A randomised controlled feasibility trial of an internet intervention to support self-management of low back pain
First-line care recommendations for low back pain (LBP) consist of advice to self-manage and remain active. Internet interventions present a potential means of providing patients with tailored self-management advice and evidence-based support for increasing physical activity.
We carried out a single-blind, randomised controlled feasibility trial of an new internet intervention ‘SupportBack’ developed to support the self-management of LBP in primary care. Patients were randomised to 1 of 3 groups receiving either usual primary care, usual primary care with the addition of the internet intervention or usual primary care with the internet intervention and physiotherapist telephone support. Patients were followed up at 3 months. The internet self-management intervention was developed to be delivered with or without clinician-support. It delivers a 6-week, tailored programme focused on graded goal setting, self-monitoring, and provision of tailored feedback to encourage physical activity in order to reduce disability. The telephone physiotherapy support consisted of 3 brief structured calls over the first 6 weeks of the intervention. The telephone support was designed to address concerns, provide reassurance and encourage adherence to the internet intervention and activity goals. Primary feasibility outcomes included recruitment of practices and patients, adherence and retention rates at 3-month follow-up. Qualitative interviews were conducted with a sample of patients (n =17) who completed the trial.
87 patients with low back pain were recruited and randomised from 12 primary care practices. Retention was above 80% across all three arms at 3 month, and 80% of patients in the intervention groups completed at least the first session of the internet programme (containing rationales for activity, addressing concerns and guidance on goal setting). Qualitative findings suggested that the majority patients in both supported and unsupported arms found the internet intervention accessible, informative and encouraging. Those in the support arm reported that the physiotherapist telephone element was helpful and reassuring.
Internet interventions have many characteristics (automation, tailoring, readily accessible), that when co-developed with target users, have the potential to help primary care patients manage their symptoms. Our results suggest that a trial of this design is feasible, and our internet intervention both supported and unsupported, is acceptable to primary care patients. Effectiveness and cost-effectiveness must now be determined in a full definitive trial.