<p>Less Pain, Better Sleep? The Effect of a Multidisciplinary Back Pain App on Sleep Quality in Individuals Suffering from Back Pain – a Secondary Analysis of App User Data</p>

Abstract

Purpose: Mobile health solutions are finding their way into health systems. The Kaia app has been shown to be able to reduce back pain in two studies. Since pain often comes along with disturbed sleep and both symptoms are strongly related we investigated whether the Kaia app training is associated with improved sleep quality. Methods: User data of individuals with back pain were collected in two app versions (cohort 1: N = 180; cohort 2: N = 159). We analyzed the ratings of sleep quality and pain intensity on a 11point numeric ratings scale (NRS; 0-10) both at the beginning of usage (baseline: BL) and on the individual last day of usage (follow-up: LU) within a 3-month training program. Results: In both cohorts, we found a significant reduction in pain intensity from BL to LU (cohort 1: M BL = 4.80; SD = 1.59 to M LU = 3.75; SD = 1.76, Δ pain =-1.04; SD = 2.12; t(158) = 6.207; p<.001/cohort 2: M BL = 4.20; SD = 1.98 to M LU = 3.65; SD = 1.78; Δ pain =-0.50; SD = 2.04; t(147) = 3.001; p = 0.003) and a significant improvement of sleep quality (cohort 1: M BL = 5.76; SD = 2.12 to M LU = 6.56; SD = 1.72; Δ sleep = t(158) = 4.310; p < 0.001/cohort 2: M BL = 6.08; SD = 2.08 to M LU = 6.76; SD = 1.55; Δ sleep = 0.67; SD = 2.13; sleep: t(147) = 3.825; p < 0.001). Interestingly, improvement of sleep quality was not fully mediated by pain reduction. Conclusion: Our analysis underlines the relationship between pain and sleep in the clinical context. Improvement of sleep quality came along with pain reduction and vice versa. Further study should explain the exact mechanisms of action which are associated with the improvement of both symptom parameters.

Digital Therapeutic Care and Decision Support Interventions for People With Low Back Pain: Systematic Review

“…Of the 12 studies, 6 (50%) [28][29][30][31][32][33] were RCTs and 4 (33%) [34][35][36][37] had a retrospective cohort design, whereas the remaining 2 (17%) were a retrospective evaluation [38] and a prospective single-arm trial [39], respectively. Of the 12 studies, 5 (42%) were published in 2020 [28,33,34,37,39], 3 (25%) in 2019 [29][30][31], 3 (25%) in 2018 [32,36,38], and 1 (8%) in 2017 [35]; moreover, 2 (17%) each were conducted in the United States [30,34], Germany [28,31], and China [29,38], 1 (8%) in India [32], and 1 (8%) in Jordan [33], whereas the remaining 3 (25%) were conducted in multiple countries. Of these 3 studies, 1 was conducted in Denmark and Norway [39] and 1 included participants from Germany, Austria, and Switzerland [35].…”

“…The study durations with regard to the digital therapeutic intervention did not vary significantly. In 58% (7/12) [28,[30][31][32]34,35,37] of the studies, the intervention was investigated for 12 weeks or 3 months, 17% (2/12) [33,39] had an intervention duration of 6 weeks, 17% (2/12) had an intervention duration of 24 weeks [36] and 24 months [29], whereas in 8% (1/12) [38], the duration was inconsistent and not clearly reported.…”

“…The DTC apps involved multiple key components that address the clinical guideline-based recommended multimodal treatment for people with LBP. In all included studies, participants had access to in-app exercise therapy either in the form of videos [28][29][30][31][32][34][35][36][37][38][39] or picture-based instructions [33]. As another key component, educational material was provided in 92% (11/12) of the apps and involved back pain-specific reading material and papers or rehabilitation plans.…”

“…As another key component, educational material was provided in 92% (11/12) of the apps and involved back pain-specific reading material and papers or rehabilitation plans. The third key component comprised psychosocial interventions that address stress and individual behavioral traits that could influence LBP, that is, in the form of cognitive behavioral therapy, personal health and behavioral coaching, or mindfulness and relaxation techniques in 58% (7/12) of the studies [28,30,31,[34][35][36][37]. The timing and frequency at which the user was required to engage with the app varied between studies, described in detail in Table 4.…”

“…In all included studies, different kinds of decision support interventions were deployed to guide and accompany the user through the DTC program and to increase engagement with the app. Basic reminders in the form of push notifications were implemented most often [29][30][31][32][33]37,38], followed by a health coach chat function for motivational and reinforcing purposes [28,31,[34][35][36][37], peer-group support through interactive discussion feeds or forums [28,30,34], a points-based rewards system [30,38], feedback messages after achieving improvements [37], and a tailored self-management plan that prompted suggestions on personalized activity goals and education sessions [39]. The applied decision support interventions encompassed a broad spectrum of behavior change techniques, including reminders, peer support, motivational messages, goal setting, coping methods, and gamification.…”