Effectiveness of App-Delivered, Tailored Self-management Support for Adults With Lower Back Pain–Related Disability

Sandal, Louise Fleng; Bach, Kerstin; Øverås, Cecilie K; Svendsen, Malene Jagd; Dalager, Tina; Jensen, Jesper Stejnicher Drongstrup; Kongsvold, Atle; Nordstoga, Anne Lovise; Bardal, Ellen Marie; Ashikhmin, Ilya; Wood, Karen; Rasmussen, Charlotte Diana Nørregaard; Stochkendahl, Mette Jensen; Nicholl, Barbara I; Wiratunga, Nirmalie; Cooper, Kay; Hartvigsen, Jan; Kjær, Per; Sjøgaard, Gisela; Nilsen, Tom Ivar Lund; Mair, Frances S; Søgaard, Karen; Mork, Paul Jarle

doi:10.1001/jamainternmed.2021.4097

Cited by 77 publications

(160 citation statements)

References 43 publications

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“…There is a dearth of studies on the effectiveness of telerehabilitation and digital care programs on acute MSK conditions. The pain reduction herein reported (64.3%, with 74.8% participants above MCID of 2.0 [ 47 ]) is higher than that reported by Huber et al , [ 61 ] for an app-based intervention for low back pain (LBP) including education, physiotherapy and mindfulness (44%, from 4.5 to 2.5 points), as well as that reported by Sandal et al, [ 62 ] after an intervention that combined usual care with a self-management LBP app including exercises and educational articles (33%, from 4.9 to 3.3). These differences may reflect the cohorts used by these studies, that included participants with both acute and chronic LBP.…”

Section: Discussioncontrasting

confidence: 50%

“…Patient engagement has been one of the main challenges in delivering effective home-based MSK care [ 76 ]. In this study, we observed a completion rate of 87.5%, higher than that reported for conventional or home-based rehabilitations (range 30–76.3%) [ 34 , 77 , 78 ], and by other digital MSK interventions (73–87%) [ 62 , 79 ].…”

Section: Discussioncontrasting

confidence: 47%

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Telerehabilitation of acute musculoskeletal multi-disorders: prospective, single-arm, interventional study

Costa

Janela

Molinos

et al. 2022

BMC Musculoskelet Disord

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Background Acute musculoskeletal (MSK) pain is very common and associated with impaired productivity and high economic burden. Access to timely and personalized, evidence-based care is key to improve outcomes while reducing healthcare expenditure. Digital interventions can facilitate access and ensure care scalability. Objective Present the feasibility and results of a fully remote digital care program (DCP) for acute MSK conditions affecting several body areas. Methods Interventional single-arm study of individuals applying for digital care programs for acute MSK pain. Primary outcome was the mean change between baseline and end-of-program in self-reported Numerical Pain Rating Scale (NPRS) score and secondary outcomes were change in analgesic consumption, intention to undergo surgery, anxiety (GAD-7), depression (PHQ-9), fear-avoidance beliefs (FABQ-PA), work productivity (WPAI-GH) and engagement. Results Three hundred forty-three patients started the program, of which 300 (87.5%) completed the program. Latent growth curve analysis (LGCA) revealed that changes in NPRS between baseline and end-of-program were both statistically (p < 0.001) and clinically significant: 64.3% reduction (mean − 2.9 points). Marked improvements were also noted in all secondary outcomes: 82% reduction in medication intake, 63% reduction in surgery intent, 40% in fear-avoidance beliefs, 54% in anxiety, 58% in depression and 79% recovery in overall productivity. All outcomes had steeper improvements in the first 4 weeks, which paralleled higher engagement in this period (3.6 vs 3.2 overall weekly sessions, p < 0.001). Mean patient satisfaction score was 8.7/10 (SD 1.26). Strengths and limitations This is the first longitudinal study demonstrating the feasibility of a DCP for patients with acute MSK conditions involving several body areas. Major strengths of this study are the large sample size, the wide range of MSK conditions studied, the breadth of outcomes measured, and the very high retention rate and adherence level. The major limitation regards to the absence of a control group. Conclusions We observed very high completion and engagement rates, as well as clinically relevant changes in all health-related outcomes and productivity recovery. We believe this DCP holds great potential in the delivery of effective and scalable MSK care. Trial registration NCT, NCT04092946. Registered 17/09/2019;

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Section: Discussioncontrasting

confidence: 50%

Section: Discussioncontrasting

confidence: 47%

Telerehabilitation of acute musculoskeletal multi-disorders: prospective, single-arm, interventional study

Costa

Janela

Molinos

et al. 2022

BMC Musculoskelet Disord

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“…Previous studies in this research area have focused predominantly on web-based applications as a stand-alone intervention without the face-to-face guidance of a health care professional [ 15 , 22 , 50 ]. Only a few studies have investigated web-based applications as an adjunct to face-to-face guidance, and the results regarding the added value of these combined interventions have been inconclusive [ 15 , 51 ]. Similar to our study, Sandal et al [ 51 ] investigated a smartphone app as an adjunct to face-to-face guidance.…”

Section: Discussionmentioning

confidence: 99%

“…Only a few studies have investigated web-based applications as an adjunct to face-to-face guidance, and the results regarding the added value of these combined interventions have been inconclusive [ 15 , 51 ]. Similar to our study, Sandal et al [ 51 ] investigated a smartphone app as an adjunct to face-to-face guidance. The app was tailored using artificial intelligence and did not influence face-to-face guidance.…”

Section: Discussionmentioning

confidence: 99%

The 3-Month Effectiveness of a Stratified Blended Physiotherapy Intervention in Patients With Nonspecific Low Back Pain: Cluster Randomized Controlled Trial

Koppenaal¹,

Pisters²,

Kloek³

et al. 2022

J Med Internet Res

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Background Patient education, home-based exercise therapy, and advice on returning to normal activities are established physiotherapeutic treatment options for patients with nonspecific low back pain (LBP). However, the effectiveness of physiotherapy interventions on health-related outcomes largely depends on patient self-management and adherence to exercise and physical activity recommendations. e-Exercise LBP is a recently developed stratified blended care intervention comprising a smartphone app integrated with face-to-face physiotherapy treatment. Following the promising effects of web-based applications on patients’ self-management skills and adherence to exercise and physical activity recommendations, it is hypothesized that e-Exercise LBP will improve patients’ physical functioning. Objective This study aims to investigate the short-term (3 months) effectiveness of stratified blended physiotherapy (e-Exercise LBP) on physical functioning in comparison with face-to-face physiotherapy in patients with nonspecific LBP. Methods The study design was a multicenter cluster randomized controlled trial with intention-to-treat analysis. Patients with nonspecific LBP aged ≥18 years were asked to participate in the study. The patients were treated with either stratified blended physiotherapy or face-to-face physiotherapy. Both interventions were conducted according to the Dutch physiotherapy guidelines for nonspecific LBP. Blended physiotherapy was stratified according to the patients’ risk of developing persistent LBP using the Keele STarT Back Screening Tool. The primary outcome was physical functioning (Oswestry Disability Index, range 0-100). Secondary outcomes included pain intensity, fear-avoidance beliefs, and self-reported adherence. Measurements were taken at baseline and at the 3-month follow-up. Results Both the stratified blended physiotherapy group (104/208, 50%) and the face-to-face physiotherapy group (104/208, 50%) had improved clinically relevant and statistically significant physical functioning; however, there was no statistically significant or clinically relevant between-group difference (mean difference −1.96, 95% CI −4.47 to 0.55). For the secondary outcomes, stratified blended physiotherapy showed statistically significant between-group differences in fear-avoidance beliefs and self-reported adherence. In patients with a high risk of developing persistent LBP (13/208, 6.3%), stratified blended physiotherapy showed statistically significant between-group differences in physical functioning (mean difference −16.39, 95% CI −27.98 to −4.79) and several secondary outcomes. Conclusions The stratified blended physiotherapy intervention e-Exercise LBP is not more effective than face-to-face physiotherapy in patients with nonspecific LBP in improving physical functioning in the short term. For both stratified blended physiotherapy and face-to-face physiotherapy, within-group improvements were clinically relevant. To be able to decide whether e-Exercise LBP should be implemented in daily physiotherapy practice, future research should focus on the long-term cost-effectiveness and determine which patients benefit most from stratified blended physiotherapy. Trial Registration ISRCTN Registry 94074203; https://doi.org/10.1186/ISRCTN94074203 International Registered Report Identifier (IRRID) RR2-https://doi.org/10.1186/s12891-020-3174-z

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“…Overall 464 unique articles were identified once 14 duplicates were removed. Two reviewers completed title and abstract screening identifiying 29 for full-text screening; of these, 21 met our criteria, 8 are ongoing studies,56–63 8 are completed trials where a process evaluation was conducted but results are not available,64–71 and 5 are completed studies with process evaluation results available 72–76. As with the studies that were synthesised in our review, these included participants from a range of different ages and health conditions for example, insomnia disorder, diabetes, heart disease, hip fracture and obesity and generally focused on increasing physical activity, reducing sedentary behaviour or were lifestyle or weight loss interventions.…”

Section: Discussionmentioning

confidence: 99%

Systematic review of process evaluations of interventions in trials investigating sedentary behaviour in adults

et al. 2022

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ObjectivesTo systematically review and synthesise findings from process evaluations of interventions in trials which measured sedentary behaviour as an outcome in adults to explore: (1) how intervention content, implementation, mechanisms of impact and context influence outcomes and (2) how these interventions are experienced from different perspectives (participants, carers, staff).DesignSystematic review and narrative synthesis underpinned by the Medical Research Council process evaluation framework.Data sourcesDatabases searches were conducted in March 2019 then updated in May 2020 and October 2021 in: CINAHL, SPORTDiscus, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, AMED; EMBASE, PsycINFO, MEDLINE, Web of Science and ProQuest Dissertations & Theses.Eligibility criteriaWe included: Process evaluations of trials including interventions where sedentary behaviour was measured as an outcome in adults aged 16 or over from clinical or non-clinical populations. We excluded studies if interventions were delivered in educational or workplace settings, or if they were laboratory studies focused on immediate effects of breaking sitting.Data extraction and synthesisTwo independent reviewers extracted and coded data into a framework and assessed the quality of studies using the Mixed Methods Appraisal Tool. We synthesised findings using a narrative approach.Results17 process evaluations were included. Five interventions focused on reducing sedentary behaviour or sitting time, 12 aimed to increase physical activity or promote healthier lifestyles. Process evaluations indicated changes in sedentary behaviour outcomes were shaped by numerous factors including: barriers (eg, staffing difficulties and scheduling problems) and facilitators (eg, allowing for flexibility) to intervention delivery; contextual factors (eg, usual lifestyle and religious events) and individual factors (eg, pain, tiredness, illness, age and individual preferences).DiscussionIntervention requires careful consideration of different factors that could influence changes in sedentary behaviour outcomes to ensure that interventions can be tailored to suit different individuals and groups.PROSPERO registration numberCRD42018087403.

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Effectiveness of App-Delivered, Tailored Self-management Support for Adults With Lower Back Pain–Related Disability

Abstract: This randomized clinical trial examines a decision support tool that provides lower back pain information and self-management recommendations that are specific to an individual’s characteristics, symptoms, and symptom progression.

Cited by 77 publications

References 43 publications

Telerehabilitation of acute musculoskeletal multi-disorders: prospective, single-arm, interventional study

Telerehabilitation of acute musculoskeletal multi-disorders: prospective, single-arm, interventional study

The 3-Month Effectiveness of a Stratified Blended Physiotherapy Intervention in Patients With Nonspecific Low Back Pain: Cluster Randomized Controlled Trial

Systematic review of process evaluations of interventions in trials investigating sedentary behaviour in adults

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