Digital Support Interventions for the Self-Management of Low Back Pain: A Systematic Review
Low back pain (LBP) is a common cause of disability and is ranked as the most burdensome health condition globally. There is growing interest in the potential role of digital health as a means of optimising effective treatment strategies. This study aimed to synthesize and critically appraise the published literature regarding the use of interactive digital interventions to support patient self-management of LBP and to determine: 1) What outcome measures have been used in trials of digital self-management interventions in LBP and what effects, if any, have been reported? ;2) What are the key components of reported digital self-management interventions for LBP, including theoretical underpinnings?; and 3) What are the key characteristics of digital self-management interventions that appear to be associated with beneficial effects?
Bibliographic databases searched from 2000 -March 2016 included: Medline, Embase, CINAHL, PsycINFO, Cochrane Library (including CDSR, DARE, Central, and HTA databases), DoPHER and TROPHI, Social Science Citation Index, and Science Citation Index. Reference and citation searching also undertaken. Search strategy combined the concepts: 1) back pain, 2) digital intervention, and 3) self-management. Only randomized controlled trials (RCTs) protocols or completed RCTs involving adults with LBP published in peer-reviewed journals included. Two reviewers independently screened titles and/or abstracts, full text articles, extracted data and assessed risk of bias using Cochrane risk of bias tool. Third reviewer adjudicated on any disagreements.
Of 7014 references identified, 11 included, describing 9 separate studies: 6 completed RCTs and 3 protocols for future RCTs. The completed RCTs included a total of 2706 participants (range of 114-1343 participants per study) and varied considerably in nature and delivery of interventions, duration and definition of LBP symptoms, the outcomes measured and the effectiveness of the interventions. Participants generally Caucasian (74% to 87%), younger (mean age 42.5- 52.7 years), and in five of six RCT reports, the majority were female (58% - 83%) and most (42% - 75%) reported educational levels as years of college or more. Only one study reported a between group difference in favour of the digital intervention over a passive waiting list. There was considerable variation in the extent of reporting concerning the characteristics, components and level of detail for the theories underpinning each digital intervention. None of the studies showed evidence of harm.
Participants were predominantly female, white, well-educated and middle-aged so the wider applicability of digital self-management interventions remains uncertain. There was considerable inconsistency in choice of outcomes and in reporting of the characteristics, components and theories underpinning digital interventions. No information on cost effectiveness was reported. While there was no evidence of harm the strength of evidence in favour of interactive digital interventions to support patient self-management of LBP remains weak.