Comparison of Telerehabilitation and Face-to-Face McKenzie Therapy Following Unilateral Biportal Endoscopic Discectomy: A Multicentre Retrospective Matched Cohort Study

AIM: To compare short-term pain, disability, and functional outcomes between telerehabilitation and face-to-face McKenzie therapy following unilateral biportal endoscopic (UBE) discectomy for lumbar disc herniation (LDH). METHODS: This multicentre retrospective matched cohort study included adults undergoing UBE discectomy for LDH at Shanghai Sixth People’s Hospital and Xiyuan Hospital of China Academy of Chinese Medical Sciences between October 2023 and December 2024. Patients received either in-home telerehabilitation (Tele) or in-clinic physiotherapy (Clinic) according to the standard practice of the treating centre rather than by random allocation. Propensity score matching (PSM, 1:1) was used to reduce confounding. Both groups completed a 12-week McKenzie programme. Primary outcomes were Modified Von Korff (MvK) pain and disability scales and the Oswestry Disability Index (ODI) at 12 weeks. Secondary outcomes included visual analogue scale (VAS) scores, modified lumbar Schober (MLS), and the 6-minute walk test (6MWT). RESULTS: After matching, 122 patients were included (Tele: n = 61; Clinic: n = 61). Matching reduced between-group imbalance for every covariate, with all absolute standardised mean differences (SMDs) below 0.25, although modest residual imbalances remained for some covariates. For the primary outcomes, scores decreased significantly from baseline to 12 weeks in both groups (all time effects, p < 0.001), with no significant group × time interactions detected (MvK pain, p = 0.979; MvK disability, p = 0.794; ODI, p = 0.910). The between-group difference on the MvK pain scale at 12 weeks was substantially smaller than the established minimal clinically important difference (MCID) of 10 points. All secondary outcomes also improved significantly in both groups (all time effects, p < 0.001), with no significant between-group differences detected (all interaction p > 0.05). Overall adverse event rates were comparable between groups. CONCLUSIONS: Telerehabilitation and face-to-face McKenzie therapy were associated with comparable short-term improvements after UBE discectomy. These findings suggest that telerehabilitation may be a feasible alternative to in-clinic rehabilitation, although prospective randomised trials are needed for confirmation.