BACK-TO-FIT<SUP>TM</SUP>– A NOVEL DIGITAL INTERVENTION TO PROMOTE EXERCISE SELF-MANAGEMENT IN LOW BACK PAIN: A PRELIMINARY EVALUATION WITH A 4-WEEK FOLLOW-UP

A. Senarath Rathnayake^1,2, V. Sparkes¹, L. Sheeran¹

¹Cardiff University, School of Healthcare Sciences, Cardiff, United Kingdom, ²University of Hertfordshire, School of Health and Social Work, Department of Physiotherapy, Hatfeild, United Kingdom

Background: Low back pain (LBP) is globally the number one cause of disability, and in the majority of patients, LBP can be regarded as non-specific (NSLBP). Exercise and self-management are highly recommended in NSLBP best practice guidelines. Despite the well-established recommendations and guidelines, people with NSLBP find it difficult to engage in physical activity (PA) and exercise due to the complex nature of their pain. Digital interventions (DIs) show promise in helping people with NSLBP to self-manage and be active. However, existing DIs do not meet consumer needs, and the effects of the DIs remain unclear. BACK-to-FIT^TM is evidence, theory, and practice-based DI developed to promote PA and exercise self-management in people with NSLBP, using stakeholder input across 3 developmental phases as recommended by Medical Research Guidelines-UK.

Purpose: To evaluate the usability, technology acceptance potential health benefits of BACK-to-FIT^TM.

Methods: This single-arm study enrolled 16 participants who experienced recurrent NSLBP and had pain within the past 4 weeks. Participants used BACK-to-FIT^TM for 4-weeks, which provided 4 distinct modules of exercise and LBP education to improve self-management and exercise/PA engagement. Participants completed an online survey that included baseline and post-intervention outcome measure questionnaires at the enrolment and after 4-week follow-up. Usability was measured with the System usability score (SUS), and technology acceptance was measured with a 7-point Likert scale questionnaire (ranging from strongly disagree to strongly agree) based on Technology acceptance model 3 (TAM3). Potential health benefits were measured with a 10-point numerical pain rating scale (NPRS), self-efficacy for exercise questionnaire (SEE), Oswestry Disability Index (ODI), and International Physical Activity Questionnaire- short form (IPAQ-SF). Mean values and standard deviations of all of the above outcomes were compared.

Results: Follow-up data for 4-weeks was obtained for 12 participants. The mean usability score was 81.87 (SD 12.65, range 50.50 – 95.00), which falls in the good to excellent range in the adjective rating scale of the SUS. More than 75% of the sample always agreed (> somewhat agree) on all of the measurement items across eight measured TAM constructs revealing high rates of technology acceptance. The lowest and highest mean scores reported were 5.04 (for subjective norm) and 6.6 (for computer anxiety). The mean score of the pain intensity of the sample measured using the NPRS was reduced by 1.89, and the SEE score increased by 22.17 compared to the baseline measures. Participants’ mean score for the total level of PA increased by 556.63 MET (metabolic equivalent) -minutes/week (, while vigorous and moderate PA increased by 366.66 and 268.34 MET-minutes/week, respectively. The only decreased mean score reported was walking, by 78.38 MET-minutes/week.

Conclusions: The novel intervention BACK-to-FIT^TM has shown good usability, technology acceptance and potential benefits, including reduced LBP intensity, improved exercise self-efficacy and improved total, moderate and vigorous PA levels among participants.

Implications: It is anticipated that BACK-to-FIT^TM can aid in enhancing LBP exercise self-management and be an excellent resource to reduce the massive burden of LBP. Moreover, it merits further development and subsequent evaluation in larger-scale studies to affirm its feasibility and effectiveness.

Funding acknowledgements: This study was funded by Biomechanics and Bioengineering Research Centre Versus Arthritis, Cardiff University, UK(Grant number -CA20781)

Keywords:
Low back pain
Exercise and Physical activity
Digital interventions

Topics:
Musculoskeletal: spine
Health promotion & wellbeing/healthy ageing/physical activity
Innovative technology: information management, big data and artificial intelligence

Did this work require ethics approval? Yes

Institution: Cardiff University

Committee: School of Healthcare Sciences Ethics Committee

Ethics number: REC745