Helping sufferers of lower back pain stay on track with their therapy
The recent Global Burden of Disease study showed that low back pain (LBP) is the most significant contributor to disability in Europe. After upper respiratory infection, hypertension and coughing, LBP is the most common diagnosis seen in primary healthcare. Over 85 % of these have LBP that cannot reliably be attributed to a specific disease or pathology. As the majority of cases are non-specific, self-management through physical activity and strength/stretching exercises is the main way to cope with this type of LBP. But as many of us know, exercise and stretching regimes can be hard to stick to due to lack of feedback and reinforcement. Enter the EU’s selfBACK project. The team set out to design and develop a decision support system using an app and a wearable. Their success can be measured by the positivity of those using their system. “The very high level of user satisfaction and engagement with the selfBACK app during the trial exceeded our best hopes and came as a pleasant surprise. At the 3-month follow-up, more than 70 % of the participants in the intervention group had used the app for more than half of the weeks, and quite a few users continued to use the app after the trial was completed at 9 months,” says Paul Jarle Mork, project coordinator based at the Norwegian University of Science and Technology in Trondheim.
Motivation through positive feedback
The selfBACK app provides weekly, individually tailored, self-management recommendations for three main components that are endorsed by current clinical guidelines: physical activity, strength and flexibility exercises, and daily educational messages. The app also provides general information about LBP along with access to several tools such as goal-setting, mindfulness audios, pain-relieving exercises, and sleep reminders, that the users can use at their convenience, for self-motivation. The app uses AI in the form of case-based reasoning in particular, to create weekly, personalised self-management plans. “To create these plans, we compare answers to questionnaires about pain, function, lifestyle, and so on, to find similar plans from other users and then tailor them to the new user’s preferences,” explains Kerstin Bach, also based at the Norwegian University of Science and Technology, who has been the project manager and technical lead. The system also considers the user’s recent exercises and physical activity in the form of step counting. Each plan is presented on the mobile app showing the goals and achievements along with clear instructions on how to do the exercises. “And when a motivational tap on the shoulder is needed, the app uses notifications to remind and encourage the users throughout the week about the available content,” says Mork, adding: “By following the weekly self-management plans, the user can collect badges and rewards that are displayed in the app.” The selfBACK system keeps a record of each user’s answers to the questionnaires, achievements, barriers, and exercise preferences. For example, if a user prefers a certain type of exercise, the system will pick that from a similar group of users. “During every weekly session, the app will ask one to five questions about the pain, barriers to progress or other factors, and the answers are used to update the potential pool of content provided to the user. So, in comparison to other approaches, the selfBACK system will always start from an individual case and adapt it to its user.”
Putting the tech to the test
The effectiveness of the system was evaluated in a randomised controlled trial in Denmark and Norway, using the reduction of pain-related disability at 3 months as a primary outcome. Participants were over 18, had non-specific LBP, and had a smartphone and access to email. Eligible individuals who sought care for LBP in primary care or at an outpatient spine clinic were enrolled in the trial from 8 March to 14 December 2019. A total of 461 participants were included in the randomised trial. A control group followed traditional methods of care. The other used the selfBACK system alongside the standard therapy, including advice or treatment offered to the participants by their clinician. At a 3 month follow-up, 52 % of the participants using the selfBACK app along with standard care had achieved a significant reduction in pain-related disability compared to only 39 % in the control group.
Broad range of expertise behind the technology
The selfBACK project brought together experts from several disciplines, including computer scientists, app developers, medicine/public health experts, exercise physiologists and psychologists. In developing and designing the selfBACK system, the team used the intervention mapping approach, which provides a systematic approach for developing an intervention. Good news for Europe’s millions of sufferers: a Danish company will commercialise the selfBACK system. “Hopefully, the selfBACK app may be available in several European countries by the end of 2022,” Mork adds.
Keywords
selfBACK, lower back pain, LBP, app, self-motivation, therapy, tailor-made, contextual advice
