Development and preliminary evaluation of a digital health intervention to facilitate physical activity and exercise self-management in people with low back pain

Senarath Rathnayake, Akushla 2022. Development and preliminary evaluation of a digital health intervention to facilitate physical activity and exercise self-management in people with low back pain. PhD Thesis, Cardiff University. Item availability restricted.

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Abstract

Background: Low back pain (LBP) is the number one cause of dyability globally. In the majority of patients LBP is non-specific (NSLBP). Despite the well-established recommendations and guidelines, people with NSLBP find it difficult to engage in physical activity (PA) and exercise due to the complex nature of their pain. Digital interventions offer potential solution to encourage people with NSLBP to be active and exercise. However current interventions provide only general advice not considering the complexity of NSLBP and have shown poor outcomes. Aim: To explore the potential role of a digital intervention in promoting optimum exercise self-management in people with NSLBP. Methods: Following the MRC Guidance on the Development and Evaluation of Complex Interventions which advocates using theory, evidence, user testing and appropriate modelling and piloting, this project had 3 phases. Stage 1: identifying the evidence base using a systematic review and meta-analysis focussed on the effect of self-management interventions with exercise components, Stage 2: identifying or developing theory using a focus group study and a mixed methods survey involving stakeholders to identify the interventions functions to include in the intervention to deliver a tailored ESM for NSLBP. Stage 3: developing the BACK-to-FIT digital platform and preliminary evaluation. A prototype version of the website was developed with input from stage 1 and 2. Implementation and behaviour change theories informed this process. Primary outcome of the preliminary evaluation was usability, measured using System usability score (SUS). Secondary outcome measures were technology acceptance measured with TAM3 questionnaire, and potential health benefits measured with NPRS, exercise self-efficacy questionnaire (SSE), Oswestry disability index (ODI), Coping strategies questionnaire (CSQ-24) and level of PA (IPAQ-SF). User experience of the BACK-to-FIT was explored using semi-structured individual interviews. Results: Stage 1 : Demonstrated that self-management programmes with exercise components in them have moderate but significant, short-, intermediate- and long-term positive effect both on pain and disability in patients with chronic NSLBP. A vast heterogeneity was present in the content, frequency and duration of the interventions. Furthermore, not all exercise programmes were tailored according to persons’ need and capabilities. Stage 2: Results from focus group discussions involving 14 musculoskeletal physiotherapists indicated the key considerations when designing a tailored ESM programme for people with NSLBP and identified important components to include in a potential digital ESM intervention included: improving LBP education and awareness, strategies to improve self-monitoring and adherence, use of general and specific exercise, progression and regression of exercise and providing feedback. Findings from the survey with 71 LBP experts responded, revealed 17 key subjective questions and 5 physical tests together with 2 new tests suggested by experts when designing a tailored ESM intervention in NSLBP. Stage 3: The BACK-to-FIT digital platform, prototype version was developed using Intervention functions and behaviour change identified from stage 2. It consisted of 4 main modules involving one LBP education module and 3 exercise modules with 35 different exercises. Twelve participants used the intervention for four weeks and completed the follow up study; Age range 25-50 (mean 38.8), 50% male and 50% female. Primary outcome – mean usability score was 81.87 (47.5-95) measured out of 100. Secondary outcomes - the highest and lowest mean scores obtained for any TAM3 construct were 6.6 and 5.04 for computer anxiety and subjective norm constructs respectively. The highest possible score to achieve was 7. Secondary outcome scores for pain, disability, exercise self-efficacy, catastrophising and PA levels improved from 4.00 (NPRS), 15.33 (ODI), 37.5 (SEE), 9.08 (CSQ-24) and 1513.62 MET -minutes/week (IPAQ-SF) to 2.16 (NPRS), 9.00 (ODI) , 59.67 (SEE) , 5.41 (CSQ-24) and 2070.25 MET -minutes/week (IPAQ-SF) at 4-week follow-up. Feedback from interviews was mainly positive with some suggestions focused on future improvements of the interventions. Conclusion: BACK-to-FIT has been shown to be acceptable to potential end users, has very good usability and has potential for effectiveness. This intervention merits further development, and subsequent evaluation in a larger scale study.

Item Type:	Thesis (PhD)
Date Type:	Completion
Status:	Unpublished
Schools:	Healthcare Sciences
Date of First Compliant Deposit:	22 May 2023
Last Modified:	25 May 2023 09:25
URI:	https://orca.cardiff.ac.uk/id/eprint/159756

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