Mobile-Web App to Self-Manage Low Back Pain: Randomized Controlled Trial
Mobile-Web App to Self-Manage Low Back Pain: Randomized Controlled Trial
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DOI：
10.2196/jmir.3130
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发表时间：
2015-01-01
影响因子：
7.4
通讯作者：
Ary, Dennis V.
中科院分区：
文献类型：
--
作者：
Irvine, A. Blair;Russell, Holly;Ary, Dennis V.
背景：非特异性腰痛（NLBP）是指没有潜在医学原因的背痛（如肿瘤、感染、骨折、椎间盘突出、椎管狭窄）。美国医师学会（ACP）和美国疼痛学会（APS）建议对持续4周以上的NLBP进行多学科治疗。然而，这种方法对许多医生来说是不切实际的，而且相对较少的提供者提供符合ACP-APS联合指南的NLBP治疗。目的：本研究评估了一种名为“FitBack”的移动网络干预的效果，该干预可以帮助用户实施定制策略来管理和预防NLBP的发生。方法：在基线、2个月（T2）和4个月（T3）时，共招募、筛选、同意和在线评估597名成年人。基线评估后，参与者被随机分为三组：FitBack干预组、收到8封电子邮件敦促参与者链接到6个NLBP网络资源的替代护理组和对照组。FitBack组每周也会收到电子邮件提醒，持续8周，并通过电子邮件进行评估。只联系对照组进行评估。结果：在4个月的随访中，与对照组相比，FitBack计划的使用者在关键的身体、行为和工作场所结果测量的每项比较中都表现出更大的改善。此外，在4个月的随访中，FitBack计划的使用者在当前背痛、行为和工作场所结果方面的表现优于替代护理组。例如，对照组的受试者报告当前背部疼痛的可能性是FitBack组的1.7倍；在4个月的随访中，替代护理组的受试者报告当前背痛的可能性是后者的1.6倍。此外，在4个月的随访中，与对照组和替代护理组相比，FitBack计划的使用者在患者激活、计划行为理论的构建和对疼痛的态度方面表现出更大的改善。结论：本研究表明，基于理论的独立移动网络干预，根据用户的偏好和兴趣定制内容，可以成为腰痛自我管理的有效工具。从RE-AIM的角度来看（即覆盖范围、功效/有效性、采用、实施保真度和维护），该研究支持这样一种观点，即这种干预作为一种潜在的成本效益工具具有相当大的价值，可以覆盖大量人群。考虑到FitBack干预既没有得到专业护理人员的支持，也没有纳入可能为参与者提供额外支持的健康促进活动，研究结果是有希望的。不过，还需要进行更多的研究，以了解随着时间的推移，如何使用自我引导的移动网络干预措施，并了解与用户持续参与相关的因素。
Background: Nonspecific low back pain (NLBP) is the diagnosis for individuals with back pain that has no underlying medical cause (eg, tumor, infection, fracture, herniated disc, spinal stenosis). The American College of Physicians (ACP) and American Pain Society (APS) recommend multidisciplinary treatments for NLBP that lasts more than 4 weeks. This approach, however, is impractical for many physicians to implement, and relatively few providers offer NLBP treatment that meets the joint ACP-APS guidelines.Objective: This study evaluated the efficacy of a mobile-Web intervention called " FitBack" to help users implement self-tailored strategies to manage and prevent NLBP occurrences.Methods: A total of 597 adults were recruited, screened, consented, and assessed online at baseline, at 2 months (T2), and at 4 months (T3). After baseline assessments, participants were randomized into three groups: FitBack intervention, alternative care group that received 8 emails urging participants to link to six Internet resources for NLBP, and control group. The FitBack group also received weekly email reminder prompts for 8 weeks plus emails to do assessments. The control group was only contacted to do assessments.Results: Users of the FitBack program showed greater improvement compared to the control group in every comparison of the critical physical, behavioral, and worksite outcome measures at 4-month follow-up. In addition, users of the FitBack program performed better than the alternative care group on current back pain, behavioral, and worksite outcomes at 4-month follow-up. For example, subjects in the control group were 1.7 times more likely to report current back pain than subjects in the FitBack group; subjects in the alternative care group were 1.6 times more likely to report current back pain at 4-month follow-up. Further, the users of the FitBack program showed greater improvement compared to both the control and alternative care groups at 4-month follow-up on patient activation, constructs of the Theory of Planned Behavior, and attitudes toward pain.Conclusions: This research demonstrated that a theoretically based stand-alone mobile-Web intervention that tailors content to users' preferences and interests can be an effective tool in self-management of low back pain. When viewed from the RE-AIM perspective (ie, reach, efficacy/effectiveness, adoption, implementation fidelity, and maintenance), this study supports the notion that there is considerable value in this type of intervention as a potentially cost-effective tool that can reach large numbers of people. The results are promising considering that the FitBack intervention was neither supported by professional caregivers nor integrated within a health promotion campaign, which might have provided additional support for participants. Still, more research is needed on how self-guided mobile-Web interventions will be used over time and to understand factors associated with continuing user engagement.