An Evaluation of a Mobile App for Chronic Low Back Pain Management: Prospective Pilot Study

Abstract

Background Chronic low back pain is challenging to manage due to multidisciplinary considerations. It has substantial socioeconomic impacts and cannot be simply treated with pharmacotherapy, nonsurgical intervention, or spine surgery. Medical consensus recommends optimizing conservative self-management therapies (eg, home exercise, wellness strategies, yoga, etc) as first-line treatment options for chronic low back pain. However, access to these modalities is often limited and secondary to cost, convenience, and ease of use. Mobile health apps have emerged as a cost-effective and accessible option for chronic low back pain self-management. Established in-person pain programs can provide the structure for an optimal mobile app adaptation. PainNavigator (PainNavigator, Inc) is an example of a mobile app that is based on an Ascension-Illinois group–based pain program—Pain Rehabilitation Outpatient-Camp. Objective This was a prospective pilot clinical trial that evaluated the PainNavigator platform’s utility in low back pain management to inform future trial development. Methods A total of 75 participants who used PainNavigator were studied. Pain, Enjoyment, and General Activity (PEG-3) scale scores and scores from a brief anxiety and depression scale based on the Patient Health Questionnaire-4 (PHQ-4) were obtained at baseline and following program completion. The PEG-3 total score was used, in addition to individual items—Average Pain, Pain Effect on Enjoyment, and Pain Effect on Activity. The PHQ-4 total score was also used, in addition to other individual items, including Felt Depressed, Loss of Interest, Felt Anxious, and Difficult to Control Worry. Paired sample t tests (2-tailed) compared mean differences in scores from before and after participants received the intervention. Results The analysis found that PEG-3 (n=27) and PHQ-4 (n=27) total scores were significantly lower upon the completion of PainNavigator (P<.001 and P=.001, respectively). The findings showed a 36% reduction in PEG-3 total scores, a 40% reduction in pain intensity, and a 40% reduction in PHQ-4 total scores. Scores for individual PEG-3 scale and PHQ-4 items also significantly decreased. All PEG-3 measures had large effect sizes. The PHQ-4 total score and Difficult to Control Worry item had large effect sizes, while the other three measures had medium effect sizes. Conclusions These findings show that PainNavigator has clinical significance in managing chronic low back pain and can be easily utilized to improve patient care. All PEG-3 scale and PHQ-4 measures significantly improved following the use of the platform, supporting the multidimensional, biopsychosocial approach to low back pain management. Differences in effect sizes may inform quality improvement investigations, such as optimizing features that impact measures with only medium effect sizes. This feasibility study demonstrates an effective protocol, and it will inform future, more extensive randomized controlled trials.

Low back pain self-management mobile applications: a systematic review on digital platforms

“…Therefore, it is crucial to investigate the quality and effectiveness of these tools to avoid health risks. Although exercises can help reduce pain, they should not replace in-person care, as individual needs vary and other strategies may be more effective in different cases, strengthening adherence ( 24 , 28 , 29 ) . However, exercise apps can complement the care for people with low back pain, especially in remote environments ( 4 , 30 , 31 ) .…”

“…The feasibility study concluded that the Pain Navigator platform can be used to treat low back pain, as it presents biopsychosocial effect measures, modalities focused on users’ needs and is clinically important. The focus is not just on pain levels, but also on functionality ( 28 ) . Manage My Pain was considered acceptable by the majority of patients in an academic pain management program.…”

Digital Therapeutics (DTx) Expand Multimodal Treatment Options for Chronic Low Back Pain: The Nexus of Precision Medicine, Patient Education, and Public Health

“…Digital health technologies for CLBP provide diverse treatment and self-management modalities [35,55,[94][95][96][97][98][99][100][101][102][103][104][105][106][107][108]. Examples of mobile apps for CLBP include "BackRx" delivering yoga and Pilates exercises for patients with discogenic CLPB [97,109], as well as PainNavigator delivering CLBP management, including education, physical exercises, yoga, and mindfulness [110]. A 12-week study of the use of a mobile app delivering the digital care program Hinge Health for low back pain reported improvement in pain and disability outcomes, as well as depression and anxiety symptoms [111,112].…”

Exploring mHealth applications for self-management of chronic low back pain: A survey of features and benefits

“…Overall, it served as a practical mobile application for the self-management of long-term CLBP. Browne et al [80] evaluated the utility of a PainNavigator application providing self-assessment, education, and goal-setting for CLBP management. They found clinical significance for the application and showed that it could be easily used to improve rehabilitation and self-management.…”