Irvine A Blair, Russell Holly, Manocchia Michael, Mino David E, Cox Glassen Terri, Morgan Rebecca, Gau Jeff M, Birney Amelia J, Ary Dennis V
ORCAS, Eugene, OR, United States.
J Med Internet Res. 2015 Jan 2;17(1):e1. doi: 10.2196/jmir.3130.
Nonspecific low back pain (NLBP) is the diagnosis for individuals with back pain that has no underlying medical cause (eg, tumor, infection, fracture, herniated disc, spinal stenosis). The American College of Physicians (ACP) and American Pain Society (APS) recommend multidisciplinary treatments for NLBP that lasts more than 4 weeks. This approach, however, is impractical for many physicians to implement, and relatively few providers offer NLBP treatment that meets the joint ACP-APS guidelines.
This study evaluated the efficacy of a mobile-Web intervention called "FitBack" to help users implement self-tailored strategies to manage and prevent NLBP occurrences.
A total of 597 adults were recruited, screened, consented, and assessed online at baseline, at 2 months (T2), and at 4 months (T3). After baseline assessments, participants were randomized into three groups: FitBack intervention, alternative care group that received 8 emails urging participants to link to six Internet resources for NLBP, and control group. The FitBack group also received weekly email reminder prompts for 8 weeks plus emails to do assessments. The control group was only contacted to do assessments.
Users of the FitBack program showed greater improvement compared to the control group in every comparison of the critical physical, behavioral, and worksite outcome measures at 4-month follow-up. In addition, users of the FitBack program performed better than the alternative care group on current back pain, behavioral, and worksite outcomes at 4-month follow-up. For example, subjects in the control group were 1.7 times more likely to report current back pain than subjects in the FitBack group; subjects in the alternative care group were 1.6 times more likely to report current back pain at 4-month follow-up. Further, the users of the FitBack program showed greater improvement compared to both the control and alternative care groups at 4-month follow-up on patient activation, constructs of the Theory of Planned Behavior, and attitudes toward pain.
This research demonstrated that a theoretically based stand-alone mobile-Web intervention that tailors content to users' preferences and interests can be an effective tool in self-management of low back pain. When viewed from the RE-AIM perspective (ie, reach, efficacy/effectiveness, adoption, implementation fidelity, and maintenance), this study supports the notion that there is considerable value in this type of intervention as a potentially cost-effective tool that can reach large numbers of people. The results are promising considering that the FitBack intervention was neither supported by professional caregivers nor integrated within a health promotion campaign, which might have provided additional support for participants. Still, more research is needed on how self-guided mobile-Web interventions will be used over time and to understand factors associated with continuing user engagement.
Clinicaltrials.gov NCT01950091; http://clinicaltrials.gov/ct2/show/NCT01950091 (Archived by WebCite at http://www.webcitation.org/6TwZucX77).
非特异性下腰痛（NLBP）是对无潜在医学病因（如肿瘤、感染、骨折、椎间盘突出、椎管狭窄）的背痛患者的诊断。美国医师学会（ACP）和美国疼痛协会（APS）建议对持续超过4周的NLBP进行多学科治疗。然而，这种方法对许多医生来说实施起来不切实际，而且相对较少的医疗服务提供者提供符合ACP-APS联合指南的NLBP治疗。
本研究评估了一种名为“FitBack”的移动网络干预措施的效果，以帮助用户实施自我定制的策略来管理和预防NLBP的发生。
共招募了597名成年人，在基线、2个月（T2）和4个月（T3）时进行在线筛查、同意参与和评估。基线评估后，参与者被随机分为三组：FitBack干预组、接受8封电子邮件敦促其链接到六个NLBP互联网资源的替代护理组和对照组。FitBack组还在8周内每周收到电子邮件提醒提示以及用于评估的电子邮件。对照组仅被联系进行评估。
在4个月的随访中，在关键的身体、行为和工作场所结局指标的每次比较中，FitBack计划的用户与对照组相比都有更大的改善。此外，在4个月的随访中，FitBack计划的用户在当前背痛、行为和工作场所结局方面的表现优于替代护理组。例如，对照组的受试者报告当前背痛的可能性是FitBack组受试者的1.7倍；在4个月的随访中，替代护理组的受试者报告当前背痛的可能性是FitBack组的1.6倍。此外，在4个月的随访中，FitBack计划的用户在患者激活、计划行为理论的构成要素以及对疼痛的态度方面与对照组和替代护理组相比都有更大的改善。
本研究表明，一种基于理论的独立移动网络干预措施，根据用户的偏好和兴趣定制内容，可以成为下腰痛自我管理的有效工具。从RE-AIM角度（即覆盖范围、疗效/有效性、采用率、实施保真度和维持率）来看，本研究支持这样一种观点，即这种类型的干预作为一种潜在的具有成本效益的工具，能够覆盖大量人群，具有相当大的价值。考虑到FitBack干预既没有得到专业护理人员的支持，也没有纳入健康促进活动中（而健康促进活动可能会为参与者提供额外支持），这些结果是很有前景的。尽管如此，仍需要更多关于自我引导的移动网络干预措施如何随着时间的推移被使用以及了解与持续用户参与相关因素的研究。
Clinicaltrials.gov NCT01950091；http://clinicaltrials.gov/ct2/show/NCT01950091（由WebCite存档于http://www.webcitation.org/6TwZucX77）
