The overall aim of the BACKTRACK project was to improve access to context specific evidence-based care for people with LBP in Uganda to reduce its disability burden, and to improve functional and participatory outcomes.
The programme theory for the BACKTRACK project was developed by the UCD and Mbarara research team using a Theory of Change approach.
Care pathways and BACKTRACK content was based on a literature review followed by consensus by clinical working group, composed of seven clinical and academic physiotherapists working in Ireland and Uganda who had significant clinical experience, an in-depth understanding of evidence-based physiotherapy for LBP, and deep insights and experiences of their respective health systems and referral pathways. Two software developers with significant experience of developing mHealth apps and integration of digital health records, worked in tandem with the clinical working group to build and revise the mHealth app.
We recruited frontline clinicians (nurses and clinical officers), working in ten rural health centres in Uganda as end-user representatives. We used an iterative agile co-design approach whereby each participating clinician (n=19) gave cyclical qualitative feedback on the app on 3 occasions via one face to face group meeting and two telephone interviews(3). The quantitative data gathered by the app served as a complementary source of feedback. This feedback was incorporated into the final version of the app.
Three LBP care pathways were identified. 'Green' was for those with low or moderate risk of persistent pain who could be managed at health centre level. 'Yellow' was for those at high risk of developing persistent pain, and referred for physiotherapy at the regional referral hospital. 'Red' category was for people at risk of having a serious pathology, who would be referred to the regional referral hospital.
The question set developed for the mHealth app was composed of 4 categories of questions: demographics , clinical characteristics, serious underlying pathology and the STARTBACK screening tool.
Clinician feedback suggested that BACKTRACK was useful and improved LBP management, reducing painkillers consumption, and providing basic rehabilitation services at community-level. Feedback to enhance the app included the need for faster operational times, reduce the sensitivity of the red flag questions and further education and training for clinicians about LBP management.
BACKTRACK was valued by clinicians and participation in the project enhanced knowledge of and interest in management of LBP amongst clinicians, who's predominant focus is on management of communicable diseases and maternal and child health.
Education and training for frontline clinicians on LBP management is crucial to underpin technology enabled care pathways, to improve community-based management and health outcomes for people with LBP in rural Uganda
Health Technology
Low income countries
