Accepted for/Published in: JMIR mHealth and uHealth
Date Submitted: Jun 21, 2022
Date Accepted: Jun 9, 2023
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
The modifying role of pain duration and pain intensity on the effectiveness of app-delivered self-management for low back pain: Secondary analysis of the SELFBACK randomized controlled trial
ABSTRACT
Background:
mHealth solutions are a promising method for delivering tailored self-management interventions to patients with non-specific low back pain (LBP). However, it is not clear if the effectiveness of such self-management interventions depends on patients’ initial pain characteristics. High pain intensity and long-term symptoms of LBP have been associated with an unfavorable prognosis, and current best evidence indicates that long-term LBP (lasting more than 3 months) requires a more extensive treatment approach compared to acute LBP. The artificial intelligence-based SELFBACK app supports tailored and evidence-based self-management of non-specific LBP and have been shown to reduce LBP-related disability.
Objective:
To explore if baseline duration and intensity of LBP modify the effectiveness of the SELFBACK intervention.
Methods:
In this secondary analysis of the SELFBACK randomized controlled trial (RCT), we explore if baseline duration and intensity of LBP modify the effectiveness of the SELFBACK intervention. In the RCT, 461 adults who sought care for LBP in primary care or an outpatient spine clinic were randomized to receive the SELFBACK intervention adjunct to usual care (n=232) or usual care alone (n=229). Participants were then stratified according to duration of the current LBP episode at baseline (≤12 weeks vs >12 weeks) or baseline LBP intensity (≤5 points vs >5 points) measured by a 0-10 numeric rating scale (NRS). Outcomes were LBP-related disability measured by the Roland Morris Disability Questionnaire, average LBP intensity (NRS), pain self-efficacy, and global perceived effect.
Results:
Overall, there was no clear effect modification by duration or intensity of LBP at either three or nine months follow-up. However, there was suggestive evidence that the effect of the SELFBACK intervention on LBP-related disability at three months was largely confined to people with the highest vs the lowest LBP intensity (mean difference between the intervention and control group; -1.8 [95% CI -3.0 to -0.7] vs 0.2 [95% CI -1.1 to 0.7], respectively), but that this was not sustained at 9 months.
Conclusions:
The results suggest that intensity and duration of LBP have negligible influence on the effectiveness of the SELFBACK intervention on LBP-related disability, average LBP intensity, pain self-efficacy and global perceived effect. Clinical Trial: The multicenter SELFBACK RCT is registered in Clinicaltrials.gov: (NTC03798288). Registered 7 January 2019.
Citation
Request queued. Please wait while the file is being generated. It may take some time.
Copyright
© The authors. All rights reserved. This is a privileged document currently under peer-review/community review (or an accepted/rejected manuscript). Authors have provided JMIR Publications with an exclusive license to publish this preprint on it's website for review and ahead-of-print citation purposes only. While the final peer-reviewed paper may be licensed under a cc-by license on publication, at this stage authors and publisher expressively prohibit redistribution of this draft paper other than for review purposes.