A Decision Support System to Enhance Self-Management of Low Back Pain: Protocol for the selfBACK Project

Mork, Paul Jarle; Bach, Kerstin

doi:10.2196/resprot.9379

Cited by 55 publications

(70 citation statements)

References 60 publications

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“…For acute non-specific low back pain that does not have serious pathology (red flags have been excluded), initial reassurance, advice to stay active and self-management are all that is needed [ 6 , 7 , 9 , 11 ]. Self-management can include self-exercises and education from reading booklets or being involved in on-line education for low back pain [ 16 ] (Table 1 ).…”

Section: Preventionmentioning

confidence: 99%

Physical Therapy Approaches in the Treatment of Low Back Pain

Shipton

2018

Pain Ther

123

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Globally, in 2016, low back pain (LBP) contributed 57.6 million of total years lived with disability. Low Back Pain Guidelines regularly recommend the use of physical exercise for non-specific LBP. Early non-pharmacological treatment is endorsed. This includes education and self-management, and the recommencement of normal activities and exercise, with the addition of psychological programs in those whose symptoms persist. The aim of physical treatments is to improve function and prevent disability from getting worse. There is no evidence available to show that one type of exercise is superior to another, and participation can be in a group or in an individual exercise program. Active strategies such as exercise are related to decreased disability. Passive methods (rest, medications) are associated with worsening disability, and are not recommended. The Danish, United States of America, and the United Kingdom Guidelines recommend the use of exercise on its own, or in combination with other non-pharmacological therapies. These include tai chi, yoga, massage, and spinal manipulation. Public health programs should educate the public on the prevention of low back pain. In chronic low back pain, the physical therapy exercise approach remains a first-line treatment, and should routinely be used.

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Section: Preventionmentioning

confidence: 99%

Physical Therapy Approaches in the Treatment of Low Back Pain

Shipton

2018

Pain Ther

123

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“…Section 1, rationale for GLA:D Back, was based on literature dealing with back pain, its consequences for the individual and the society, prognostic factors for disabling back pain as well as the challenges facing clinicians. Section 2, program objectives of GLA:D Back, was developed by the primary working group at SDU using an iterative process, with feedback from the expert group, and in collaboration with the self BACK [ 14 ] and BetterBack☺ groups [ 13 ]. It included the results from the processes related to Section 3, program design, theories and evidence , with core elements for the intervention content extracted from clinical guidelines, reviews and randomised controlled trials and these were discussed in the multidisciplinary expert group.…”

Section: Methodsmentioning

confidence: 99%

GLA:D® Back group-based patient education integrated with exercises to support self-management of back pain - development, theories and scientific evidence -

Kjær

Kongsted

Hansen

et al. 2018

BMC Musculoskelet Disord

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BackgroundClinical guidelines recommend that people with back pain be given information and education about their back pain, advice to remain active and at work, and exercises to improve mobility and physical activity. Guidelines, however, rarely describe how this is best delivered. The aim of this paper is to present the development, theories, and underlying evidence for ‘GLA:D Back’ - a group education and exercise program that translates guideline recommendations into a clinician-delivered program for the promotion of self-management in people with persistent/recurrent back pain.MethodsGLA:D Back, which included a rationale and objectives for the program, theory and evidence for the interventions, and program materials, was developed using an iterative process. The content of patient education and exercise programs tested in randomised trials was extracted and a multidisciplinary team of expert researchers and clinicians prioritised common elements hypothesised to improve back pain beliefs and management skills. The program was tested on eight people with persistent back pain in a university clinic and 152 patients from nine primary care physiotherapy and chiropractic clinics. Following feedback from the clinicians and patients involved, the working version of the program was created.ResultsEducational components included pain mechanisms, pain modulation, active coping strategies, imaging, physical activity, and exercise that emphasised a balance between the sum of demands and the individual’s capacity. These were operationalised in PowerPoint presentations with supporting text to aid clinicians in delivering two one-hour patient education lectures.The exercise program included 16 supervised one-hour sessions over 8 weeks, each comprising a warm-up section and eight types of exercises for general flexibility and strengthening of six different muscle groups at four levels of difficulty. The aims of the exercises were to improve overall back fitness and, at the same time, encourage patients to explore variations in movement by incorporating education content into the exercise sessions.ConclusionFrom current best evidence about prognostic factors in back pain and effective treatments for back pain, research and clinical experts developed a ready-to-use structured program - GLA:D® Back - to support self-management for people with persistent/recurrent back pain.Electronic supplementary materialThe online version of this article (10.1186/s12891-018-2334-x) contains supplementary material, which is available to authorized users.

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“…The selfBACK app is an add-on to and not a substitution for treatment or seeking advice from HCPs. The development of the selfBACK app, its underlying structure, and development of content have been described in detail elsewhere [16]. In brief, the selfBACK app provides weekly tailored self-management plans targeting three main activities: (1) general physical activity (i.e., number of steps) measured by a step-detecting wristband, (2) strength and flexibility exercises, and (3) patient education (Fig.…”

Section: Interventionmentioning

confidence: 99%

“…In the selfBACK project, a decision support system (DSS) has been developed to support self-management of LBP [16,17]. The decision support incorporates evidence-based and tailored recommendations for selfmanagement delivered via an app.…”

Section: Introductionmentioning

confidence: 99%

A digital decision support system (selfBACK) for improved self-management of low back pain: a pilot study with 6-week follow-up

Sandal

Øverås

Nordstoga

et al. 2020

Pilot Feasibility Stud

Self Cite

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Background: Very few of the publicly available apps directed towards self-management of low back pain (LBP) have been rigorously tested and their theoretical underpinnings seldom described. The selfBACK app was developed in collaboration with end-users and clinicians and its content is supported by best evidence on selfmanagement of LBP. The objectives of this pilot study were to investigate the basis for recruitment and screening procedures for the subsequent randomized controlled trial (RCT), to test the inclusion process in relation to questionnaires and app installation, and finally to investigate the change in primary outcome over time. Methods: This single-armed pilot study enrolled 51 participants who had sought help for LBP of any duration from primary care (physiotherapy, chiropractic, or general practice) within the past 8 weeks. Participants were screened for eligibility using the PROMIS-Physical-Function-4a questionnaire. Participants were asked to use the selfBACK app for 6 weeks. The app provided weekly tailored self-management plans targeting physical activity, strength and flexibility exercises, and education. The construction of the self-management plans was achieved using case-based reasoning (CBR) methodology to capture and reuse information from previous successful cases. Participants completed the primary outcome pain-related disability (Roland-Morris Disability Questionnaire [RMDQ]) at baseline and 6-week follow-up along with a range of secondary outcomes. Metrics of app use were collected throughout the intervention period. Results: Follow-up data at 6 weeks was obtained for 43 participants. The recruitment procedures were feasible, and the number needed to screen was acceptable (i.e., 1.6:1). The screening questionnaire was altered during the pilot study. The inclusion process, answering questionnaires and app installation, were feasible. The primary outcome (RMDQ) improved from 8.6 (SD 5.1) at baseline to 5.9 (SD 4.0) at 6-week follow-up (change score 1.8, 95% CI 0.7 to 2.9). Participants spent on average 134 min (range 0-889 min) using the app during the 6-week period.

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A Decision Support System to Enhance Self-Management of Low Back Pain: Protocol for the selfBACK Project

Cited by 55 publications

References 60 publications

Physical Therapy Approaches in the Treatment of Low Back Pain

Physical Therapy Approaches in the Treatment of Low Back Pain

GLA:D® Back group-based patient education integrated with exercises to support self-management of back pain - development, theories and scientific evidence -

A digital decision support system (selfBACK) for improved self-management of low back pain: a pilot study with 6-week follow-up

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