Telerehabilitation Program to Improve Function in People With Chronic Low Back Pain Compared With Conventional Care
Effectiveness of an Additional Telerehabilitation Program Combined With Conventional Care on Functional Improvement in Patients With Chronic Low Back Pain at the Primary Care Level in the Mexican Institute of Social Security (IMSS): A Pragmatic Randomized Controlled Trial
Coordinación de Investigación en Salud, Mexico
200 participants
Oct 3, 2025
INTERVENTIONAL
Conditions
Summary
The goal of this clinical trial is to evaluate whether an additional telerehabilitation program, combined with conventional care, can improve functional recovery in adults with chronic low back pain treated in primary care clinics of the Mexican Institute of Social Security (IMSS). The main questions it aims to answer are: * Does the telerehabilitation program lead to greater functional improvement, measured by the Oswestry Disability Index (ODI), compared with conventional care alone? * Does the program reduce pain intensity and improve adherence and satisfaction among participants? Researchers will compare patients receiving conventional care plus telerehabilitation with those receiving conventional care only to determine whether the digital intervention provides additional clinical benefits. Participants will: * Continue their usual medical care for chronic low back pain at IMSS clinics. * Follow a 6-week telerehabilitation program delivered through an online platform, including educational videos, stretching and strengthening exercises, and weekly virtual check-ins. * Complete baseline and post-intervention assessments of pain, disability, and satisfaction.
Eligibility
Inclusion Criteria7
- Adults between 18 and 60 years of age.
- Clinical diagnosis of chronic non-specific low back pain (duration ≥ 12 weeks).
- Pain intensity ≥ 3 on the Visual Analogue Scale (VAS) at baseline.
- Enrolled as beneficiaries of the Mexican Institute of Social Security (IMSS) and receiving care at a primary care clinic.
- Access to a smartphone or computer with internet connection.
- Ability to read and understand written instructions in Spanish.
- Willingness to participate and provide written informed consent.
Exclusion Criteria8
- Specific causes of low back pain (e.g., fractures, tumors, infections, inflammatory or rheumatic diseases).
- Neurological deficits suggestive of radiculopathy or myelopathy.
- Pregnancy.
- Severe psychiatric or cognitive disorders that limit participation.
- Recent spinal surgery (within the last 6 months).
- Participation in another rehabilitation or exercise program for low back pain within the previous 3 months.
- Any medical condition that contraindicates physical exercise, as determined by the treating physician.
- The upper age limit of 60 years was established to minimize confounding factors related to advanced degenerative joint disease. Individuals older than 60 frequently present radiographic or clinical signs of grade III or higher lumbar osteoarthritis, which may produce chronic pain and functional limitation independent of the intervention. Including these participants could obscure the true effect of the telerehabilitation program on functional improvement and pain reduction in patients with non-specific chronic low back pain.
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Interventions
A six-week telerehabilitation program provided in addition to conventional medical care for patients with chronic low back pain. The program is delivered through the Moodle platform and supported by WhatsApp communication. It includes five progressive modules with educational videos, stretching and strengthening exercises based on Williams and McKenzie methods, core stabilization and flexibility routines, and relaxation techniques adapted from Jacobson's progressive relaxation. Participants complete home-based exercises and one weekly virtual session, record their activities in logs, and receive feedback from the rehabilitation team.
Standard medical care provided at IMSS primary care clinics for patients with chronic low back pain. It includes physician consultations, pharmacologic management as needed (analgesics, NSAIDs), ergonomic and posture advice, and the institutional educational brochure on back hygiene and exercises. No telerehabilitation components are included
Locations(1)
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NCT07248813