JMIR Publications

ABSTRACT

Background:

Low back pain (LBP) is a leading cause of work absence worldwide. Online, digital interventions have the potential to support open access to interventions that can support and enable self-management.

Objective:

This study aimed to explore the feasibility, usability and acceptability of an online educational programme to support self-management strategies for people with persistent LBP.

Methods:

In this multicentre, multinational uncontrolled feasibility study, adults in employment with persistent LBP were recruited online in Italy, Portugal, Sweden and United Kingdom and were offered the opportunity to use the online MyRelief educational programme for one month. Clinical measures collected at pre- and post-intervention, and measures of patient enablement and participant-reported usability and satisfaction collected post-intervention only. Feasibility was assessed using measures of recruitment, retention, and participants’ perceptions of the system, via the System Usability Scale (SUS) and qualitative feedback. Effects of the programme on clinical markers, including Oswestry Disability Questionnaire, EQ-5D-5L and Patient Enablement Index, were reported descriptively.

Results:

The recruitment of study participants met the a priori feasibility criteria, achieving an 80% recruitment rate (n=40/50). However, retention proved challenging, falling short of the a priori feasibility criteria with a retention rate of 55% (n=22/40) and a drop-out rate exceeding 35%. Approximately half of the sample reported low levels of functional disability, and a clinically significant improvement was observed in the EQ-5D weighted health index from baseline to follow-up. The quality of outcome measure completion was high. The SUS score for the MyRelief website was 72.4 (95% CI: 67.5-73.3), indicating that it met minimal industry standards. Nonetheless, qualitative feedback highlighted challenges relating to access and navigation within the website.

Conclusions:

The study was feasible in terms of recruitment, however the population had low baseline disability scores which is not representative of the wider persistent LBP population. Future studies could address this by widening recruitment strategies, in particular recruiting from healthcare settings. Accessibility and usability could be improved by a clear and intuitive navigation system, while understanding end-user preferences is key to optimizing the format for online digital health interventions. Clinical Trial: ClinicalTrial.gov, NCT04673773. Registered 17 December 2020, https://clinicaltrials.gov/ct2/show/NCT04673773