selfBACK: A decision support system for self-management of low back pain

Problem

Low back pain (LBP) is the biggest contributor to disability in the UK and globally, and is a particular challenge for primary care. Self-management is encouraged as the core component of LBP care yet adherence to self-management is often difficult. This is likely, in part, due to the lack of support, feedback and reinforcement for self-management. selfBACK aims to develop a digital support tool to help individuals with low back pain to manage their pain better through tailored support in decision making and positive reinforcement of appropriate actions.

Approach

This is a five year project funded by the European Commission’s Horizon 2020 programme. Four workpackages (involving health and computer science experts) focus on developing the selfBACK digital support system, which is a predictive Case-Based Reasoning computer system that is based on existing cases. It will be the first of its kind to utilize background data about the patient, self-monitoring of pain and functional ability, along with continuous recording of the patient's physical activity and sleep by a wristband, to deduce tailored and personalized recommendations for self-management of low back pain. Key tasks being undertaken by the healthcare team to underpin development of the decision support system include: a systematic literature review of digital interventions for self management of musculoskeletal pain; simulation of cases to populate the digital tool; and establishing suitable explanation engines, iteratively with user participation. Once the selfBACK system is developed it will undergo piloting and then testing in a randomised controlled trial (RCT) involving three countries (UK, Denmark and Norway). The RCT will test the effectiveness of the system, in terms of reducing pain related disability, in a population of individuals who have consulted a primary care practitioner for LBP. It is envisaged that the selfBACK system will be a smart phone application that will be linked with a wristband device to monitor activity patterns. An in-depth process evaluation will be conducted alongside the trial to determine the likely future implementability of the system for a wider LBP population.

Findings

This study is in its early stages, having commenced in January 2016. A systematic review of digital support interventions for musculoskeletal pain is underway, as is simulation of LBP cases from clinical trials of LBP management in Norway and Denmark.

Consequences

This programme of work presents an innovative approach to LBP management that has the potential to help individuals manage their own LBP more effectively and to reduce the demands on primary care practitioners and scarce health care resources. This study is led by Norwegian University of Science & Technology (Trondheim), with partners at The University of Glasgow, Robert Gordon University (Aberdeen), Kiolis (Paris), National Research Centre for Working Environment (Copenhagen), Health Leads (Netherlands), The University of Southern Denmark (Odense).