Ferrero Alessandro [University of Eastern Piedmont, Novara, Italy]
Caretto Francesca [University of Turin, Turin, Italy]
Lambert Giorgia [University of Turin, Turin, Italy]
Piano Leonardo [University of Turin, Turin, Italy]
Trucco Marco [University of Turin, Turin, Italy]
Chiarotto Alessandro [Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands]
The management of patients with nonspecific Low Back Pain (LBP) should follow a biopsychosocial framework, with a focus on education that supports self-management and resumption of normal activities of daily living. In recent international guidelines, the use of self-management techniques for patients with LBP has been recommended among first-line treatments for patients with LBP. Moreover, it has been recognized that access to digital apps can help the self-management of people with LBP and can reduce pressure on health services. So the use of apps could be a solution to the need of distance management of patients with LBP, promoting the self-management of this health condition.
The aim of this systematic review was to investigate the effectiveness of the use of mobile apps for the treatment of patients with nonspecific acute, subacute and chronic LBP. We considered the use of apps as the only form of intervention or in adjunction to rehabilitation treatments.
We registered the protocol in PROSPERO (CRD42023435062). We searched CENTRAL, Embase, CINAHL, MEDLINE, Scopus and PEDro (up to April 16, 2023). In addition, we performed backward and forward citation tracking in Web of Science, a search in clinical trials register (clinicaltrials.gov) and a search in the grey literature (Google Scholar). We included parallel-group full-scale or pilot randomized controlled trials (RCTs) in patients with acute, subacute or chronic nonspecific LBP. We included studies using apps for mobile devices. We considered studies using mobile apps as unique form of treatment or in adjunction to the rehabilitation treatment, compared with the rehabilitation treatment alone. We also investigated the use of a specific type of app compared to other types of apps. We considered the following primary outcomes: pain intensity, physical function, self-efficacy and health-related quality of life, at short term, medium term and long term follow-up. We assessed the risk of bias (RoB) using the RoB checklist of the Cochrane Back and Neck Group. We performed a random-effects meta-analysis for clinically homogeneous RCTs. We assessed the certainty of evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.
We included 8 RCTs1-8. There was very low certainty evidence that the use of an app in addition to the rehabilitation treatment was not more effective than the rehabilitation treatment alone for pain at short term (MD: −0.14; 95% CI: -1.1, 0.83) in a mixed population of acute, subacute and chronic nonspecific LBP. There was moderate certainty evidence that the use of an app in adjunction to the rehabilitation treatment was more effective than rehabilitation treatment alone for pain at long term (MD: −0.58; 95% CI: -1.00, -0.17), but with no clinically relevant effects in a mixed population of acute, subacute and chronic nonspecific LBP. All other comparisons for all outcomes were underpinned by a single RCT. Overall, no clinically relevant differences emerged from these trials, also when there were statistically significant improvements in favor of the app treatment.
The use of an app in adjunction to the rehabilitation treatment could make a small improvement in pain at long term, but not in short term, when compared to rehabilitation treatment alone in a mixed population of nonspecific LBP. Moreover, the use of mobile apps can be considered a valid alternative to the in-person rehabilitation, showing not inferior results than rehabilitation in the management of patients with nonspecific LBP and promoting the self-management of these patients.
