Treatment of Low Back Pain with a Digital Multidisciplinary Pain Treatment App: Short-Term Results

Abstract

Background: Even though modern concepts of disease management of unspecific low back pain (LBP) postulate active participation of patients, this strategy is difficult to adapt unless multidisciplinary pain therapy is applied. Recently, mobile health solutions have proven to be effective aides to foster self-management of many diseases.

Objective: The objective of this paper was to report on the retrospective short-term results of a digital multidisciplinary pain app for the treatment of LBP.

Methods: Kaia is a mobile app that digitalizes multidisciplinary pain treatment and is in the market as a medical product class I. For the current study, the data of anonymized Kaia users was retrospectively analyzed. User data were evaluated for 12 weeks regarding duration of use and effect on in-app user reported pain levels, using the numerical rating scale (NRS), depending on whether LBP was classified as acute, subacute, or chronic back pain according to current guidelines.

Results: Data of 180 users were available. The mean age of the users was 33.9 years (SD 10.9). Pain levels decreased from baseline NRS 4.8 to 3.75 for all users at the end of the observation period. Users who completed 4, 8, or 12 weeks showed an even more pronounced decrease in pain level NRS (baseline 4.9 [SD 1.7] versus 3.6 [SD 1.5] at 4 weeks; baseline 4.7 [SD 1.8] versus 3.2 [SD [2.0] at 8 weeks; baseline 4.6 [SD 2.2] versus 2.6 [SD 2.0] at 12 weeks). In addition, subgroup analysis of acute, subacute, or chronic classification revealed no significant main effect of group (P>.30) on the reduction of pain. Conclusions: This retrospective study showed that in a pre-selected population of app users, an app digitalizing multidisciplinary rehabilitation for the self-management of LBP reduced user-reported pain levels significantly. The observed effect size was clinically relevant. Ongoing prospective randomized controlled trials (RCTs) will adjust for potential bias and selection effects.

Conclusions: This retrospective study showed that in a pre-selected population of app users, an app digitalizing multidisciplinary rehabilitation for the self-management of LBP reduced user-reported pain levels significantly. The observed effect size was clinically relevant. Ongoing prospective RCTs will adjust for potential bias and selection effects.

Keywords: app; lower back pain; mHealth; retrospective study; self-management.

Figure 1

Examples of daily content from the app for each of the categories and design of the coach chat.

Figure 2

Development of user numbers over time.

Figure 3

Mean (SE) baseline (BL) pain levels and pain levels of the day of the last use (LU) both for completers of the program (12 weeks) and all users. NRS: numerial rating scale.

Figure 4

Development of mean (SD) pain levels both for the baseline (BL) and the 3 follow-up measures (4 weeks, N=71; 8 weeks, N=30; 12 weeks, N=20).

Figure 5

Development of pain levels over time (baseline versus 4, 8, and 12 weeks) for the 3 chronification groups (stratified by duration of their complaints). Less than 6 weeks: 4 weeks, N=12; 8 weeks, N=4; 12 weeks, N=1. Between 6 and 12 weeks: 4 weeks, N=10; 8 weeks, N=4; 12 weeks, N=3. More than 12 weeks: 4 weeks, N=49; 8 weeks, N=21; 12 weeks, N=16.