Smartphone applications for the self-management of low back pain

Author: Claudia Didyk

Didyk, Claudia, 2024 Smartphone applications for the self-management of low back pain, Flinders University, College of Nursing and Health Sciences

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Low back pain (LBP) is a leading cause of disability worldwide and a global economic health issue. Low back pain is estimated to affect 70-90% of people at some time in their lives and is the second leading cause of disease burden in Australia. Current LBP guidelines recommend interventions that have been investigated by many studies over the years and these include self-management, active rehabilitation and exercise. Usual self-management varies, but includes a range of strategies such as exercise, advice from health professionals, pharmacological management and passive treatments. Smartphone applications (apps) are an easily accessible and cost-effective option that may help improve self-management. Most of the population in developed countries use a smartphone, and this is increasing at a steady rate. They offer consumers a mobile health platform that can be used in place of or as an adjunct to in-clinic treatment. As a result, they have the potential to decrease healthcare costs and improve access to health management guidance and monitoring. Apps offer the potential for widespread implementation of health care interventions.

This program of research was undertaken in a series of four studies. Study one is a systematic review aimed at synthesising the evidence of effectiveness of smartphone apps for the self-management of low back pain in adults and exploring participant adherence with smartphone apps for the self-management of LBP. Overall, the findings suggest that smartphone apps for the self-management of LBP provide more effective reduction in pain and disability than usual care or minimal interventions, however, the evidence is inconclusive. The limited number of papers and heterogeneity of the research make it difficult to determine what apps work best and with whom. Wider use of smartphone apps for the self-management of LBP and its effectiveness are still unclear.

Study two is a systematic assessment aimed at evaluating the availability, content, and quality of commercially available, self-contained smartphone apps for the self-management of low back pain in adults. The results showed that smartphone apps for the self-management of low back pain are of average to good quality, but few were designed to specifically incorporate self-management support and behaviour change potential, as such have questionable potential for self-management and behaviour change. A clear need for stricter regulation of application content and consumer education is highlighted due to the low quality information and advice provided for low back pain.

Study three used two online surveys, a health professional survey and a consumer survey, to explore consumers’ and health professionals’ choice of self-management options for low back pain and use of smartphone apps for the self-management of low back pain. The results showed that few health professionals and consumers used apps due to lack of knowledge. All consumer app users had LBP and most found that app use helped improve their LBP. The small percentage of both consumer and health professional app users outlines the underutilisation of this self-management tool.

Study four used workshops to co-design a tool for use by consumers to assess LBP self-management apps. The co-design process involved both consumer and health professional input, as well as input from the research team. A new app assessment tool was developed, and pilot tested for usability with a separate group of participants. The app assessment tool allows for quick, easy evaluation of currently available LBP self-management apps by consumers and health professionals. Apps are an underutilised, yet potentially cost effective, portable and scalable self-management tool for LBP and this tool was developed to increase adoption of app use.

Overall, this research adds to the knowledge base and contributes to the paucity of research in this area. To our knowledge this is the first program of research that combines key elements to inform consumer and health professional choice. The developed co-designed tool allows for fast, easy integration into the clinical setting.

Keywords: low back pain, smartphone apps, self-management, behaviour change, self-efficacy, personality traits, consumers, co-design, health professionals, barriers, app assessment, LBP Self-Management App Review Tool (LBP-SMART)

Subject: Rehabilitation thesis

Thesis type: Doctor of Philosophy
Completed: 2024
School: College of Nursing and Health Sciences
Supervisor: Associate Professor Belinda Lange