Is there a relationship between pain-related outcomes and satisfaction and autonomy support with the selfBACK app for people with low back pain?

Conference: 
SAPC ASM 2022 - UCLan
Talk Code: 
P1.2C.2
Presenter: 
Karen Wood
Co-authors: 
Karen Wood( 1), Tom I L Nilsen (2), Paul Jarle Mork (2), Jan Hartvigsen (3,4); Frances S Mair (1), Barbara I Nicholl (1)
Author institutions: 
(1) Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom, (2) Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway, (3) Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark, (4) Nordic Institute of Chiropractic and Clinical Biomechanics, Odense, Denmark

Problem

Low back pain (LBP) is the largest cause of disability worldwide. The use of digital health interventions (DHIs) for the self-management of LBP is growing; two factors that may influence their effectiveness are user satisfaction and autonomy. Although satisfaction with DHIs is often assessed, its relationship with study outcomes is rarely examined and there is little evidence on the impact of autonomy support on DHI outcomes. The selfBACK smartphone app is an evidence-based, decision support system designed to support the self-management of non-specific LBP, shown in a randomised controlled trial (RCT) to reduce pain-related disability compared to a usual care group. The aim of this study was to explore the relationship between satisfaction and autonomy support, with pain-related outcomes among participants in the selfBACK RCT.

Approach

An exploratory secondary analysis of data collected in the selfBACK RCT among 461 people with non-specific LBP in Denmark and Norway. Levels of satisfaction (satisfaction rating question) and autonomy support (Virtual Care Climate Questionnaire) were compared against the primary RCT outcome, pain−related disability (Roland Morris Disability Questionnaire [RMDQ]), and pain self-efficacy (Pain Self Efficacy Questionnaire [PSEQ]). A linear mixed model was used to 1) estimate within group changes in mean RMDQ and PSEQ from baseline to 3 and 9 months, and 2) compare the difference in mean change from baseline to three and nine months between those reporting high versus low satisfaction with the selfBACK app, as well as between those reporting low satisfaction and the control group. A similar analysis was used to estimate mean changes and between group differences for those reporting high versus low autonomy support, and low autonomy support versus controls.

Findings

No statistically significant differences were found in RMDQ or PSEQ between more and less satisfied, and more and less autonomy-supported app users. There was also no statistically significant difference in relation to either outcome measure between less satisfied app users and control group. However, while no statistically significant difference was found in mean RMDQ scores, less autonomy-supported app users achieved a greater improvement in mean PSEQ score over 9 months than the control group (difference in change between groups: 3.5, 95% CI 1.3 to 5.7, P=.002).

Consequences

This secondary analysis found no significant differences in outcomes between more and less satisfied, and more and less autonomy-supported, app users. The results show less satisfied and less autonomy-supported app users had similar changes in back-related disability and pain self-efficacy. This limited evidence for no relationship between satisfaction and support and pain-related outcomes, suggests the selfBACK app is suitable for users regardless of these factors. However, being satisfied with and feeling support by an app, would be expected to encourage engagement and would be the preferred experience.

Submitted by: 
Karen Wood
Funding acknowledgement: 
European Union Horizon 2020 research and innovation programme, grant agreement No. 689043