Luiz Hespanhol

Background: Nonspecific chronic low back pain (LBP) is a major contributor to disability and economic burden worldwide, particularly in low- and middle-income regions. Telehealth has emerged as a promising approach to improving healthcare accessibility and treatment effectiveness. This study aims to assess the feasibility of conducting a randomized controlled trial (RCT) to evaluate the effectiveness and equity of a telehealth-delivered exercise and pain education program compared to an in-person intervention and a waitlist control group. Methods: This protocol describes a feasibility study with a sequential explanatory mixed-methods design, developed to inform a future three-arm RCT with economic evaluation. A total of 39 participants with chronic non-specific LBP will be recruited from Fortaleza, Brazil. Key feasibility indicators (e.g., recruitment rate, adherence, acceptability) and clinical outcomes (pain intensity, disability, quality of life, etc.) will be assessed at baseline and post-treatment (8 weeks). Discussion: The integrated findings will determine the feasibility of proceeding with a definitive trial designed to evaluate the effectiveness, cost-effectiveness, and equity of this telehealth model. This study is crucial for developing and scaling up evidence-based telehealth strategies that are not only effective, but also affordable and accessible for vulnerable populations with chronic low back pain in low-resource settings. Trial Registration: www.ensaiosclinicos.gov.br (RBR-4d7kgrw) on April 2, 2024.

Background: Online home exercises represent opportunities to increase physical activity levels. However, high dropout rates are commonly reported in such programmes. This study aimed to investigate the predictors of dropping out from an online home exercise programme. Methods: A total of 760 individuals from nine countries participated in this 8-week prospective cohort study derived from a randomised controlled trial. The participants were randomised into "4-week live-streamed exercise –>4-week recorded exercise" or "4-week no intervention –>4-week recorded exercise" group. Repeated measurements using weekly questionnaires were performed. Pain intensity, disability, mental well-being score, exercise motivation, sleep quality, impulsiveness/anxiety, and physical activity level were analysed. Results: A total of 53.8% (95% confidence interval [CI] 50.3%–57.3%) participants dropped out from the programme. The identified predictors of dropping out from the programme were: well-being (odds ratio [OR] 0.94, 95% CI 0.91–0.97) and disability (OR 1.02, 95% CI 1.002–1.04) at baseline considering the first 4 weeks; age (0.98; 95% CI 0.96–1.00) and baseline well-being (0.93; 95% CI 0.89–0.97) considering the entire follow-up (8 weeks); exercise motivation (0.92; 95% CI 0.87 to 0.97) and general impulsiveness/anxiety (1.04; 95% CI 1.01–1.07) repeated measured over time. Conclusion: About half of the participants dropped out from the online home exercise programme. Higher baseline scores in mental well-being and age predicted a reduction in dropping out. Higher baseline disability predicted an increase in dropping out. During the follow-up, higher exercise motivation was associated with a reduction in dropping out, and higher impulsiveness and anxiety were associated with an increase in dropping out.