Clinical and Cost Effectiveness of a Clinic-Based and Two Digital Applications of Mckenzie Therapy for Chronic Low-Back Pain

Objectives This study evaluated the clinical and cost effectiveness of a clinic-based McKenzie therapy (CBMT), mobile-phone based McKenzie therapy (TBMT) and virtual-reality based McKenzie therapy (VRGMT) in patients with long-term low back pain (LBP). Methods One hundred twenty consenting patients with long-term LBP were randomised into CBMT; n = 43; TBMT; n = 36; VRGMT; n = 41 and completed the study. The intervention was applied thrice weekly for eight weeks. Outcomes were assessed in terms of Pain Intensity (PI), Back Extension Muscles’ Endurance (BEME), Activity Limitation (AL), Participation Restriction (PR), Fear Avoidance Belief (FAB), Kinesiophobi (Kp), General Health Status (GHS) and resource use questionnaire. Data were analysed using descriptive and inferential statistics. Economic evaluation estimates were the incremental cost effectiveness ratios. Results The mean of age of the participants was 42.9 ± 12.1years. There was a significant difference (p < 0.05) within group comparison across baseline, 4th and 8th week for all the variables. However, there were no significant differences (p > 0.05) across the groups at 4th week, except for CBMT. Across group analysis showed there were significant differences in the mean change for ODI, FABQ-P, FABQ-W, TSK, and all GHS domains except for MH (all p < 0.05). Similarly, there were significant differences in across the groups at the end of the eight weeks in mean change for ODI, FAB-P, and all domains of GHS (all p < 0.05) except for RLM (p > 0.05). Compared to CBMT, BEVRG and TBMT were dominant interventions. Conclusions The findings of the study indicate that CBMT and its digital variants are effective for reducing pain and disability and improving psychosocial outcomes and GHS in patients with chronic LBP. However, BEVRG and TBMT compared to CBMT were cost effective as they offer the lowest cost and highest health benefits in this patient group.