Abstract
BackgroundLow back pain (LBP) is a leading cause of disability worldwide. Most patients with LBP encountered in primary care settings have nonspecific LBP, that is, pain with an unknown pathoanatomical cause. Self-management in the form of physical activity and strength and flexibility exercises along with patient education constitute the core components of the management of nonspecific LBP. However, the adherence to a self-management program is challenging for most patients, especially without feedback and reinforcement. Here we outline a protocol for the design and implementation of a decision support system (DSS), selfBACK, to be used by patients themselves to promote self-management of LBP.ObjectiveThe main objective of the selfBACK project is to improve self-management of nonspecific LBP to prevent chronicity, recurrence and pain-related disability. This is achieved by utilizing computer technology to develop personalized self-management plans based on individual patient data.MethodsThe decision support is conveyed to patients via a mobile phone app in the form of advice for self-management. Case-based reasoning (CBR), a technology that utilizes knowledge about previous cases along with data about the current patient case, is used to tailor the advice to the current patient, enabling a patient-centered intervention based on what has and has not been successful in previous patient cases. The data source for the CBR system comprises initial patient data collected by a Web-based questionnaire, weekly patient reports (eg, symptom progression), and a physical activity-detecting wristband. The effectiveness of the selfBACK DSS will be evaluated in a multinational, randomized controlled trial (RCT), targeting care-seeking patients with nonspecific LBP. A process evaluation will be carried out as an integral part of the RCT to document the implementation and patient experiences with selfBACK.ResultsThe selfBACK project was launched in January 2016 and will run until the end of 2020. The final version of the selfBACK DSS will be completed in 2018. The RCT will commence in February 2019 with pain-related disability at 3 months as the primary outcome. The trial results will be reported according to the CONSORT statement and the extended CONSORT-EHEALTH checklist. Exploitation of the results will be ongoing throughout the project period based on a business plan developed by the selfBACK consortium. Tailored digital support has been proposed as a promising approach to improve self-management of chronic disease. However, tailoring self-management advice according to the needs, motivation, symptoms, and progress of individual patients is a challenging task. Here we outline a protocol for the design and implementation of a stand-alone DSS based on the CBR technology with the potential to improve self-management of nonspecific LBP.ConclusionsThe selfBACK project will provide learning regarding the implementation and effectiveness of an app-based DSS for patients with nonspecific LBP.Registered Report IdentifierRR1-10.2196/9379
Highlights
BackgroundThe recent Global Burden of Disease Study showed that low back pain (LBP) is the most significant contributor to years lived with disability worldwide [1,2]
The trial results will be reported according to the CONSORT statement and the extended CONSORT-EHEALTH checklist
We outline a protocol for the design and implementation of a stand-alone decision support system (DSS) based on the Case-based reasoning (CBR) technology with the potential to improve self-management of nonspecific Low back pain (LBP)
Summary
BackgroundThe recent Global Burden of Disease Study showed that low back pain (LBP) is the most significant contributor to years lived with disability worldwide [1,2]. SelfBACK addresses nonspecific LBP, that is, pain with an unknown pathoanatomical cause, which comprises >85% of all patients with LBP observed in primary care settings [5,6]. The main components recommended in the management of LBP include education and reassurance, staying active both in and outside of work, and regular strength and flexibility exercises to prevent relapse, pain-related disability, and chronicity. The possibility of delivering tailored support to individual patients has a significant potential with some evidence that tailoring the self-management advice to patients with LBP is more effective compared with nontailoring [18]. Self-management in the form of physical activity and strength and flexibility exercises along with patient education constitute the core components of the management of nonspecific LBP. We outline a protocol for the design and implementation of a decision support system (DSS), selfBACK, to be used by patients themselves to promote self-management of LBP
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