Study: Hybrid layered physical therapy no more effective than face-to-face care

A blended approach to physical therapy, using digital interventions to support face-to-face care, was no more effective in treating nonspecific low back pain compared to face-to-face therapy alone, according to a study published in JMIR.


The study found that stratified blended physical therapy, which divides patients into groups based on their risk of developing persistent low back pain, did not improve physical functioning compared to face-to-face physical therapy.

However, researchers found that the blended therapy improved beliefs about fear avoidance and patients’ self-reported adherence to home exercise.

“The stratified blended physical therapy intervention e-Exercise LBP [low back pain] is no more effective than face-to-face physical therapy in patients with nonspecific LRP in improving short-term physical function,” the study authors wrote.

“For both stratified blended physical therapy and face-to-face physical therapy, in-group improvements were clinically relevant. In order to decide whether e-Exercise LBP should be implemented in daily physical therapy practice, future research should focus on the long-term costs – effectiveness and determine which patients benefit most from stratified blended physical therapy.”


From June 2018 to December 2019, 434 patients with low back pain participated in either blended physiotherapy or face-to-face therapy in the Netherlands.

The blended therapy included a smartphone app with information on self-management, video exercises, and a personalized goal-based physical activity module. The duration and content they received was based on their risk of developing persistent low back pain using Keele STarT back screening tool. Those in the face-to-face group only received personalized care according to national guidelines that differentiate between different patient needs, but do not use a specific tool to stratify care.

The patients were given a questionnaire at the start of the study and after three months. The primary outcome measure studied was physical functioning, but researchers also tracked outcomes such as pain intensity, physical activity, fear-avoiding beliefs about physical activity and work, catastrophic pain, self-efficacy, self-management ability, health-related quality of life, and patient self-reported adherence to home exercise.


Digital physiotherapy and musculoskeletal care are a Growing Field in the US Some of the bigger players, including Hinge Health and SWORD Health, raised nine-figure funding rounds last year.

Earlier this week, RecoveryOne, that too scored $33 million in a Series C round in 2021, launched its own computer vision tool that can track movement and provide feedback to patients on how to perform exercises.

Meanwhile, there are a number of hybrid healthcare startups in the general health space that aim to integrate virtual and personal care, including Carbon Health and One Medical.


Researchers noted that a limitation of the study could be that patients’ risk of developing persistent low back pain affected the results.

“Especially in the highest-risk group, consistent differences between groups were seen in both primary and secondary outcomes, supporting the rationale for stratified blended physical therapy.

“Since this was not the primary aim of this study, the sample size calculation did not take into account interaction, the numbers were small and therefore the results should be interpreted with caution,” the authors wrote.