Abstract
BACKGROUND: Low back pain (LBP) is prevalent in 30-70% of populations in developed and industrialized nations, imposing substantial healthcare costs and work absenteeism. However, research addressing chronic nonspecific low back pain (CNLBP) within the Black population globally, remains limited, particularly studies considering the specific sociocultural and demographic factors affecting this group. Telerehabilitation offers a novel opportunity for physiotherapists to manage musculoskeletal conditions to facilitate remote care delivery. This study aims to evaluate the effect of graded activity (gradual increases in difficulty) on the Afro-Brazilian adult population with CNLBP through the use of telerehabilitation. METHODS: This randomized, double-blind clinical trial employs a 1:1 allocation ratio with 102 Afro-Brazilian participants divided into two groups of 51 each. Eligibility criteria include both sexes, aged 18-65, with CNLBP persisting for ≥ 3 months, residing in Brazil. Participants are allocated to the Experimental Group (Graded Activity and Educational Program; EG) or the Control Group (Educational Program; CG). The intervention consists of a telerehabilitation program delivered via a mobile health (mHealth) application, conducted across 12 sessions over 4 weeks. Pain intensity serves as the primary outcome, while secondary outcomes include functional capacity, quality of life, anxiety, and fear-avoidance beliefs. We will also examine the extent to which the reduction in pain intensity varies by perceived discrimination. Assessments occur at baseline, post-intervention (4 weeks), and follow-ups at 3 and 6 months. Data are managed through a secure, web-based electronic data capture system. DISCUSSION: Telerehabilitation, as a remote, home-based intervention, holds promise for managing CNLBP, especially among historically underserved populations such as Afro-Brazilians. This study addresses gaps in research by focusing on racial and ethnic disparities in health access and outcomes, offering insights into the potential of telerehabilitation to mitigate inequities. TRIAL REGISTRATION: The study protocol is registered with ClinicalTrials.gov (NCT06443229, June 5, 2024).