Background & Aims
Low back pain (LBP) is the leading cause of disability globally [1], resulting in significant healthcare costs of approximately 108 billion USD annually [2]. To address challenges such as waiting times, poor infrastructure, and limited access to therapy associated with traditional in-person LBP care, alternative approaches are necessary. Telemedicine is a rapidly growing alternative to conventional physiotherapy. It offers advantages such as reduced travel times [3], enhanced time flexibility [4], and self-management [5]. Evidence supports similar effectiveness in improving pain and physical function compared to conventional in-person care for LBP [6,7]. However, usability is a critical barrier to practical implementation and can negatively affect compliance [8]. This study evaluates the usability of the “NOLA” app, which integrates exercise and education for LBP. It also examines patient perspectives on telemedicine, app usage, adherence, and motivation.
Methods
For this pre-planned secondary analysis of a three-arm randomized trial, we recruited participants with LBP from May to August 2022 and randomized them into App, Physio+App, or Physio groups. In this sub-analysis, we included the App and Physio+App groups. Participants in the App group were given access to the app “NOLA” and used the individualized exercise program and knowledge lessons integrated in the app autonomously, supported by video tutorials. Participants in the Physio+App group received standard physiotherapy integrated with the use of the app. The intervention duration was 6 weeks for both groups. Data on baseline characteristics, System Usability Scale (SUS) [9], Telemedicine Perception Questionnaire (TPQ) [10], app usage, adherence, and motivation were collected online. Outcomes were analyzed quantitatively and reported as frequencies of answers for each question in the questionnaires, as well as mean and standard deviation for the overall score of the SUS and TPQ.
Results
Of 93 participants, 64 were randomized either to the App or Physio+App group with 38 participants providing data. The mean age was 49.9 years, with 78% experiencing low back pain for more than two years. Usability scores (SUS [0-100]) were good (Mean (SD) Physio+App: 79.3 (16.3), App: 75.3 (18.1)). Positive perceptions of telemedicine were noted with 84% rating it an adequate addition to usual care. No difference was found for the TPQ overall score [0-60] between groups (Mean (SD) Physio+App: 44.3 (5.0), App: 42.6 (4.6)). Pain improvement was positively associated with the TPQ overall score (F1,35 = 7.5, p = 0.01), but could only account for 15.4% of the variance in the TPQ. App usage varied, with 43% using it three to five days per week, and 76% reporting motivation to train with the app. The dropout rates were similar (App: 14/32, Physio+App: 12/32, Physio: 11/29), but participants who dropped out had statistically significant less pain at baseline than those who completed the study.
Conclusions
In conclusion, our randomized controlled trial indicated a good usability of the app “NOLA”, as well as positive patient perceptions of telemedicine in general. Despite concerns about the lack of physical contact, participants recognized telemedicine as a convenient addition to usual care. Participants were motivated to train with the app and used it frequently, highlighting the potential of such interventions in managing LBP. However, it is important to note that high dropout rates in the study could potentially bias results. It remains unclear whether the reasons for dropout were related to the app or not. The findings of this study provide valuable insights into the evolving field of telemedicine, indicating that well-designed apps can improve patient engagement and satisfaction in individuals with LBP. Further exploration and optimization of app-based interventions is necessary for their effective integration into routine clinical practice.
References
1 Ferreira ML, De Luca K, Haile LM, et al. Global, regional, and national burden of low back pain, 1990–2020, its attributable risk factors, and projections to 2050: a systematic analysis of the Global Burden of Disease Study 2021. The Lancet Rheumatology. 2023;5:e316–29.
2 Martin BI. Expenditures and Health Status Among Adults With Back and Neck Problems. JAMA. 2008;299:656.
3 Lord Ferguson S. Is the End of the Pandemic the End of Telerehabilitation? Physical Therapy. 2022;102:pzac004.
4 Scott Kruse C, Karem P, Shifflett K, et al. Evaluating barriers to adopting telemedicine worldwide: A systematic review. J Telemed Telecare. 2018;24:4–12.
5 Fernandes LG, Devan H, Fioratti I, et al. At my own pace, space, and place: a systematic review of qualitative studies of enablers and barriers to telehealth interventions for people with chronic pain. Pain. 2022;163:e165–81.
6 Kaczorowski S, Donath L, Owen PJ, et al. Telemedicine for Patients with Musculoskeletal Pain Lacks High-Quality Evidence on Delivery Modes and Effectiveness: An Umbrella Review. Telemedicine and e-Health. 2023;tmj.2023.0255.
7 Lara-Palomo IC, Gil-Martínez E, Ramírez-García JD, et al. Efficacy of e-Health Interventions in Patients with Chronic Low-Back Pain: A Systematic Review with Meta-Analysis. Telemedicine and e-Health. 2022;tmj.2021.0599.
8 Eze ND, Mateus C, Cravo Oliveira Hashiguchi T. Telemedicine in the OECD: An umbrella review of clinical and cost-effectiveness, patient experience and implementation. PLoS ONE. 2020;15:e0237585.
9 Brooke J. SUS: A quick and dirty usability scale. Usability Eval Ind. 1995;189.
10 Altmann P, Ivkic D, Ponleitner M, et al. Individual Perception of Telehealth: Validation of a German Translation of the Telemedicine Perception Questionnaire and a Derived Short Version. Int J Environ Res Public Health. 2022;19:902.
Presenting Author
Svenja Kaczorowski
Poster Authors
Svenja Kaczorowski
MSc
Hochschule für Gesundheit Bochum
Lead Author
Katharina Trompeter
PhD
Hochschule für Gesundheit [University of Applied Sciences] Bochum
Lead Author
Carolin Kramer
MSc
Hochschule für Gesundheit [University of Applied Sciences] Bochum
Lead Author
Christian Grüneberg
PhD
Hochschule für Gesundheit [University of Applied Sciences] Bochum
Lead Author
Christian Thiel
PhD
Hochschule für Gesundheit [University of Applied Sciences] Bochum
Lead Author
Lars Donath
PhD
German Sport University, Department of Intervention Research in Exercise Training
Lead Author
Daniel Belavy
PhD
Hochschule für Gesundheit [University of Applied Sciences] Bochum
Lead Author
Topics
- Specific Pain Conditions/Pain in Specific Populations: Low Back Pain