EFFECTIVENESS OF MOBILE-APP BASED PHYSIOTHERAPY EXERCISE PROGRAMS IN IMPROVING ADHERENCE AND FUNCTIONAL OUTCOMES IN CHRONIC LOW BACK PAIN PATIENTS IN PAKISTAN

Abstract

BACKGROUND: Chronic low back pain (CLBP) remains a leading cause of disability worldwide, with poor exercise adherence being a critical barrier to effective rehabilitation. In Pakistan, limited physiotherapy access and inconsistent follow-up further hinder long-term recovery. The integration of mobile health (mHealth) solutions presents an opportunity to enhance self-management and adherence in CLBP rehabilitation.

OBJECTIVE: To evaluate the effectiveness of a mobile app–based physiotherapy exercise program in improving adherence and functional outcomes among patients with chronic low back pain in Pakistan.

 METHODOLOGY: A randomized controlled trial was conducted across three tertiary hospitals in Lahore, Karachi, and Islamabad from March to November 2022. A total of 160 patients with non-specific CLBP were randomly assigned to either a mobile app–based physiotherapy group (n=80) or a conventional physiotherapy group (n=80). The intervention group received a 12-week guided exercise program via the “PhysioBackPak” app, while controls received printed exercise instructions. Outcome measures included the Exercise Adherence Rating Scale (EARS), Oswestry Disability Index (ODI), Numeric Pain Rating Scale (NPRS), Short Form-36 (SF-36), and Pain Self-Efficacy Questionnaire (PSEQ). Data were analyzed using repeated measures ANOVA and independent t-tests, with significance set at p<0.05.

 RESULTS: The app-based group demonstrated significantly higher adherence (82.4% vs. 64.7%, p<0.001), greater reduction in disability (ODI: 42.8±10.5 to 21.6±8.9), and lower pain scores (NPRS: 6.9±1.1 to 3.2±1.3). Quality of life and self-efficacy improved markedly compared to controls (p<0.01). No adverse effects were reported.

CONCLUSION: Mobile app–based physiotherapy significantly enhances adherence, pain relief, and functional recovery in CLBP patients, offering a feasible and scalable approach for digital rehabilitation in Pakistan’s healthcare system.

 KEY TERMS: Adherence, Chronic Low Back Pain, Digital Health, Mobile Applications, Pain Management, Pakistan, Physiotherapy, Rehabilitation