Digital care vs. conventional physiotherapy for low back pain

Study overview

Chronic low back pain is a leading cause of disability, and conventional physiotherapy is a recommended first-line treatment. This randomized controlled trial compared Sword’s digital care program with evidence-based in-person physiotherapy for chronic low back pain.

The study enrolled 140 participants and randomized them to either digital care or conventional in-person physiotherapy. The primary outcome was disability improvement, with secondary outcomes including pain, anxiety, depression, surgery intent, medication use, fear-avoidance beliefs, physical activity, absenteeism, presenteeism, and overall productivity.

Key findings

Digital care produced equivalent disability improvement

The study found no meaningful difference in the primary outcome between digital care and conventional physiotherapy, supporting equivalence in disability improvement for chronic low back pain.

Secondary outcomes were also comparable

Pain, anxiety, depression, and overall productivity impairment improved similarly across groups, suggesting that the digital program achieved comparable outcomes across multiple dimensions of recovery.

Dropout was lower in the digital group

The study reported a significantly lower dropout rate in the digital care group, with 15.7% dropout compared with 34.3% in the conventional physiotherapy group.

Satisfaction and adherence were high

Patient satisfaction and adherence were high and similar between groups, supporting the acceptability of a fully remote model for chronic low back pain.

Why this study matters

This study is one of the strongest pieces of evidence in Sword’s comparative effectiveness library. It directly compares digital care with conventional in-person physiotherapy rather than relying only on baseline-to-endpoint change.

For clinical audiences, the study supports digital care as a credible alternative to conventional physiotherapy for chronic low back pain. For organizations evaluating access and scale, the lower dropout rate is especially meaningful because outcomes depend on members staying engaged in care.

Read the full study