJECTIVES

To (i) qualitatively assess patients' thoughts and beliefs regarding HEP performance and (ii) quantitatively define the relationship between adherence to HEPs and functional outcomes and identify variables that impact adherence.

DESIGN

Mixed-methods.

METHOD

Part 1 involved semi-structured interviews with patients attending PT for neck pain. Responses were assessed using thematic analysis. Part 2 involved a retrospective chart review of patients seen in outpatient PT for neck pain. Between-group (adherent and non-adherent) differences in functional scores were analyzed using a linear mixed model. Sex, age, and functional score data was entered into a regression model to explore their ability to predict adherence.

RESULTS

25 participants were interviewed. Qualitative analysis revealed the following themes associated with adherence to a HEP: (i) prior PT, (ii) observability of outcomes, (iii) expectations of PT, and (iv) experience of pain. Retrospective data from 187 patients was analyzed. Functional scores at discharge were significantly higher (p = 0.03, mean difference = 12.4) in the adherent group. Age (OR = 0.98; 95% CI = 0.93-1.02), male sex (OR = 1.23; 95% CI = 0.22-6.91), and functional scores at intake (OR = 0.99; 95% CI = 0.92-1.07) were not significant predictors of non-adherence.

CONCLUSIONS

Individual patient experiences such as delayed improvement in symptoms and/or experience of pain associated with HEP performance may contribute to poor adherence to HEPs. Adherence to a HEP was associated with superior functional outcomes compared to non-adherence. Age, sex, and functional scores were not predictors of non-adherence.

Adherence and Effect of Home-Based Rehabilitation with Telemonitoring Support in Patients with Chronic Non-Specific Low Back Pain: A Pilot Study

Home-based exercises have been on the rise recently. This pilot study aimed to assess the adherence and effect of a home-based rehabilitation programme using telemonitoring in patients with chronic non-specific low back pain (CNLBP). Twenty-seven patients with CNLBP were enrolled in the study, each of whom underwent a neurological assessment, including patient-oriented measures and a functional assessment-a battery of tests that comprehensively evaluated trunk muscle function. The rehabilitation programme lasted 18 weeks and included daily home-based exercises. A mobile application or an exercise diary was used to monitor compliance. Adherence to the programme was excellent for both the diary and mobile application groups, with 82.3% in the diary group exercising at least once a day and 72.9% twice a day, and 94.8% in the mobile application group exercising at least once a day and 86.6% twice a day. Both patient-oriented and functional outcomes improved significantly; however, the relative changes of the parameters in these two groups did not correlate, which supports the idea that trunk muscle function does not directly relate to patient complaints and that CNLBP is a multifactorial issue. This model of rehabilitation programme should be used in clinical practice, as its adherence and effectiveness seem noticeable.

Validity and reliability of the Turkish Örebro musculoskeletal pain screening questionnaire-short form

BACKGROUND: The Örebro Musculoskeletal Pain Screening Questionnaire (ÖMPSQ) is one of the most recognized and widely used instruments for identifying the risk of pain chronicity. OBJECTIVE: The aim of the study was to provide the reliability and validity of the Turkish ÖMPSQ-Short Form (ÖMPSQ-SF). METHODS: Fifty-seven acute and subacute low back pain patients were included in the study. ÖMPSQ short form and long form, Oswestry Disability Index (ODI), Central Sensitization Inventory (CSI), fear-avoidance beliefs questionnaires were applied simultaneously for validation. The ÖMPSQ-SF was re-applied after 7–10 days to determine test-retest reliability. The data were analyzed by the paired-samples t test, correlation analysis, Cronbach’s alpha, intraclass correlation coefficient (ICC) and confirmatory factor analysis. RESULTS: The mean age of the participants was 39.05±15.68 years. Cronbach’s alpha was 0.723, and the ICC was 0.84. There were moderate to strong correlation among the ÖMPSQ-SF and the ODI, CSI, ÖMPSQ-long form, Fear-Avoidance Beliefs Questionnaire work subscale (r = 0.72, r = 0.353, r = 0.648, r = 0.457 respectively). CONCLUSION: The results show that the Turkish version of the ÖMPSQ–SF is a valid and reliable questionnaire and could be used in clinical and scientific studies.

A systematic review of how adherence to caregiver facilitated therapeutic activities for children are assessed and reported in published research

This systematic review assessed four measurement properties of measures (instruments) used by researchers to assess adherence to caregiver facilitated therapeutic activities (CFTA) for children in published research. The measurement properties considered in this systematic review were dyadic considerations, interpretability, reliability, and validity of the instruments used to assess adherence or compliance. Two databases (http://www.pubmed.gov and EMBASE) were searched for studies that reported adherence or compliance to CFTA prescribed by physiotherapists or occupational therapists or speech and language therapists. Papers included in this review were those that studied children less than 18 years old and or their primary caregivers. Data were extracted by the authors using a data extraction table adapted from the work of Bollen and colleagues (2014) and by rating the measurement properties of the adherence measures identified based on predefined rating criteria (see supplementary file and Table 1 respectively). The authors relied only on the published research articles and any associated published supplementary files/data. None of the 40 adherence instruments identified wholly fulfilled all the criteria of the four measurement properties assessed. The results of this systematic review show that the measures used by researchers for assessing adherence to CFTA generally lack validity, reliability, and dyadic considerations.

Factors associated with exercise adherence to prevent or treat neck and low back pain: A systematic review

BACKGROUND

Much attention has been paid to the evaluation of the efficacy of exercise therapy or increasing physical activity with the aim to prevent or alleviate neck and low back pain. However, exercise adherence is necessary for the effective management of neck and low back pain.

OBJECTIVE

We aimed to systematically review randomized controlled trials and cohort studies to gain insights into the factors associated with adherence to exercise or physical activity programs to prevent or treat neck pain and low back pain.

METHOD

Publications were systematically searched from 1980-December 2019 in several databases. The following key words were used: neck pain or low back pain paired with exercise or physical activity and adherence or compliance. Relevant studies were retrieved and assessed for methodological quality by two independent reviewers. Quality of evidence was assessed and rated according to GRADE guidelines.

RESULTS

Nine randomized controlled trials and eight cohort studies were included in this review. Randomized controlled trials indicated moderate-quality evidence for the association between exercise adherence and self-efficacy. Cohort studies showed moderate-quality evidence for the association between exercise adherence and education level.

CONCLUSIONS

Literature investigating factors associated with exercise adherence to prevent or treat neck and low back pain was heterogeneous. Few factors were found to be associated with exercise adherence. More studies are needed before any firm conclusions can be reached.

Does exercise improve healing of diabetic foot ulcers? A systematic review

BACKGROUND

For patients with diabetic foot ulcers, offloading is one crucial aspect of treatment and aims to redistribute pressure away from the ulcer site. In addition to offloading strategies, patients are often advised to reduce their activity levels. Consequently, patients may avoid exercise altogether. However, it has been suggested that exercise induces an increase in vasodilation and tissue blood flow, which may potentially facilitate ulcer healing. The aim of this systematic review was to determine whether exercise improves healing of diabetic foot ulcers.

REVIEW

We conducted a systematic search of MEDLINE, CINAHL and EMBASE between July 6, 2009 and July 6, 2019 using the key terms and subject headings diabetes, diabetic foot, physical activity, exercise, resistance training and wound healing. Randomised controlled trials were included in this review. Three randomised controlled trials (139 participants) were included in this systematic review. All studies incorporated a form of non-weight bearing exercise as the intervention over a 12-week period. One study conducted the intervention in a supervised setting, while two studies conducted the intervention in an unsupervised setting. Two studies found greater improvement in percentage wound size reduction in the intervention group compared with the control group, with one of these studies achieving statistically significant findings (p < 0.05). The results of the third study demonstrated statistically significant findings for total wound size reduction (p < 0.05), however results were analysed within each treatment group and not between groups.

CONCLUSION

This systematic review found there is insufficient evidence to conclusively support non-weight bearing exercise as an intervention to improve healing of diabetic foot ulcers. Regardless, the results demonstrate some degree of wound size reduction and there were no negative consequences of the intervention for the participants. Given the potential benefits of exercise on patient health and wellbeing, non-weight bearing exercise should be encouraged as part of the management plan for treatment of diabetic foot ulcers. Further research is required to better understand the relationship between exercise and healing of diabetic foot ulcers.

Effects of scapular stabilization exercises in patients of chronic neck pain with scapular dyskinesis: A quasi-experimental study

Objectives

This study aims to investigate the effectiveness of scapular stabilization exercises in patients with chronic neck pain and scapular dyskinesis.

Patients and methods

This single-center, prospective study included a total of 36 patients (17 males, 19 females; mean age: 41±12.8 years; range, 25 to 57 years) with chronic neck pain and scapular dyskinesis between April 2018 and September 2018. The patients were randomly assigned to three treatment groups. Group 1 (n=13) consisted of those receiving scapular stabilization exercises by a physiotherapy specialist control in addition to the routine physiotherapy and rehabilitation program; Group 2 (n=12) consisted of those receiving the routine physiotherapy and rehabilitation program in addition to scapular stabilization exercises in-home training program; and Group 3 (n=11) consisted of those receiving the routine physiotherapy and rehabilitation program alone. The assessments were made using the Visual Analog Scale (VAS) and Northwick Park Neck Pain Questionnaire (NPQ).

Results

Significant differences were found in the pre- and post-treatment VAS scores, and Group 1 and Group 2 created this significant difference (p<0.05). A significant difference was also observed in the pre- and post-treatment NPQ scores among the groups (p<0.05). Group 1 showed the most significant improvement of the NPQ scores (p<0.05).

Conclusion

Our study results suggest that addition of scapular stabilization exercises to the routine physiotherapy components may be an effective method for improving pain and functional results.

Efficacy of an innovative smartphone application for office workers with chronic non-specific low back pain: a pilot randomized controlled trial

OBJECTIVE

To evaluate the efficacy of a newly developed evidence-based low back pain (LBP) management smartphone application.

DESIGN

A double-blinded randomized controlled trial where participants randomly assigned to either an experimental group (EG) or a control group (CG).

SETTING

Governmental and private institutions.

PARTICIPANTS

About 40 office workers, aged 30 to 55 years, had pain due to non-specific LBP > 3 on Visual Analogue Scale, and with pain chronicity > 3 months.

INTERVENTIONS

The EG received full version of the application 'Relieve my back' included evidence-based instructions and therapeutic exercises for LBP management, whereas the CG received placebo version included instructions about nutrition.

MAIN MEASURES

Primary outcome measures included pain measured by Visual Analogue Scale (VAS), disability measured by Oswestry Disability Index (ODI), and quality of life measured by Short-Form Health Survey (SF-12).

RESULTS

Following six weeks of using the application, compared to CG, the EG group demonstrated significant decrease in pain intensity (-3.45 (2.21) vs -0.11 (1.66), P < 0.001), in ODI score (-11.05 (10.40) vs -0.58 (9.0), P = 0.002), and significant increase in physical component of SF-12 (12.85 (17.20) vs -4.63 (12.04), P = 0.001).

CONCLUSION

'Relieve my back' application might be efficacious in reducing pain and disability and improving the quality of life of office workers with non-specific LBP.

[Mitosis in regenerating comb row and the double-nucleated cells of Ctenophora]

Background

Conservative scoliosis therapy in the form of assisted physiotherapeutic scoliosis exercises is supplemented by self-contained training at home, depending on the approach (eg, Schroth, the Scientific Exercises Approach to Scoliosis). Complex exercises, lack of awareness of the importance of training, and missing supervision by therapists often lead to uncertainty and reduced motivation, which in turn reduces the success of home-based therapy. Increasing digitalization in the health care sector offers opportunities to close this gap. However, research is needed to analyze the requirements and translate the potential of digital tools into concrete solution concepts.

Objective

The aim of this study is to evaluate the potential for optimizing home-based scoliosis therapy in terms of motivation, assistive devices, and digital tools.

Methods

In collaboration with the Institute of Physiotherapy at the Jena University Hospital, a survey was initiated to address patients with scoliosis and physical therapists. A digital questionnaire was created for each target group and distributed via physiotherapies, scoliosis forums, the Bundesverband für Skoliose Selbsthilfe e. V. newsletter via a link, and a quick response code. The survey collected data on demographics, therapy, exercise habits, motivation, assistive devices, and digital tools. Descriptive statistics were used for evaluation.

Results

Of 141 survey participants, 72 (51.1%; n=62, 86.1%, female; n=10, 13.9%, male) patients with scoliosis with an average age of 40 (SD 17.08) years and 30 scoliosis therapists completed the respective questionnaires. The analysis of home-based therapy showed that patients with scoliosis exercise less per week (2 times or less; 45/72, 62.5%) than they are recommended to do by therapists (at least 3 times; 53/72, 73.6%). Patients indicated that their motivation could be increased by practicing together with friends and acquaintances (54/72, 75%), a supporting therapy device (48/72, 66.7%), or a digital profile (46/72, 63.9%). The most important assistive devices, which are comparatively rarely used in home-based therapy, included balance boards (20/72, 27.8%), wall bars (23/72, 31.9%), mirrors (36/72, 50%), and long bars (40/72, 55.6%). Therapists saw the greatest benefit of digital tools for scoliosis therapy in increasing motivation (26/30, 87%), improving home therapy (25/30, 83%), monitoring therapy progress (25/30, 83%), and demonstrating exercise instructions (24/30, 80%).

Conclusions

In this study, we investigated whether there is any potential for improvement in home-based scoliosis therapy. For this purpose, using online questionnaires, we asked patients with scoliosis and therapists questions about the following topics: exercise habits, outpatient and home-based therapy, motivation, supportive devices, and digital tools. The results showed that a lack of motivation, suitable training equipment, and tools for self-control leads to a low training workload. From the perspective of the patients surveyed, this problem can be addressed through community training with friends or acquaintances, a supportive therapy device, and digital elements, such as apps, with training instructions and user profiles.