Mobile-Web app to self-manage low back pain: randomized controlled trial

A Blair Irvine, Holly Russell, Michael Manocchia, David E Mino, Terri Cox Glassen, Rebecca Morgan, Jeff M Gau, Amelia J Birney, Dennis V Ary, A Blair Irvine, Holly Russell, Michael Manocchia, David E Mino, Terri Cox Glassen, Rebecca Morgan, Jeff M Gau, Amelia J Birney, Dennis V Ary

Abstract

Background: Nonspecific low back pain (NLBP) is the diagnosis for individuals with back pain that has no underlying medical cause (eg, tumor, infection, fracture, herniated disc, spinal stenosis). The American College of Physicians (ACP) and American Pain Society (APS) recommend multidisciplinary treatments for NLBP that lasts more than 4 weeks. This approach, however, is impractical for many physicians to implement, and relatively few providers offer NLBP treatment that meets the joint ACP-APS guidelines.

Objective: This study evaluated the efficacy of a mobile-Web intervention called "FitBack" to help users implement self-tailored strategies to manage and prevent NLBP occurrences.

Methods: A total of 597 adults were recruited, screened, consented, and assessed online at baseline, at 2 months (T2), and at 4 months (T3). After baseline assessments, participants were randomized into three groups: FitBack intervention, alternative care group that received 8 emails urging participants to link to six Internet resources for NLBP, and control group. The FitBack group also received weekly email reminder prompts for 8 weeks plus emails to do assessments. The control group was only contacted to do assessments.

Results: Users of the FitBack program showed greater improvement compared to the control group in every comparison of the critical physical, behavioral, and worksite outcome measures at 4-month follow-up. In addition, users of the FitBack program performed better than the alternative care group on current back pain, behavioral, and worksite outcomes at 4-month follow-up. For example, subjects in the control group were 1.7 times more likely to report current back pain than subjects in the FitBack group; subjects in the alternative care group were 1.6 times more likely to report current back pain at 4-month follow-up. Further, the users of the FitBack program showed greater improvement compared to both the control and alternative care groups at 4-month follow-up on patient activation, constructs of the Theory of Planned Behavior, and attitudes toward pain.

Conclusions: This research demonstrated that a theoretically based stand-alone mobile-Web intervention that tailors content to users' preferences and interests can be an effective tool in self-management of low back pain. When viewed from the RE-AIM perspective (ie, reach, efficacy/effectiveness, adoption, implementation fidelity, and maintenance), this study supports the notion that there is considerable value in this type of intervention as a potentially cost-effective tool that can reach large numbers of people. The results are promising considering that the FitBack intervention was neither supported by professional caregivers nor integrated within a health promotion campaign, which might have provided additional support for participants. Still, more research is needed on how self-guided mobile-Web interventions will be used over time and to understand factors associated with continuing user engagement.

Trial registration: Clinicaltrials.gov NCT01950091; https://ichgcp.net/clinical-trials-registry/NCT01950091 (Archived by WebCite at http://www.webcitation.org/6TwZucX77).

Keywords: Internet; app; computers; low back pain; mobile; prevention; self-treatment.

Conflict of interest statement

Conflicts of Interest: Blair Irvine was the grant Principal Investigator. Now retired, he was employed as a Research Scientist at ORCAS, a health care technology company that creates self-management programs to improve physical and emotional well-being. Software development was funded with a Small Business Innovation Research grant, which was designed to stimulate research and product development. Thus, improved versions of FitBack will be marketed. Dr Irvine and the other authors derived no financial benefit from sales or from publication of this research.

Figures

Figure 1
Figure 1
FitBack daily tracking page. Users indicate intensity of current pain (top left), can add current pain prevention activities (middle left), and use the journal tool (bottom left). Users can access featured and recommended videos (right) and charts of activities and pain (snapshot and link bottom right).
Figure 2
Figure 2
Research design flowchart for FitBack program evaluation.

References

    1. Chou R, Qaseem A, Snow V, Casey D, Cross JT, Shekelle P, Owens DK, Clinical Efficacy Assessment Subcommittee of the American College of Physicians. American College of Physicians. American Pain Society Low Back Pain Guidelines Panel Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society. Ann Intern Med. 2007 Oct 2;147(7):478–91.
    1. Dagenais S, Caro J, Haldeman S. A systematic review of low back pain cost of illness studies in the United States and internationally. Spine J. 2008;8(1):8–20. doi: 10.1016/j.spinee.2007.10.005.
    1. Deyo RA, Mirza SK, Martin BI. Back pain prevalence and visit rates: estimates from U.S. national surveys, 2002. Spine (Phila Pa 1976) 2006 Nov 1;31(23):2724–7. doi: 10.1097/.
    1. Strine TW, Hootman JM. US national prevalence and correlates of low back and neck pain among adults. Arthritis Rheum. 2007 May 15;57(4):656–65. doi: 10.1002/art.22684.
    1. Nachemson AL, Jonsson E. Neck and Back Pain: The Scientific Evidence of Causes, Diagnosis, and Treatment. Philadelphia, PA: Lippincott Williams & Wilkins; 2000.
    1. Pruitt SD, Von Korff M. Improving the management of low back pain: a paradigm shift for primary care. In: Turk DC, Gatchel RJ, editors. Psychological Approaches to Pain Management: A Practitioner's Handbook. New York: The Guilford Press; 2002. pp. 301–316.
    1. Bratton RL. Assessment and management of acute low back pain. Am Fam Physician. 1999 Nov 15;60(8):2299–308.
    1. Wright AR, Gatchel RJ. Occupational musculoskeletal pain and disability. In: Turk DC, Gatchel RJ, editors. Psychological Approaches to Pain Management: A Practitioner's Handbook. New York: The Guilford Press; 2002. pp. 349–364.
    1. Luo X, Pietrobon R, Sun SX, Liu GG, Hey L. Estimates and patterns of direct health care expenditures among individuals with back pain in the United States. Spine (Phila Pa 1976) 2004 Jan 1;29(1):79–86. doi: 10.1097/01.BRS.0000105527.13866.0F.
    1. Martin BI, Deyo RA, Mirza SK, Turner JA, Comstock BA, Hollingworth W, Sullivan SD. Expenditures and health status among adults with back and neck problems. JAMA. 2008 Feb 13;299(6):656–64. doi: 10.1001/jama.299.6.656.
    1. Atlas SJ, Wasiak R, van den Ancker M, Webster B, Pransky G. Primary care involvement and outcomes of care in patients with a workers' compensation claim for back pain. Spine (Phila Pa 1976) 2004 May 1;29(9):1041–8.
    1. Turunen JH, Mäntyselkä PT, Kumpusalo EA, Ahonen RS. How do people ease their pain? A population-based study. J Pain. 2004 Nov;5(9):498–504. doi: 10.1016/j.jpain.2004.08.003.
    1. Wolsko PM, Eisenberg DM, Davis RB, Kessler R, Phillips RS. Patterns and perceptions of care for treatment of back and neck pain: results of a national survey. Spine (Phila Pa 1976) 2003 Feb 1;28(3):292–7; discussion 298. doi: 10.1097/01.BRS.0000042225.88095.7C.
    1. Savigny P, Watson P, Underwood M, Guideline Development Group Early management of persistent non-specific low back pain: summary of NICE guidance. BMJ. 2009;338:b1805.
    1. Gatchel RJ. Clinical Essentials of Pain Management. Washington, DC: American Psychological Association (APA); 2005.
    1. Collins JJ, Baase CM, Sharda CE, Ozminkowski RJ, Nicholson S, Billotti GM, Turpin RS, Olson M, Berger ML. The assessment of chronic health conditions on work performance, absence, and total economic impact for employers. J Occup Environ Med. 2005 Jun;47(6):547–57.
    1. Working Knowledge: Harvard Business School; 2004. [2013-12-12]. Help your employees fight illness. A presenteeism report card .
    1. Stewart WF, Ricci JA, Chee E, Morganstein D. Lost productive work time costs from health conditions in the United States: results from the American Productivity Audit. J Occup Environ Med. 2003 Dec;45(12):1234–46. doi: 10.1097/01.jom.0000099999.27348.78.
    1. Stewart WF, Ricci JA, Chee E, Morganstein D, Lipton R. Lost productive time and cost due to common pain conditions in the US workforce. JAMA. 2003 Nov 12;290(18):2443–54. doi: 10.1001/jama.290.18.2443.
    1. Linton SJ. A cognitive-behavioral approach to the prevention of chronic back pain. In: Turk DC, Gatchel RJ, editors. Psychological Approaches to Pain Management: A Practitioner's Handbook. New York: The Guilford Press; 2002. pp. 317–333.
    1. Thorn BE. Cognitive therapy for chronic pain: a step-by-step guide. New York: Guilford Press; 2004.
    1. Jensen IB, Bergström G, Ljungquist T, Bodin L. A 3-year follow-up of a multidisciplinary rehabilitation programme for back and neck pain. Pain. 2005 Jun;115(3):273–83. doi: 10.1016/j.pain.2005.03.005.
    1. Storrø S, Moen J, Svebak S. Effects on sick-leave of a multidisciplinary rehabilitation programme for chronic low back, neck or shoulder pain: comparison with usual treatment. J Rehabil Med. 2004 Jan;36(1):12–6.
    1. van den Hout JH, Vlaeyen JW, Heuts PH, Zijlema JH, Wijnen JA. Secondary prevention of work-related disability in nonspecific low back pain: does problem-solving therapy help? A randomized clinical trial. Clin J Pain. 2003;19(2):87–96.
    1. Whitehurst DG, Lewis M, Yao GL, Bryan S, Raftery JP, Mullis R, Hay EM. A brief pain management program compared with physical therapy for low back pain: results from an economic analysis alongside a randomized clinical trial. Arthritis Rheum. 2007 Apr 15;57(3):466–73. doi: 10.1002/art.22606.
    1. Keefe FJ, Abernethy AP, C Campbell L. Psychological approaches to understanding and treating disease-related pain. Annu Rev Psychol. 2005;56:601–30. doi: 10.1146/annurev.psych.56.091103.070302.
    1. Lethem JS, Slade PD, Troup JD, Bentley G. Outline of a fear-avoidance model of exaggerated pain perception—I. Behav Res and Ther. 1983 Jan;21(4):401–408. doi: 10.1016/0005-7967(83)90009-8.
    1. Vlaeyen JW, Linton SJ. Fear-avoidance and its consequences in chronic musculoskeletal pain: a state of the art. Pain. 2000 Apr;85(3):317–332. doi: 10.1016/S0304-3959(99)00242-0.
    1. Lang E, Liebig K, Kastner S, Neundörfer B, Heuschmann P. Multidisciplinary rehabilitation versus usual care for chronic low back pain in the community: effects on quality of life. Spine J. 2003;3(4):270–6.
    1. Kent PM, Keating JL, Taylor NF. Primary care clinicians use variable methods to assess acute nonspecific low back pain and usually focus on impairments. Man Ther. 2009 Feb;14(1):88–100. doi: 10.1016/j.math.2007.12.006.
    1. Keefe FJ, Rumble ME, Scipio CD, Giordano LA, Perri LM. Psychological aspects of persistent pain: current state of the science. J Pain. 2004 May;5(4):195–211. doi: 10.1016/j.jpain.2004.02.576.
    1. Veterans Health Administration/Department of Defense VHA/DOD Clinical practice guideline for management of low back pain or sciatica in the primary care setting. 2005. [2013-12-12].
    1. Sheldon P, Huesler C. Adobe Experience Manager. [2013-11-01]. 7 ways to simplify your mobile strategy. .
    1. Latimer AE, Salovey P, Rothman AJ. The effectiveness of gain-framed messages for encouraging disease prevention behavior: is all hope lost? J Health Commun. 2007;12(7):645–9. doi: 10.1080/10810730701619695.
    1. Rothman AJ, Salovey P. Shaping perceptions to motivate healthy behavior: the role of message framing. Psychol Bull. 1997 Jan;121(1):3–19.
    1. Irvine AB, Philips L, Seeley J, Wyant S, Duncan S, Moore RW. Get Moving: a web site that increases physical activity of sedentary employees. Am J Health Promot. 2011;25(3):199–206. doi: 10.4278/ajhp.04121736.
    1. Irvine AB, Gelatt VA, Seeley JR, Macfarlane P, Gau JM. Web-based intervention to promote physical activity by sedentary older adults: randomized controlled trial. J Med Internet Res. 2013;15(2):e19. doi: 10.2196/jmir.2158.
    1. Bandura A. Self-efficacy: toward a unifying theory of behavioral change. Psychol Rev. 1977 Mar;84(2):191–215.
    1. Bandura A. Social Foundations of Thought and Action: A Social Cognitive Theory. Englewood Cliffs, N.J: Prentice-Hall; 1986.
    1. Ajzen I. The theory of planned behavior. Organ Behav Hum Decis Process. 1991 Dec;50(2):179–211. doi: 10.1016/0749-5978(91)90020-T.
    1. Fishbein M, Ajzen I. Predicting and Changing Behavior: The Reasoned Action Approach. New York: Psychology Press; 2009.
    1. Webb TL, Joseph J, Yardley L, Michie S. Using the internet to promote health behavior change: a systematic review and meta-analysis of the impact of theoretical basis, use of behavior change techniques, and mode of delivery on efficacy. J Med Internet Res. 2010;12(1):e4. doi: 10.2196/jmir.1376.
    1. Wong D, Hockenberry-Eaton M, Wilson D, Winkelstein M, Schwartz P. Wong's essentials of pediatric nursing. St. Louis, Mo: Elsevier Mosby; 2005.
    1. WebMD Back Pain Health Center. 2013. [2013-12-12]. .
    1. Mayo Clinic Back Pain. [2013-11-25]. .
    1. Wikipedia Back Pain. [2013-11-20]. .
    1. MedlinePlus Back Pain. [2013-11-20]. .
    1. OrthoInfo Low Back Pain. [2014-11-06]. .
    1. Gelatt VA, Adler-Baeder F, Seeley JR. An interactive Web-based program for parents in stepfamilies: Development and evaluation of efficacy. Fam Relat. 2010;59(5):572–586. doi: 10.1111/j.1741-3729.2010.00624.x.
    1. Dominick SA, Irvine AB, Beauchamp N, Seeley JR, Nolen-Hoeksema S, Doka KJ, Bonanno GA. An internet tool to normalize grief. Omega (Westport) 2009;60(1):71–87.
    1. Swartz LH, Sherman CA, Harvey SM, Blanchard J, Vawter F, Gau J. Midlife women online: evaluation of an internet-based program to prevent unintended pregnancy & STIs. J Women Aging. 2011 Oct;23(4):342–59. doi: 10.1080/08952841.2011.613255.
    1. Dworkin RH, Turk DC, Farrar JT, Haythornthwaite JA, Jensen MP, Katz NP, Kerns RD, Stucki G, Allen RR, Bellamy N, Carr DB, Chandler J, Cowan P, Dionne R, Galer BS, Hertz S, Jadad AR, Kramer LD, Manning DC, Martin S, McCormick CG, McDermott MP, McGrath P, Quessy S, Rappaport BA, Robbins W, Robinson JP, Rothman M, Royal MA, Simon L, Stauffer JW, Stein W, Tollett J, Wernicke J, Witter J, IMMPACT Core outcome measures for chronic pain clinical trials: IMMPACT recommendations. Pain. 2005 Jan;113(1-2):9–19. doi: 10.1016/j.pain.2004.09.012.
    1. Kerns RD, Turk DC, Rudy TE. The West Haven-Yale Multidimensional Pain Inventory (WHYMPI) Pain. 1985 Dec;23(4):345–56.
    1. Cleeland CS, Ryan KM. Pain assessment: global use of the Brief Pain Inventory. Ann Acad Med Singapore. 1994 Mar;23(2):129–38.
    1. Nelson E, Wasson J, Kirk J, Keller A, Clark D, Dietrich A, Stewart A, Zubkoff M. Assessment of function in routine clinical practice: description of the COOP Chart method and preliminary findings. J Chronic Dis. 1987;40 Suppl 1:55S–69S.
    1. Lerner D, Amick BC, Rogers WH, Malspeis S, Bungay K, Cynn D. The Work Limitations Questionnaire. Med Care. 2001 Jan;39(1):72–85.
    1. Koopman C, Pelletier KR, Murray JF, Sharda CE, Berger ML, Turpin RS, Hackleman P, Gibson P, Holmes DM, Bendel T. Stanford Presenteeism Scale: Health status and employee productivity. J Occup Environ Med. 2002 Jan;44(1):14–20.
    1. Hibbard JH, Mahoney ER, Stockard J, Tusler M. Development and testing of a short form of the Patient Activation Measure. Health Serv Res. 2005 Dec;40(6 Pt 1):1918–30. doi: 10.1111/j.1475-6773.2005.00438.x.
    1. Hibbard JH, Stockard J, Mahoney ER, Tusler M. Development of the Patient Activation Measure (PAM): conceptualizing and measuring activation in patients and consumers. Health Serv Res. 2004 Aug;39(4 Pt 1):1005–26. doi: 10.1111/j.1475-6773.2004.00269.x.
    1. Turk DC, Dworkin RH, Allen RR, Bellamy N, Brandenburg N, Carr DB, Cleeland C, Dionne R, Farrar JT, Galer BS, Hewitt DJ, Jadad AR, Katz NP, Kramer LD, Manning DC, McCormick CG, McDermott MP, McGrath P, Quessy S, Rappaport BA, Robinson JP, Royal MA, Simon L, Stauffer JW, Stein W, Tollett J, Witter J. Core outcome domains for chronic pain clinical trials: IMMPACT recommendations. Pain. 2003 Dec;106(3):337–45.
    1. Tait RC, Chibnall JT. Development of a brief version of the Survey of Pain Attitudes. Pain. 1997 Apr;70(2-3):229–35.
    1. Jensen MP, Turner JA, Romano JM. What is the maximum number of levels needed in pain intensity measurement? Pain. 1994 Sep;58(3):387–92.
    1. Burwinkle T, Robinson JP, Turk DC. Fear of movement: factor structure of the Tampa Scale of Kinesiophobia in patients with fibromyalgia syndrome. J Pain. 2005 Jun;6(6):384–91. doi: 10.1016/j.jpain.2005.01.355.
    1. Sauro J. Measuring usability with the System Usability Scale (SUS) 2011. Feb 2, [2011-08-24]. .
    1. Bangor A, Kortum K, Miller J. Determining what individual SUS scores mean: adding an adjective rating scale. JUS. 2009;4(3):114–123.
    1. Cohen J. Statistical Power Analysis for the Behavioral Sciences. Hillsdale, NJ: L. Erlbaum Associates; 1988.
    1. Schafer JL, Graham JW. Missing data: our view of the state of the art. Psychol Methods. 2002 Jun;7(2):147–77.
    1. Raghunathan T, Solenberger P, Van Hoewyk J. IVEware: Imputation and Variance Estimation Software User Guide. Ann Arbor, MI: University of Michigan Institute for Social Research; 2002.
    1. Abayomi K, Gelman A, Levy M. Diagnostics for multivariate imputations. J Royal Statistical Soc C. 2008 Jun;57(3):273–291. doi: 10.1111/j.1467-9876.2007.00613.x.
    1. Schneider F, de Vries H, Candel M, van de Kar A, van Osch L. Periodic email prompts to re-use an internet-delivered computer-tailored lifestyle program: influence of prompt content and timing. J Med Internet Res. 2013;15(1):e23. doi: 10.2196/jmir.2151.
    1. Fisher RJ. Social desirability bias and the validity of indirect questioning. J Consum Res. 1993 Sep;20(2):303–315.
    1. Zickuhr K, Smith A. Pew Research Internet Project. 2012. [2013-11-20]. Digital differences .
    1. Glasgow RE, Vogt TM, Boles SM. Evaluating the public health impact of health promotion interventions: the RE-AIM framework. Am J Public Health. 1999 Sep;89(9):1322–1327. doi: 10.2105/AJPH.89.9.1322.
    1. Eysenbach G, CONSORT-EHEALTH Group CONSORT-EHEALTH: improving and standardizing evaluation reports of Web-based and mobile health interventions. J Med Internet Res. 2011;13(4):e126. doi: 10.2196/jmir.1923.

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