Therapeutic Exercise and Education for Low Back Pain

This study will evaluate a new treatment program for patients with ongoing or long-term low back pain who receive care at primary care physiotherapy units. Participants with subacute or chronic nonspecific low back pain will be randomly divided into three groups for comparison of their progress. The first group will receive an eight-week program of therapeutic exercise and health education, which will be delivered entirely online. The second group will receive the same exercise and education program in face-to-face sessions. The third group will receive standard physiotherapy care. The study will last eight weeks, and researchers will follow up with participants three months later. The project's main goal is to measure changes in participants' daily disability levels. The researchers will also examine other important factors, such as pain intensity, fear of movement, anxiety, depression, quality of life, and overall satisfaction with the care received. Measurements will be taken before the study begins, immediately after the eight-week program ends, and at the three-month follow-up. This trial aims to find more accessible, evidence-based ways to treat back pain, reduce hospital waiting lists, and improve patient well-being by combining digital and in-person care.

Inclusion criteria: * Patients with non-specific low back pain, aged 18 years or older. * Pain duration of more than six weeks * Onset or modification of low back pain with maintenance of positions and/or movements * Presenting a mild-to-moderate level of disability, as determined by the Oswestry Disability Index (ODI) questionnaire. * Presence of limitations or symptoms in at least two range of motion (ROM) or coordination assessment tests, as described in clinical guidelines: * Lumbar and/or hip range of motion (ROM) measured with inclinometry Prone instability test * Presence of aberrant movements: * Painful arc with flexion or return from flexion * Instability catch * Gower sign * Reversal of lumbopelvic rhythm * Strength and endurance of the abdominal musculature * Email access and a device with an internet connection are required. * Availability and willingness to participate in all study sessions. Exclusion criteria: * Presence of acute, nociplastic, radicular, and/or referred pain * Presence of red flags * Previous surgeries in the spine, pelvis, or hip * Presence of concomitant cardiovascular, neurological, endocrine, or immune pathologies that prevent physical activity * Presence of psychiatric disorders * Pregnancy * Having received physiotherapy treatment, analgesic blocks, corticosteroid injections, or any other type of intervention within the last three months * Changes in lifestyle habits, work conditions, or physical activity levels within the last three months * Inability to meet the program's physical or cognitive demands during the eight weeks