Background: The prevalence of spinal complaints such as low back pain is rising due to factors like aging, sedentary lifestyle, and obesity. Traditional conservative treatments include physical therapy and lifestyle modifications. The digital revolution in healthcare has introduced app-based interventions as a promising alternative.
Rationale: Given the high burden of spinal complaints and the associated economic impact, there is need for effective and efficient treatment modalities. This is especially evident in Western healthcare systems with growing demands and limited resources due to the changing demographic of the population. An app-based approach offers a viable solution by combining evidence-based conservative treatments. Moreover, an app-based treatment could offer personalized treatment, real-time feedback, and enhanced patient engagement at lower costs, presents as a viable solution.
Objective: This pilot study aims to evaluate the efficacy of an app-based treatment method combining physical exercise, graded activity, and pain journaling for patients with spinal complaints who will otherwise receive physical therapy, general lifestyle advice, or an expectant treatment in current practice.
Study design: Single center prospective study.
Study population: A total of 30 patients over 18 years old suffering from spinal complaints for which in current practice physical therapy, general lifestyle advice, or an expectant treatment will be advised.
Intervention: An app-based treatment consisting of a combination of physical exercise, graded activity, and pain journaling.
Main study parameters/endpoints: Primary endpoint: Patients' experience and satisfaction qualitatively, measured using semi-structured face-to-face interviews after three months of treatment.
Secondary endpoints: Quality of Life (Qol) measured with the EuroQol 5 dimensions (EQ-5D-5L) at baseline, one, two and three months after starting the intervention. Change in back- and leg-pain, measured with the Visual Analogue Scale (VAS). Change in disability, measured with the Oswestry Disability Index (ODI). Change in catastrophizing of pain, measured with the Pain Catastrophizing Scale (PCS). Change in lost productivity, measured with patient reported missed working days. Healthcare consumption, measured with number of visits to doctor or paramedic. Change in Body Mass Index, measured using patients' input on length and weight. Adherence of participants measured using frequency of patients' input in the mobile application. Safety measured using the (serious) adverse events ((S)AE).
Nature and extent of the burden and risks associated with participation, benefit and group relatedness: The nature and extent of the burden associated with participation in the app-based treatment program primarily involve adherence to recommended activities and inputting relevant health data. Given that the investigators are integrating existing treatment modalities, such as physical exercise, graded activity, and pain journaling, the risks associated with participation are minimal, as these interventions are already deemed safe and widely practiced. The responsibility for determining each patient's suitability for participation in this study lies with the referring physician. Participants can expect benefits such as improved pain management, enhanced physical function, and better overall well-being.
Patients visiting the spine-centre at Zuyderland Medical Centre.
Suffering from spinal complaints for which in current practice physical therapy, general lifestyle advice, or an expectant treatment would be advised.
Minimum age of 18 years.
Psychosocially, mentally, and physically able to fully comply with this study protocol.
Requiring a specific intervention (e.g., surgery, pain treatment, rehabilitation, bracing)
Inadequate command of the Dutch language.
Digitally illiterate or otherwise unable to use an application on a mobile phone.
Active spinal infection.
Single group
The app-based treatment consists of a combination of physical exercise, graded activity, and pain journaling.
DeviceThe app-based treatment consists of a combination of physical exercise, graded activity, and pain journaling. The app will be installed on the participant's mobile device. The app will be used anonymously, and patients use their unique study code to activate the app. The content and user-interface of the app-based treatment were developed in collaboration with healthcare professionals for relevant medical specialties, including orthopedic surgery, neurosurgery, neurology, physiotherapy, and rehabilitation. The content is based on expert opinion from these fields. Additionally, there is scientific evidence indicating that the treatments used within the app are safe and effective. The app has been tested for usability and functionality by both professionals and laypersons, including individuals with back pain.
The primary outcome is qualitative information on the viability, feasibility, effectiveness, and safety.
The data used is gathered by evaluating the patients' experience and satisfaction qualitatively, using semi-structured face-to-face interviews at three months follow-up.
Secondary outcome, Quality of Life
Change in QoL, measured with the ED-5D-5L.
Secondary outcome, pain
Change in pain, measured with the Visual Analogue Scale (VAS).
Secondary outcome, disablity
Change in disability, measured with the Oswestry Disability Index (ODI). o
Secondary outcome, productivity
Change in lost productivity, measured with missed working days.
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Zuyderland Medisch Centrum
Lead sponsor
The eHealth Project B.V.
Collaborator
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