To provide a comprehensive overview of the effects, barriers, and facilitators associated with the use of SMIs for improving pain, disability, and quality of life in patients with spinal pain.
A systematic literature search was conducted in PUBMED, CINAHL, EMBASE, and PsycINFO from inception to April 2024. Systematic reviews (SRs) focusing on SMIs for spinal pain and qualitative studies investigating patients’ perceptions of using digital SMIs for spinal pain were included. All data were screened independently by 2 reviewers. We focused on digital SMIs in the qualitative studies as this will likely be the most common delivery form of SMIs in the future. Due to significant heterogeneity across the included studies, particularly in study design, outcomes, and SMIs, a meta-analysis was not feasible. For qualitative studies, we focused on user perspectives of SMIs for spinal pain. Themes relating to the aim of this review were extracted and an iterative thematic analysis was applied. Key themes related to the review’s objectives were identified and synthesized to draw meaningful conclusions.
Twenty-three SRs (N=90,018) and 9 qualitative studies (N=177) were included. Most of the SRs found positive effects of SMIs (n=13), while 8 studies reported mixed or equivalent outcomes compared to other treatments. The SMIs were heterogeneous in terms of type and volume and SMI principles were often observed in the control arms of the included studies. Qualitatvely, we identified six key themes related to digital self-management strategies for spinal pain: 1. Facilitators, 2. Barriers, 3. Benefits, 4. Effects, 5. Trustworthiness of information, and 6. Technical features. SMIs were generally considered beneficial, highlighting the ease of access to information, exercises, and action plans, which enhanced understanding and supported pain management. Barriers included poor health, unrealistic goal setting, and technical challenges.
The findings generally supported the use of SMIs for spinal pain. However, the volume of care was often greater in the intervention groups which may affect the results. Additionally, the comparators in some studies may have included SMI principles, such as usual care, guideline-based advice, and exercise. A clear consensus on what constitutes SMI is necessary for more accurate comparisons. The qualitative findings suggest that digital self-management platforms are feasible and beneficial for people with spinal pain, provided the user has confidence in using these tools.
The concept of SMI is inconsistently defined and applied in the literature, leading to variability in its interpretation and implementation. A clear consensus on the essential components of SMI is crucial before incorporating it into clinical guidelines and healthcare policy. A standardised definition would ensure more consistent application and evaluation, ultimately improving the clarity of the effectiveness of SMIs for spinal pain.
Self-management
Digital healthcare
