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.

Department of Neurology Center for Neuromuscular Diseases University Hospital Brno 625 00 Brno Czech Republic

Department of Public Health Faculty of Medicine Masaryk University 625 00 Brno Czech Republic

Department of Rehabilitation and Sports Medicine 2nd Medical Faculty Charles University and University Hospital Motol 150 06 Prague Czech Republic

Department of Rehabilitation University Hospital Brno 625 00 Brno Czech Republic

Faculty of Medicine Masaryk University 625 00 Brno Czech Republic

Institute of Biostatistics and Analysis Ltd 602 00 Brno Czech Republic

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Saragiotto B.T., Maher C.G., Yamato T.P., Costa L.O., Menezes Costa L.C., Ostelo R.W., Macedo L.G. Motor Control Exercise for Chronic Non-specific Low-back Pain. Cochrane Database Syst. Rev. 2016;2016:CD012004. doi: 10.1002/14651858.CD012004. PubMed DOI PMC

Airaksinen O., Brox J.I., Cedraschi C., Hildebrandt J., Klaber-Moffett J., Kovacs F., Mannion A.F., Reis S., Staal J.B., Ursin H., et al. Chapter 4. European Guidelines for the Management of Chronic Nonspecific Low Back Pain. Eur. Spine J. 2006;15((Suppl. S2)):S192–S300. doi: 10.1007/s00586-006-1072-1. PubMed DOI PMC

Panjabi M.M. A Hypothesis of Chronic Back Pain: Ligament Subfailure Injuries Lead to Muscle Control Dysfunction. Eur. Spine J. 2006;15:668–676. doi: 10.1007/s00586-005-0925-3. PubMed DOI PMC

Agten A., Verbrugghe J., Stevens S., Boomgaert L., O Eijnde B., Timmermans A., Vandenabeele F. Feasibility, Accuracy and Safety of a Percutaneous Fine-Needle Biopsy Technique to Obtain Qualitative Muscle Samples of the Lumbar Multifidus and Erector Spinae Muscle in Persons with Low Back Pain. J. Anat. 2018;233:542–551. doi: 10.1111/joa.12867. PubMed DOI PMC

Mannion A.F. Fibre Type Characteristics and Function of the Human Paraspinal Muscles: Normal Values and Changes in Association with Low Back Pain. J. Electromyogr. Kinesiol. 1999;9:363–377. doi: 10.1016/S1050-6411(99)00010-3. PubMed DOI

Adams M.A., Hutton W.C. Has the Lumbar Spine a Margin of Safety in Forward Bending? Clin. Biomech. 1986;1:3–6. doi: 10.1016/0268-0033(86)90028-8. PubMed DOI

Kalichman L., Carmeli E., Been E. The Association between Imaging Parameters of the Paraspinal Muscles, Spinal Degeneration, and Low Back Pain. BioMed Res. Int. 2017;2017:2562957. doi: 10.1155/2017/2562957. PubMed DOI PMC

Hildebrandt M., Fankhauser G., Meichtry A., Luomajoki H. Correlation between Lumbar Dysfunction and Fat Infiltration in Lumbar Multifidus Muscles in Patients with Low Back Pain. BMC Musculoskelet. Disord. 2017;18:12. doi: 10.1186/s12891-016-1376-1. PubMed DOI PMC

Freeman M.D., Woodham M.A., Woodham A.W. The Role of the Lumbar Multifidus in Chronic Low Back Pain: A Review. PM R. 2010;2:142–146. doi: 10.1016/j.pmrj.2009.11.006. quiz 1 p following 167. PubMed DOI

Padwal J., Berry D.B., Hubbard J.C., Zlomislic V., Allen R.T., Garfin S.R., Ward S.R., Shahidi B. Regional Differences between Superficial and Deep Lumbar Multifidus in Patients with Chronic Lumbar Spine Pathology. BMC Musculoskelet. Disord. 2020;21:764. doi: 10.1186/s12891-020-03791-4. PubMed DOI PMC

Steele J., Fisher J., Perrin C., Conway R., Bruce-Low S., Smith D. Does Change in Isolated Lumbar Extensor Muscle Function Correlate with Good Clinical Outcome? A Secondary Analysis of Data on Change in Isolated Lumbar Extension Strength, Pain, and Disability in Chronic Low Back Pain. Disabil. Rehabil. 2019;41:1287–1295. doi: 10.1080/09638288.2018.1424952. PubMed DOI

Steele J., Bruce-Low S., Smith D. A Reappraisal of the Deconditioning Hypothesis in Low Back Pain: Review of Evidence from a Triumvirate of Research Methods on Specific Lumbar Extensor Deconditioning. Curr. Med. Res. Opin. 2014;30:865–911. doi: 10.1185/03007995.2013.875465. PubMed DOI

Frizziero A., Pellizzon G., Vittadini F., Bigliardi D., Costantino C. Efficacy of Core Stability in Non-Specific Chronic Low Back Pain. J. Funct. Morphol. Kinesiol. 2021;6:37. doi: 10.3390/jfmk6020037. PubMed DOI PMC

Corp N., Mansell G., Stynes S., Wynne-Jones G., Morsø L., Hill J.C., van der Windt D.A. Evidence-Based Treatment Recommendations for Neck and Low Back Pain across Europe: A Systematic Review of Guidelines. Eur. J. Pain. 2021;25:275–295. doi: 10.1002/ejp.1679. PubMed DOI PMC

Akuthota V., Ferreiro A., Moore T., Fredericson M. Core Stability Exercise Principles. Curr. Sports Med. Rep. 2008;7:39–44. doi: 10.1097/01.CSMR.0000308663.13278.69. PubMed DOI

Panjabi M.M. The Stabilizing System of the Spine. Part I. Function, Dysfunction, Adaptation, and Enhancement. J. Spinal Disord. 1992;5:383–389; discussion 397. doi: 10.1097/00002517-199212000-00001. PubMed DOI

Panjabi M.M. The Stabilizing System of the Spine. Part II. Neutral Zone and Instability Hypothesis. J. Spinal Disord. 1992;5:390–396; discussion 397. doi: 10.1097/00002517-199212000-00002. PubMed DOI

Janssens L., Brumagne S., McConnell A.K., Hermans G., Troosters T., Gayan-Ramirez G. Greater Diaphragm Fatigability in Individuals with Recurrent Low Back Pain. Respir. Physiol. Neurobiol. 2013;188:119–123. doi: 10.1016/j.resp.2013.05.028. PubMed DOI

Janssens L., Brumagne S., Polspoel K., Troosters T., McConnell A. The Effect of Inspiratory Muscles Fatigue on Postural Control in People with and without Recurrent Low Back Pain. Spine. 2010;35:1088–1094. doi: 10.1097/BRS.0b013e3181bee5c3. PubMed DOI

Parreira P., Heymans M.W., van Tulder M.W., Esmail R., Koes B.W., Poquet N., Lin C.-W.C., Maher C.G. Back Schools for Chronic Non-Specific Low Back Pain. Cochrane Database Syst. Rev. 2017;8:CD011674. doi: 10.1002/14651858.CD011674.pub2. PubMed DOI PMC

Forssell M.Z. The Back School. Spine. 1981;6:104–106. doi: 10.1097/00007632-198101000-00022. PubMed DOI

Seron P., Oliveros M.-J., Gutierrez-Arias R., Fuentes-Aspe R., Torres-Castro R.C., Merino-Osorio C., Nahuelhual P., Inostroza J., Jalil Y., Solano R., et al. Effectiveness of Telerehabilitation in Physical Therapy: A Rapid Overview. Phys. Ther. 2021;101:pzab053. doi: 10.1093/ptj/pzab053. PubMed DOI PMC

Meystre S. The Current State of Telemonitoring: A Comment on the Literature. Telemed. J. E-Health. 2005;11:63–69. doi: 10.1089/tmj.2005.11.63. PubMed DOI

Quentin C., Bagheri R., Ugbolue U.C., Coudeyre E., Pélissier C., Descatha A., Menini T., Bouillon-Minois J.-B., Dutheil F. Effect of Home Exercise Training in Patients with Nonspecific Low-Back Pain: A Systematic Review and Meta-Analysis. Int. J. Environ. Res. Public Health. 2021;18:8430. doi: 10.3390/ijerph18168430. PubMed DOI PMC

Mbada C.E., Olaoye M.I., Dada O.O., Ayanniyi O., Johnson O.E., Odole A.C., Ishaya G.P., Omole O.J., Makinde M.O. Comparative Efficacy of Clinic-Based and Telerehabilitation Application of Mckenzie Therapy in Chronic Low-Back Pain. Int. J. Telerehabil. 2019;11:41–58. doi: 10.5195/ijt.2019.6260. PubMed DOI PMC

Fairbank J.C., Couper J., Davies J.B., O’Brien J.P. The Oswestry Low Back Pain Disability Questionnaire. Physiotherapy. 1980;66:271–273. PubMed

Roland M., Morris R. A Study of the Natural History of Back Pain. Part I: Development of a Reliable and Sensitive Measure of Disability in Low-Back Pain. Spine. 1983;8:141–144. doi: 10.1097/00007632-198303000-00004. PubMed DOI

Vlažná D., Krkoška P., Kuhn M., Dosbaba F., Batalik L., Vlčková E., Voháňka S., Adamová B. Assessment of Lumbar Extensor Muscles in the Context of Trunk Function, a Pilot Study in Healthy Individuals. Appl. Sci. 2021;11:9518. doi: 10.3390/app11209518. DOI

Peek K., Carey M., Mackenzie L., Sanson-Fisher R. Patient Adherence to an Exercise Program for Chronic Low Back Pain Measured by Patient-Report, Physiotherapist-Perception and Observational Data. Physiother. Theory Pract. 2019;35:1304–1313. doi: 10.1080/09593985.2018.1474402. PubMed DOI

Dhondt E., Van Oosterwijck J., Cagnie B., Adnan R., Schouppe S., Van Akeleyen J., Logghe T., Danneels L. Predicting Treatment Adherence and Outcome to Outpatient Multimodal Rehabilitation in Chronic Low Back Pain. J. Back Musculoskelet. Rehabil. 2020;33:277–293. doi: 10.3233/BMR-181125. PubMed DOI

Kolt G.S., McEvoy J.F. Adherence to Rehabilitation in Patients with Low Back Pain. Man. Ther. 2003;8:110–116. doi: 10.1016/S1356-689X(02)00156-X. PubMed DOI

Ben Salah Frih Z., Fendri Y., Jellad A., Boudoukhane S., Rejeb N. Efficacy and Treatment Compliance of a Home-Based Rehabilitation Programme for Chronic Low Back Pain: A Randomized, Controlled Study. Ann. Phys. Rehabil. Med. 2009;52:485–496. doi: 10.1016/j.rehab.2009.04.002. PubMed DOI

Murphy M.H., Lahart I., Carlin A., Murtagh E. The Effects of Continuous Compared to Accumulated Exercise on Health: A Meta-Analytic Review. Sports Med. 2019;49:1585–1607. doi: 10.1007/s40279-019-01145-2. PubMed DOI PMC

Medina-Mirapeix F., Escolar-Reina P., Gascón-Cánovas J.J., Montilla-Herrador J., Jimeno-Serrano F.J., Collins S.M. Predictive Factors of Adherence to Frequency and Duration Components in Home Exercise Programs for Neck and Low Back Pain: An Observational Study. BMC Musculoskelet. Disord. 2009;10:155. doi: 10.1186/1471-2474-10-155. PubMed DOI PMC

Anar S.Ö. The Effectiveness of Home-Based Exercise Programs for Low Back Pain Patients. J. Phys. Ther. Sci. 2016;28:2727–2730. doi: 10.1589/jpts.28.2727. PubMed DOI PMC

Escolar-Reina P., Medina-Mirapeix F., Gascón-Cánovas J.J., Montilla-Herrador J., Jimeno-Serrano F.J., de Oliveira Sousa S.L., del Baño-Aledo M.E., Lomas-Vega R. How Do Care-Provider and Home Exercise Program Characteristics Affect Patient Adherence in Chronic Neck and Back Pain: A Qualitative Study. BMC Health Serv. Res. 2010;10:60. doi: 10.1186/1472-6963-10-60. PubMed DOI PMC

Ostelo R.W.J.G., Deyo R.A., Stratford P., Waddell G., Croft P., Von Korff M., Bouter L.M., de Vet H.C. Interpreting Change Scores for Pain and Functional Status in Low Back Pain: Towards International Consensus Regarding Minimal Important Change. Spine. 2008;33:90–94. doi: 10.1097/BRS.0b013e31815e3a10. PubMed DOI

Bruce-Low S., Smith D., Burnet S., Fisher J., Bissell G., Webster L. One Lumbar Extension Training Session per Week Is Sufficient for Strength Gains and Reductions in Pain in Patients with Chronic Low Back Pain Ergonomics. Ergonomics. 2012;55:500–507. doi: 10.1080/00140139.2011.644329. PubMed DOI

Welch N., Moran K., Antony J., Richter C., Marshall B., Coyle J., Falvey E., Franklyn-Miller A. The Effects of a Free-Weight-Based Resistance Training Intervention on Pain, Squat Biomechanics and MRI-Defined Lumbar Fat Infiltration and Functional Cross-Sectional Area in Those with Chronic Low Back. BMJ Open Sport Exerc. Med. 2015;1:e000050. doi: 10.1136/bmjsem-2015-000050. PubMed DOI PMC

Storheim K., Holm I., Gunderson R., Brox J.I., Bø K. The Effect of Comprehensive Group Training on Cross-Sectional Area, Density, and Strength of Paraspinal Muscles in Patients Sick-Listed for Subacute Low Back Pain. J. Spinal Disord. Tech. 2003;16:271–279. doi: 10.1097/00024720-200306000-00008. PubMed DOI

Steele J., Bruce-Low S., Smith D., Jessop D., Osborne N. Isolated Lumbar Extension Resistance Training Improves Strength, Pain, and Disability, but Not Spinal Height or Shrinkage (“Creep”) in Participants with Chronic Low Back Pain. Cartilage. 2020;11:160–168. doi: 10.1177/1947603517695614. PubMed DOI PMC

Huijnen I.P.J., Verbunt J.A., Wittink H.M., Smeets R.J.E.M. Physical Performance Measurement in Chronic Low Back Pain: Measuring Physical Capacity or Pain-Related Behaviour? Eur. J. Physiother. 2013;15:103–110. doi: 10.3109/21679169.2013.830643. DOI

Assessment of lumbar paraspinal muscle morphology using mDixon Quant magnetic resonance imaging (MRI): a cross-sectional study in healthy subjects

Trunk muscle dysfunction in patients with myotonic dystrophy type 2 and its contribution to chronic low back pain