Digital and hybrid interventions for subacute and chronic low back pain: component network meta-analysis

Abstract Digital and hybrid interventions combining exercise, education, and psychological components are increasingly used for low back pain (LBP), but it remains unclear which components and combinations drive efficacy. We conducted a prospectively registered component network meta-analysis (CNMA) to evaluate their efficacy and safety for non-specific LBP. Six databases and two trial registries were searched to May 2025. Data on disability, pain intensity, and adverse events were analysed using a Bayesian random-effects CNMA. Of 2809 records, 56 reports of 46 studies (6717 participants; 80% chronic low back pain) were included. Hybrid interventions combining digital and in-person exercise with in-person psychological components (MD: –22.21; 95%-CrI: –34.11 to –10.67), digital and in-person exercise (MD: –15.75; 95%-CrI: –22.79 to –8.80), or digital exercise with physiotherapy (MD: –13.17; 95%-CrI: –21.18 to –5.16) reduced disability versus no intervention at short-term (minimal clinically important difference (MCID): 4.92/100 Oswestry Disability Index). Digital and in-person exercise (MD: -1.76; 95%-CrI: -2.62; -0.87) and combined digital exercise training with in-person education (MD: -1.73; 95%-CrI: -2.71; -0.83) improved pain intensity beyond the MCID (0.82/10 numeric pain rating scale). No serious adverse events were noted. Multicomponent hybrid interventions appear safe and may provide clinically meaningful improvements for chronic LBP.