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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
Karaduman C, Atas Balci L
Physiotherapy Theory and Practice 2024 Nov;40(11):2492-2502
clinical trial
5/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: No; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: No; Adequate follow-up: Yes; Intention-to-treat analysis: No; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

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 to 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 < 0.05) both the tele-supervised (p = 0.001) and in-person-supervised (p < 0.001) groups achieved superior functionality exceeding MDC. The in-person-supervised group demonstrated greater functionality (p < 0.001) than the tele-supervised group, exceeding MCID. Pain intensity decreased in the tele-supervised (p = 0.011) and in-person-supervised groups (p < 0.001) 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 = 0.071). The in-person-supervised group displayed a greater reduction in kinesiophobia than the tele-supervised (p < 0.001) and unsupervised groups (p < 0.001) 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.

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