We found that both intervention and control groups significantly improved in short-term function at Week 18, but m-health based exercise (via plus education) did not improve participant outcome. The two groups significantly improved average and most severe pain in the last 2 weeks and the PCS of SF-36 during the course of the 18-week follow-up. As for the secondary outcomes,participants were able to use patient education to treat their anxiety and depression after treatment, but the relief did not last to Week 18. Finally, the intervention group’s treatment adherence was significantly higher than that of the control group, and the results were statistically significant .
From the participants' registration information, exercise had proved to be more effective than massage; unfortunately, only a small percentage of our participants had tried exercise therapy. This outcome was similar to previous study results. Patients with low-back pain in under-resourced areas struggled to receive professional guidance, and our m-health based study addressed this problem. In our study, most patients did not receive on-site treatment due to distance and time conflicts, but these inhibitions did not affect treatment progress. Additionally, through detailed participant communication, we found that the participants lacked understanding of low-back pain and maintained negative habits, such as sedentariness, so in the intervention group, we strengthened education and communication, with the aim of teaching the participants positive-intervention habits and self-management. Patient education improved treatment adherence in our study, which should be related to strengthening patients’ understanding of low back pain. However, the intervention group’s treatment effect did not show better improvement as compared to the control group, which may be due to the following reasons: this was a pilot study with an insufficient sample size, and the patients’ severity and psychological levels in the intervention group were more serious than that of the control group. Therefore, the sample size should be expanded for future study.
The study strengths were that the study was a clinical trials without clinical sites, and participants could receive treatments anywhere and anytime. Compared to other studies on low-back pain education[33–34], our study was more convenient, efficient, and labor-saving effective with the use of Ding Talk. In our trial, participants wanted to exercise in their spare time based on the video, and they could ask questions at any time. The online-only recruitment and online-questionnaire collection also simplified the process and saved time, costs, and increased convenience to researchers. The main research site was located in the participants’ home, rather than the research center, thus, saving costs. Additionally, the online-treatment therapies prevented COVID-19 exposure due to maintaining social isolation.
However, this study has some limitations. First, the participants were required to complete the exercise program without the supervision of a physical therapist, so we couldn’t guarantee if the process completion was at quality standard. Second, the participant number was insufficient, and there was bias between the intervention and control groups on psychological indicator(s); the participants in the intervention group had poorer mental health than the control group.Third,the recruitment process may have selection bias, since the recruitment was made through a social network.
In future research, we should not only increase the patients’ psychological intervention to improve their mental health, but also make full use of advanced information technology to increase the research quality. We should adopt more useful educational measures in future research, such as the Pain Neuroscience Education. Combined with psychology methods, such as online cognitive behavioral therapy(CBT) or online mindfulness for treatment, the treatment results may improve.