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

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 20–30-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 < .05) both the tele-supervised (p = .001) and in-person-supervised (p < .001) groups achieved superior functionality exceeding MDC. The in-person-supervised group demonstrated greater functionality (p < .001) than the tele-supervised group, exceeding MCID. Pain intensity decreased in the tele-supervised (p = .011) and in-person-supervised groups (p < .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 = .071). The in-person-supervised group displayed a greater reduction in kinesiophobia than the tele-supervised (p < .001) and unsupervised groups (p < .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.