Previously submitted to: JMIR mHealth and uHealth (no longer under consideration since Feb 20, 2024)
Date Submitted: Jan 5, 2024
Open Peer Review Period: Jan 8, 2024 - Mar 4, 2024
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The efficacy of the smartphone App for the self-management of low back pain: a systematic review and assessment of their quality through Mobile Application rating scale (MARS) in Italy
ABSTRACT
Background:
Self-management interventions from mobile apps are valuable tools to support managing patients with low back pain (LBP). To date, there are no studies that have made a qualitative assessment of the content of downloadable apps in Italy related to LBP self-management.
Objective:
The purposes of this systematic review were to (a) summarize the available studies on the efficacy of smartphone apps for self-management of LBP and (b) assess quality and functionalities of several apps.
Methods:
According to the Prisma Checklist, six bibliographic databases were searched by two reviewers with the keywords 'low back pain', 'mobile application,' 'smartphone', and 'telemedicine'. Instead, mobile applications were searched on the Italian Apple App Store and Google Play Store using the keywords "Low back pain", "lumbago", and "lombalgia". Then, after extracting the data, each application was evaluated with the Mobile Application Rating Scale (MARS) by four reviewers.
Results:
After eliminating duplicates, 852 records were screened, and 16 were included in the systematic review: six Randomized Controlled Trials (RCT), three systematic reviews, three systematic assessments, one scoping review, and one non RCT. Of the six RCT included, four reported a statistically significant decrease in pain in favor of app group, and two RCTs did not. Only in a non-RCT was an increase in the disability score. In application research, we identified and evaluated 25 applications through the MARS. The overall scores ranged from 1.93 to 3.92 for the IOS app and 1,73 to 4,25 for the Play Store app. The highest values are reported in the "functionality" category and the lowest in the "information" category. ICC calculated on all applications reports good reliability values (ICC=0.791) with a 95% confidence interval ranging from 0.583 to 0.901.
Conclusions:
The findings suggest that we need more and higher quality comparison studies, and few apps meet satisfying quality, content, and functionality criteria for LBP Self-management. Integrating smartphone applications to support rehabilitation intervention is a topic that needs further exploration to assess its effects. However, to improve the “information” category, involving scientific institutions in developing new apps will be helpful.
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