JMIR Publications

ABSTRACT

Background:

Low back pain (LBP) is a major cause of disability globally. To tackle issues like long wait times and limited access to conventional care, telemedicine is emerging as a viable alternative. It offers benefits like reduced travel and increased flexibility, with evidence showing comparable effectiveness to in-person care. However, usability remains a key challenge, impacting patient compliance.

Objective:

In a three-arm randomised controlled trial, our pre-planned secondary analysis aimed to assess the usability and patient perceptions toward an autonomous app-based intervention ("NOLA") for low back pain in order to improve clinical practice of telemedicine interventions. Objectives included evaluating app usability, assessing perceptions toward telemedicine, and exploring app usage, adherence, and motivation.

Methods:

Low back pain patients were recruited from May to August 2022 and randomised into App, Physio+App, or Physio groups. App and Physio+App groups were included in this sub-analysis. Intervention duration was 6 weeks. Data on baseline characteristics, System Usability Scale, Telemedicine Perception Questionnaire, app usage, adherence, and motivation were collected online.

Results:

64 participants were randomized to use the app with available data for 38. The mean age of participants who completed was 49.9 (SD 13.6) years, with 78% experiencing low back pain for more than two years. Usability scores (0-100) were good (Median (IQR) Physio+App: 78 (58-92), App: 86 (65-91)). Positive telemedicine perceptions were noted with 84% rating it an adequate addition to usual care. App usage varied, with 43% using it three to five days per week, and 64% reported motivation to use the app. The drop-out rates (App: 14/32, 44%; Physio+App: 12/32, 38%; Physio: 11/29, 38%) were similar, but participants who dropped out had statistically significant less pain (completers: mean 3.9 (SD 2.0); drop-outs: mean 3.0 (SD 2.0); P=.02). Reasons for drop-out were mostly not related to the app.

Conclusions:

The app "NOLA" demonstrated good usability, and participants expressed positive perceptions toward telemedicine. Despite concerns about the lack of physical contact, the majority considered telemedicine a convenient form of healthcare delivery. App usage and motivation were favourable, emphasizing the potential of app-based interventions in managing low back pain. Clinical Trial: German Clinical Trial Registry (DRKS00029099)