Accepted for/Published in: JMIR mHealth and uHealth
Date Submitted: Apr 15, 2023
Date Accepted: Jul 21, 2023
Efficacy of mobile-health interventions for improving pain and disability of individuals with chronic low back pain: a systematic review with meta-analysis
ABSTRACT
Background:
Low back pain is the main cause of disability worldwide. Individuals with chronic conditions have been widely affected by the COVID-19 pandemic. In this context, mobile health (m-Health) has become popular, mostly due to the wide use of smartphones. Despite the considerable number of applications for low back pain available in the app store, the effectiveness of these technologies is not established and there is a lack of evidence regarding the effectiveness of the isolated use of mobile applications in the self-management of low back pain.
Objective:
We summarized the evidence on the effectiveness of m-health interventions on pain and disability of individuals with chronic low back pain.
Methods:
A systematic review with meta-analysis comparing m-Health to usual care or no intervention. The search terms used were related to low back pain and m-Health. Pain intensity and disability were included as primary outcomes, and quality of life as a secondary outcome. Only randomized clinical trials (RCT) were included, and the primary outcomes were pain intensity and disability, and the secondary outcome was quality of life. Searches were carried out in the following databases, without date or language restriction: PubMed, SCOPUS, EMBASE, PEDro, Cochrane and Opengray, in addition to article references. The risk of bias was analysed using the PEDro scale. Data were summarized descriptively and through meta-analysis (pain and disability). In the meta-analysis, eligible studies were combined considering clinical and methodological homogeneity. The certainty of evidence was assessed using GRADE.
Results:
Five RCTs were included, totalling 894 participants (n: 447 allocated to the m-Health group and n: 445 to the usual care group) and they had similar methodological structure and interventions. Follow-up ranged from 6 weeks to 12 months. The studies did not demonstrate significant differences for pain (MD -0.86; CI95% -2.29;0.58) and disability (SMD -0.24; CI95% -0.69; 0.20) when comparing m-Health and usual care. Most studies showed biases, with emphasis on non-concealed allocation and non-blinding of the outcome evaluator. The certainty of the evidence was rated as low for the analysed outcomes.
Conclusions:
m-Health alone was no more effective compared to usual care or no treatment in improving pain intensity and disability in individuals with low back pain. Due to the biases found and the low certainty of the evidence, the evidence remains inconclusive and future quality clinical trials are needed. Clinical Trial: PROSPERO CRD:42022338759
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