TeleBACK Will Test Whether Video Physical Therapy Can Match Clinic-Based Care for Chronic Low Back Pain
Chronic low back pain remains one of the most common drivers of disability and spending in the United States, yet a large share of eligible patients never reach physical therapy. Access barriers are built into the care pathway itself: travel, missed work, limited mobility, and the practical strain of repeated appointments can all keep people from starting or finishing treatment. TeleBACK is designed around that real-world gap. The multicentre trial will ask whether synchronous, video-based telerehabilitation can preserve the benefits of standard in-clinic physical therapy while removing some of the friction that keeps patients away from care.
The study uses a pragmatic, individually randomised, group treatment, non-inferiority design. That choice fits the clinical question. Investigators are not trying to prove that remote therapy is superior; they are asking whether it can perform well enough to justify wider use when in-person visits are difficult to access. If the telehealth model achieves outcomes within a prespecified margin, it could support a more flexible approach to rehabilitation for a population that often needs care but does not consistently receive it.
A 1,000-Patient Comparison Across Three Health Systems
TeleBACK will enrol 1,000 adults with chronic low back pain, defined as pain lasting at least three months. Participants will be drawn from primary and specialty care settings across three healthcare systems in Maryland and Utah, giving the trial a broad clinical base rather than a narrow specialty-clinic sample. Randomisation will assign patients 1:1 to one of two strategies: synchronous video-based telerehabilitation or standard in-clinic physical therapy.
Each participant will receive eight physical therapy sessions over eight weeks. In both study arms, the treatment dose is intentionally matched so the comparison focuses on delivery format rather than intensity. That structure matters for interpretation because it helps isolate whether remote care can deliver the same clinical effect as a face-to-face model when the therapeutic content is held constant.
Patients will be followed at baseline, 3 months, 6 months, and 1 year. The first 3-month checkpoint carries the main efficacy readout. Later assessments will help determine whether any early differences persist, narrow, or widen over time, especially in a condition where symptoms often fluctuate and functional recovery may lag behind initial pain relief.
Disability at 3 Months Sits at the Center of the Trial
The primary endpoint is change in low back pain-related disability at 3 months, measured with the Oswestry Disability Index. Investigators set a non-inferiority margin of 6 points, using the minimal clinically important difference for the instrument as the benchmark. In practical terms, the trial is asking whether telerehabilitation can stay close enough to in-clinic care on function that any small loss, if present, would be clinically acceptable when weighed against gains in access.
That choice reflects the reality of chronic pain treatment. For many patients, the core outcome is not simply less pain on a scale but the ability to move, work, sit, sleep, and manage daily responsibilities with less limitation. Disability captures that broader effect better than pain intensity alone, which is why it serves as the anchor outcome here.
Pain, Function, Opioid Use, and Utilization Will Be Tracked Too
Secondary outcomes extend beyond disability to include changes in pain intensity, pain interference, and physical function. The study will also examine opioid use and broader healthcare utilization tied to low back pain. Those outcomes could prove important if telerehabilitation improves access without increasing downstream resource use, or if it changes how often patients seek additional care outside the physical therapy pathway.
The inclusion of utilization outcomes gives the trial a health-systems dimension. Physical therapy is often promoted not only for symptom relief but also for its potential to reduce reliance on more expensive or less desirable care. If remote delivery can preserve that effect while making appointments easier to keep, it could carry implications for primary care referral patterns, specialty triage, and payer policy.
A telehealth model still has to prove it can work inside the daily realities of chronic pain.
Why This Trial Matters for Access, Adherence, and Patient Experience
The rationale for the study comes directly from the gap between evidence and uptake. Physical therapy improves disability and pain in low back pain and can lower the cost of care, yet fewer than 15% of eligible patients ever attend. Transportation, work schedules, and the burden of repeated visits make traditional care hard to complete. Patients with chronic pain may also find frequent clinic trips physically difficult, which can turn even a reasonable treatment plan into a logistical obstacle course.
Telerehabilitation gained visibility during the COVID-19 pandemic, when remote care became a practical necessity in many systems. TeleBACK builds on that shift by testing a video-based model in a rigorous comparative trial rather than assuming convenience automatically translates into effectiveness. The study will also look at treatment satisfaction and therapeutic alliance as exploratory measures. Those endpoints are particularly relevant in rehabilitation, where engagement, trust, and the patient-clinician relationship can shape adherence as much as the exercise program itself.
A remote visit only helps if the patient can use it, follow it, and stay with it long enough to benefit.
What the Protocol Does and Does Not Answer Yet
Because TeleBACK is a protocol rather than a completed efficacy report, the clinical value lies in the design rather than the results. The trial does not yet tell clinicians whether telerehabilitation will match in-clinic care, whether one format will perform better in certain subgroups, or whether patient satisfaction will differ enough to influence long-term adoption. It does, however, establish a clear framework for answering those questions in a real-world setting across multiple healthcare systems.
The study has Institutional Review Board approval through Johns Hopkins Medicine, which serves as the single IRB. Data sharing will follow Patient-Centered Outcomes Research Institute guidelines once the trial is complete. Trial registration is listed as NCT06821607.
For clinicians treating chronic low back pain, the central question is immediate and practical: can effective rehabilitation move closer to patients without losing its therapeutic value? TeleBACK is built to test exactly that.