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Randomized Controlled Trial
. 2022 May 16;10(5):e35867.
doi: 10.2196/35867.

Evaluation of the Effect of Patient Education and Strengthening Exercise Therapy Using a Mobile Messaging App on Work Productivity in Japanese Patients With Chronic Low Back Pain: Open-Label, Randomized, Parallel-Group Trial

Naohiro Itoh  1 , Hirokazu Mishima  1 , Yuki Yoshida  2 , Manami Yoshida  1 , Hiroyuki Oka  3 , Ko Matsudaira  3
Affiliations
Randomized Controlled Trial

Evaluation of the Effect of Patient Education and Strengthening Exercise Therapy Using a Mobile Messaging App on Work Productivity in Japanese Patients With Chronic Low Back Pain: Open-Label, Randomized, Parallel-Group Trial

Naohiro Itoh et al. JMIR Mhealth Uhealth. .

Abstract

Background: Artificial intelligence-assisted interactive health promotion systems are useful tools for the management of musculoskeletal conditions.

Objective: This study aimed to explore the effects of web-based video patient education and strengthening exercise therapy, using a mobile messaging app, on work productivity and pain in patients with chronic low back pain (CLBP) receiving pharmacological treatment.

Methods: Patients with CLBP were randomly allocated to either the exercise group, who received education and exercise therapy using a mobile messaging app, or the conventional group. For patient education, a web-based video program was used to provide evidence-based thinking regarding the importance of a cognitive behavioral approach for CLBP. The exercise therapy was developed in accordance with the recommendations for alignment, core muscles, and endogenous activation, including improvement of posture and mobility for proper alignment, stimulation and/or strengthening of deep muscles for spinal stability, and operation of intrinsic pain for the activation of endogenous substances by aerobic exercise. Both groups continued to receive the usual medical care with pharmacological treatment. The end points were changes in work productivity, pain intensity, quality of life, fear of movement, and depression. The observation period for this study was 12 weeks. An analysis adjusted for baseline values, age at the time of consent acquisition, sex, and willingness to strengthen the exercise therapy was performed.

Results: The exercise and conventional groups included 48 and 51 patients, with a mean age of 47.9 years (SD 10.2 years; n=27, 56.3% male patients) and 46.9 years (SD 12.3 years; n=28, 54.9% male patients) in the full analysis set, respectively. No significant impact of these interventions on work productivity was observed in the exercise group compared with the conventional group (primary end point: Quantity and Quality method; 0.062 vs 0.114; difference between groups -0.053, 95% CI -0.184 to 0.079; P=.43). However, the exercise group showed consistently better trends for the other end points than did the conventional group. Compared with the conventional group, the exercise group showed a significant improvement in the symptoms of low back pain (3.2 vs 3.8; difference between groups -0.5, 95% CI -1.1 to 0.0; P=.04), quality of life (EuroQoL 5 Dimensions 5 Level: 0.068 vs 0.006; difference between groups 0.061, 95% CI 0.008 to 0.114; P=.03), and fear of movement at week 12 (-2.3 vs 0.5; difference between groups -2.8, 95% CI -5.5 to -0.1; P=.04).

Conclusions: This study suggests that patient education and strengthening exercise therapy using a mobile messaging app may be useful for treating CLBP. This study does not reveal the effect of therapeutic interventions on CLBP on work productivity. Thus, further research is required to assess work productivity with therapeutic interventions.

Trial registration: University Hospital Medical Information Network Clinical Trials Registry UMIN000041037; https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000046866.

Keywords: chronic low back pain; exercise regimen; mobile app; mobile phone; patient education.

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Conflict of interest statement

Conflicts of Interest: NI, HM, YY, and MY are employees and minor stockholders of Shionogi & Co, Ltd. KM is a shareholder and an adviser of Trunk Solution Co, Ltd, and received the following support: a research grant from the Ministry of Health, Labour and Welfare; grant support from Sompo Holdings, Inc, MS&AD InterRisk Research & Consulting, Inc, Inotech Co, Ltd, NUVASIVE Japan MTG Co, Ltd, DeNA, Medical Data Scientist and Medical AI Device Development Organization, The Association for Preventive Medicine of Japan, and Murata Manufacturing Co, Ltd, including personal fees from Nippon Zoki Pharmaceutical Co, Ltd, Ono Pharmaceutical Co, Ltd, Chugai Pharmaceutical Co, Ltd, AYUMI Pharmaceutical Corporation, and Shionogi & Co, Ltd; and lecture fees from Eli Lilly Japan K.K, Pfizer Japan Inc, and Hisamitsu Pharmaceutical Co, Inc, from outside the submitted work. HO reports personal fees received from AYUMI Pharmaceutical Corporation, Nippon Zoki Pharmaceutical Co, Ltd, Ono Pharmaceutical Co, Ltd, Sompo Holdings, Inc, NuVasive Japan, Inc, Promotion of Practical Use of AI Medical Diagnosis Support Equipment, MS&AD InterRisk Research & Consulting, Inc, Inotech Corporation, Chugai Pharmaceutical Co, Ltd, The Association for Preventive Medicine of Japan, Shionogi & Co, Ltd, and MTG Co, Ltd; and grants from Pfizer Inc, outside of the submitted work.

Figures

Figure 1
Figure 1
Study design.
Figure 2
Figure 2
Examples of exercises with instructions from the artificial intelligence–assisted health program (Secaide).
Figure 3
Figure 3
Exercise menu on Secaide.
Figure 4
Figure 4
Exercise schedule on Secaide. a) One Stretch (Standing Back Extension), b) Side One Stretch, c) McKenzie Extension (Sea Lion Pose), d) Hamstring Stretch, e) Lying Waist Twist, f) Arm Leg Raise (Kneeling Superman), m) Mindfulness, n) Questionnaire.
Figure 5
Figure 5
Patient disposition. FAS: full analysis set.
Figure 6
Figure 6
Compliance rates for the use of mobile messaging app–based exercise therapy during the study duration. Exercise status is evaluated by access log to Secaide within a specified period. Percentage of patients (%)=(access days/observation period)×100. Category aggregation for the rate of adherence was performed by 0% to 25% (blue), 25% to 50% (orange), 50% to 75% (gray), and ≥75% (yellow).
See this image and copyright information in PMC

References

    1. Meucci RD, Fassa AG, Faria NM. Prevalence of chronic low back pain: systematic review. Rev Saude Publica. 2015;49:1. doi: 10.1590/S0034-8910.2015049005874. https://www.scielo.br/scielo.php?script=sci_arttext&pid=S0034-8910201500... S0034-89102015000100408 - DOI - PMC - PubMed
    1. Fujii T, Matsudaira K. Prevalence of low back pain and factors associated with chronic disabling back pain in Japan. Eur Spine J. 2013 Feb;22(2):432–8. doi: 10.1007/s00586-012-2439-0. http://europepmc.org/abstract/MED/22868456 - DOI - PMC - PubMed
    1. Inoue S, Kobayashi F, Nishihara M, Arai YC, Ikemoto T, Kawai T, Inoue M, Hasegawa T, Ushida T. Chronic pain in the Japanese community--prevalence, characteristics and impact on quality of life. PLoS One. 2015 Jun 15;10(6):e0129262. doi: 10.1371/journal.pone.0129262. https://dx.plos.org/10.1371/journal.pone.0129262 PONE-D-14-32022 - DOI - DOI - PMC - PubMed
    1. GBD 2017 Disease and Injury Incidence and Prevalence Collaborators Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018 Nov 10;392(10159):1789–858. doi: 10.1016/S0140-6736(18)32279-7. https://linkinghub.elsevier.com/retrieve/pii/S0140-6736(18)32279-7 S0140-6736(18)32279-7 - DOI - PMC - PubMed
    1. Frymoyer JW. Predicting disability from low back pain. Clin Orthop Relat Res. 1992 Jun;(279):101–9. - PubMed

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