Effect of Tele-Rehabilitation on Low Back Pain, Fatigue, and Psychological Well-being in Postpartum Women Following C-Section

Detailed Description

This study will evaluate the effect of a structured tele-rehabilitation program on low back pain, fatigue, and psychological well-being among postpartum women following cesarean section. The study will use a two-arm randomized controlled trial design. Participants will be recruited according to predefined eligibility criteria and will be randomly allocated to either an intervention group or an active comparator group.

The study will include postpartum women aged 20 to 40 years who have experienced low back pain following cesarean section and who are able to participate in tele-rehabilitation sessions. Participants with postpartum complications, neurological deficits, diagnosed spinal pathology, current physiotherapy treatment, or contraindications to exercise will be excluded. The study will be conducted over a 6-week intervention period, with assessments performed before and after the intervention. The synopsis specifies a postpartum recruitment period of approximately 2-6 weeks after delivery.

Participants will be randomly allocated using computer-generated randomization into two groups. The intervention group will receive tele-rehabilitation consisting of therapeutic exercises combined with ergonomic education and back-care advice. The active comparator group will receive ergonomic education and back-care advice without the therapeutic exercise component. Randomization will be performed independently of outcome assessment, and outcome assessors will be blinded to group allocation where feasible.

The therapeutic exercise program will be designed for postpartum women following cesarean section and will progress gradually according to participants' tolerance. The program will include gentle mobility exercises, pelvic and core muscle activation, pelvic floor exercises, strengthening exercises, and postural control activities. Exercises will include ankle pumps, heel slides, pelvic rocking, pelvic tilts, butterfly stretching, Kegel exercises, bridging, bow-and-arrow exercises, and shoulder rolls. Participants will also be encouraged to follow a gradually progressive walking program.

Ergonomic education will be provided to both groups. The education will focus on posture correction and safe performance of common postpartum activities. Participants will receive guidance regarding sitting and standing posture, breastfeeding and feeding positions, lifting and carrying the baby, bed mobility, bending and reaching, household activities, avoidance of prolonged flexed postures, back-care strategies, and activity pacing. Educational material will also be provided for home reference.

The tele-rehabilitation sessions will be delivered remotely through video-based communication platforms. Participants will receive guidance and supervision during the intervention and will be instructed to perform the prescribed exercises at home. Adherence will be monitored through follow-up communication, exercise records, or self-reported practice. Any pain or discomfort experienced during exercise will be monitored, and the exercise program will be modified when necessary.

The primary outcomes will include low back pain intensity, fatigue, and psychological well-being. Low back pain will be assessed using the Visual Analog Scale (VAS), fatigue will be assessed using the 9-item Fatigue Severity Scale (FSS), and psychological well-being will be assessed using the WHO-5 Well-Being Index. Functional disability related to low back pain will be assessed as a secondary outcome using the Oswestry Disability Index (ODI). The outcomes will be measured at baseline and immediately after completion of the 6-week intervention.

The study will determine whether adding therapeutic exercises through tele-rehabilitation to ergonomic education will provide greater improvements in low back pain, fatigue, and psychological well-being than ergonomic education alone. The findings will help assess whether remotely supervised rehabilitation can provide a practical and accessible physiotherapy approach for postpartum women who may experience difficulties accessing in-person rehabilitation after cesarean section.

The study will also provide information about the potential role of tele-rehabilitation in improving functional ability and reducing the impact of postpartum low back pain on daily activities. The results may support the development of accessible home-based physiotherapy programs for postpartum women, particularly in settings where regular face-to-face physiotherapy may be difficult to access.

Inclusion criteria

• • Postpartum women between 2-6 weeks after delivery

• Age 20-40 years
• Primiparous or multiparous
• Mild to moderate low back pain
• Able to participate in tele-rehabilitation sessions
• Post caesarian women

Exclusion criteria

• • Postpartum complications (e.g., infection, delayed healing)

• Neurological deficits
• Diagnosed spinal pathology (e.g., disc herniation, spondylolisthesis)
• Currently receiving physiotherapy treatment / taking analgesics
• Contraindications to exercise
• Nomal vaginal delivery women