Accepted for/Published in: JMIR mHealth and uHealth
Date Submitted: May 19, 2025
Open Peer Review Period: May 26, 2025 - Jul 21, 2025
Date Accepted: Apr 13, 2026
(closed for review but you can still tweet)
Warning: This is an author submission that is not peer-reviewed or edited.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.
Evaluation of the impact of a smartphone application on adherence to an exercise programme in people with chronic low back pain: a randomised controlled trial
ABSTRACT
Background:
The positive effects of multidisciplinary rehabilitation programmes tend to fade over time due to low long-term patient adherence.
Objective:
We aimed to evaluate the impact of a smartphone application on adherence to an exercise programme for people with chronic low back pain (CLBP) at 6 months.
Methods:
One hundred and ten people with CLBP were included and randomised into two groups: 54 in the intervention group (IG) received education on the use of the application in addition to usual care (a 3-week multidisciplinary rehabilitation programme with self-management education) and 56 in the control group (CG) who received only usual care. The Exercise Adherence Rating Scale (EARS) was the primary outcome. Secondary outcomes were pain (Numeric Rating Scale), disability (Oswestry Disability Index), barriers and facilitators to performing physical activity (Evaluation of Physical Activity Perception), physical capacity (battery of tests) and qualitative adherence (correctness of exercise execution). Statistical analyses were performed according to the intention-to-treat principle. A linear mixed model compared the primary endpoint between groups at 6 months.
Results:
71/110 participants were evaluated at 6 months. Adherence did not differ between groups, nor did pain, disability or barriers and facilitators to physical activity, except for the motivation criterion. Physical capacity test results (6MWT, cycle ergometer, Shirado-Ito, plank) and qualitative adherence differed between groups in favour of the IG. All outcomes improved from baseline to 6 months in the IG but not in the CG.
Conclusions:
The smartphone application did not impact adherence to an exercise programme at 6 months in individuals with CLBP. Similar results were found for pain and function. Nevertheless, the application could be a useful self-management tool in view of the positive effects on pain, function, physical capacity and qualitative adherence. Clinical Trial: ClinicalTrials.gov: NCT04264949
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