Supporting the Self-Management of Low Back Pain in Primary Care: The Development of the ‘SupportBack' Internet Intervention.

Conference: 
SAPC ASM 2015 - Oxford - Evidence and innovation in primary care
Talk Code: 
EP1A.4

The problem

Each year approximately 6-9% of the UK population will visit their GP with low back pain (LBP), at a cost of around £251million to the NHS per annum. Encouraging and supporting patients to self-manage is key in the treatment of LBP. Whilst clinician-led self-management interventions can be effective, they can be resource intensive and their availability is limited, restricting access and delaying intervention.

The approach

Internet interventions can provide a novel and efficient means for delivering self-management education and advice. We developed an internet-based self-management intervention (‘SupportBack') that can be delivered with or without clinician-support, that may enable GPs to offer patients an evidenced-based, structured programme that has the potential to be low cost. The intervention was designed as a supplementary educational package to be used in conjunction with usual primary care for LBP. A person-based approach was used to develop our intervention. This entailed working closely with LBP patients throughout development using qualitative methodologies. Intervention content is based around a weekly session structure, with tailored advice and support to help the user self-manage their LBP. The focus is primarily on increasing physical activity, but also includes modules on medication, sleep, work and mood. Twenty-five primary care LBP patients were interviewed to inductively explore issues related to delivering an online intervention for LBP. Patients also took part in usability testing and qualitative piloting of the intervention content.

Findings

Qualitative interviews confirmed that the intervention was engaging, comprehensible and acceptable to a broad range of patients. Patients provided valuable feedback on the issues of primary concern regarding their symptoms and suggested amendments to improve the user experience. This included their preference for a more individually-tailored activity programme based on their current pain or activity level. In general patients found the goal setting functionality to be helpful, and were content with the range of activities offered by the intervention. The majority of patients agreed that they would be accepting of their own GP's recommendation to try a credible intervention to help improve self-management, and that it was more likely that they would use this in conjunction with other treatments and self-management strategies.

Consequences

We have developed an internet intervention that provides a tailored six-week self-management programme. The intervention will be tested in a feasibility randomised trial comparing three treatment arms; the online intervention, the online intervention plus physiotherapist telephone support, and usual primary care alone.

Credits

  • Rosie Stanford, Keele University, Keele, UK
  • Lisa Roberts, Keele University, Keele, UK
  • Lucy Yardley, Keele University, Keele, UK
  • Paul Little, Keele University, Keele, UK
  • Jonathan Hill
  • Nadine Foster
  • Elaine Hay
  • Adam Geraghty, Keele University, Keele, UK