Digital Support Interventions for the Self-Management of Low Back Pain: A Systematic Review.
Digital Support Interventions for the Self-Management of Low Back Pain: A Systematic Review.
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DOI：
10.2196/jmir.7290
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发表时间：
2017-05-21
影响因子：
7.4
通讯作者：
Mair FS
中科院分区：
文献类型：
--
作者：
Nicholl BI;Sandal LF;Stochkendahl MJ;McCallum M;Suresh N;Vasseljen O;Hartvigsen J;Mork PJ;Kjaer P;Søgaard K;Mair FS
下背痛（LBP）是残疾的常见原因，被列为全球最沉重的健康状况。自我管理，包括增加知识，监测症状和身体活动的组成部分，在临床指南中一直被推荐为LBP管理的成本效益策略，并且对数字健康的潜在作用越来越感兴趣。该研究旨在综合和批判性地评估已发表的关于使用交互式数字干预来支持LBP自我管理的证据。研究了以下具体问题：（1）LBP数字自我管理干预的关键组成部分是什么，包括理论基础？(2)在LBP数字自我管理干预措施的随机试验中使用了哪些结果指标，以及干预措施对这些措施有什么影响？（3）干预措施的哪些具体特征或组成部分（如果有的话）似乎与有益结果相关？2000年至2016年3月检索的文献数据库包括Medline、Embase、CINAHL、PsycINFO、科克伦图书馆、DoPHER和TRoPHI、社会科学引文索引和科学引文索引。还进行了参考文献和引文检索。搜索策略结合了以下概念：（1）背痛，（2）数字干预，（3）自我管理。只有随机对照试验（RCT）方案或已完成的RCT涉及LBP成人发表在同行评议的期刊。两名评审员独立筛选标题和摘要、全文文章、提取数据，并使用科克伦偏倚风险工具评估偏倚风险。第三位独立评审员对分歧意见进行了裁定。数据以叙述方式合成。在识别的7014篇参考文献中，纳入了11篇，描述了9项研究：6项已完成的RCT和3项未来RCT的方案。已完成的随机对照试验共纳入2706名受试者（每项研究的受试者范围为114-1343名），在干预措施的性质和实施、LBP的持续时间/定义、测量的结局和干预措施的有效性方面存在很大差异。参与者一般为白色中年人，在6份随机对照试验报告中，5份报告大多数为女性，大多数报告的教育水平为大学或更高。只有一项研究报告了支持数字干预的组间差异。有相当大的差异，在报告的特点，组成部分，和理论的基础上每一个干预措施的程度。没有一项研究显示出危害的证据。这些文献极其庞杂，很难理解什么可能最有效，对谁最有效，在什么情况下最有效。参与者主要是女性、白色、受过良好教育的中年人，因此数字自我管理干预措施的广泛适用性仍然不确定。没有报告关于成本效益的信息。支持LBP患者自我管理的交互式数字干预的证据基础仍然薄弱。
Low back pain (LBP) is a common cause of disability and is ranked as the most burdensome health condition globally. Self-management, including components on increased knowledge, monitoring of symptoms, and physical activity, are consistently recommended in clinical guidelines as cost-effective strategies for LBP management and there is increasing interest in the potential role of digital health. The study aimed to synthesize and critically appraise published evidence concerning the use of interactive digital interventions to support self-management of LBP. The following specific questions were examined: (1) What are the key components of digital self-management interventions for LBP, including theoretical underpinnings? (2) What outcome measures have been used in randomized trials of digital self-management interventions in LBP and what effect, if any, did the intervention have on these? and (3) What specific characteristics or components, if any, of interventions appear to be associated with beneficial outcomes? Bibliographic databases searched from 2000 to March 2016 included Medline, Embase, CINAHL, PsycINFO, Cochrane Library, DoPHER and TRoPHI, Social Science Citation Index, and Science Citation Index. Reference and citation searching was also undertaken. Search strategy combined the following concepts: (1) back pain, (2) digital intervention, and (3) self-management. Only randomized controlled trial (RCT) protocols or completed RCTs involving adults with LBP published in peer-reviewed journals were included. Two reviewers independently screened titles and abstracts, full-text articles, extracted data, and assessed risk of bias using Cochrane risk of bias tool. An independent third reviewer adjudicated on disagreements. Data were synthesized narratively. Of the total 7014 references identified, 11 were included, describing 9 studies: 6 completed RCTs and 3 protocols for future RCTs. The completed RCTs included a total of 2706 participants (range of 114-1343 participants per study) and varied considerably in the nature and delivery of the interventions, the duration/definition of LBP, the outcomes measured, and the effectiveness of the interventions. Participants were generally white, middle aged, and in 5 of 6 RCT reports, the majority were female and most reported educational level as time at college or higher. Only one study reported between-group differences in favor of the digital intervention. There was considerable variation in the extent of reporting the characteristics, components, and theories underpinning each intervention. None of the studies showed evidence of harm. The literature is extremely heterogeneous, making it difficult to understand what might work best, for whom, and in what circumstances. Participants were predominantly female, white, well educated, and middle aged, and thus the wider applicability of digital self-management interventions remains uncertain. No information on cost-effectiveness was reported. The evidence base for interactive digital interventions to support patient self-management of LBP remains weak.