Faculty of Medicine and Health, The University of Sydney, Level 7, Susan Wakil Health Building D18, Sydney, NSW, 2006, Australia.
Faculty of Health, Education, Medicine and Social Care, Anglia Ruskin University, Cambridge, UK.
Chiropr Man Therap. 2021 Aug 17;29(1):32. doi: 10.1186/s12998-021-00389-y.
In chronic conditions, such as back pain, the use of interventions that address physical, social and psychological aspects within a biopsychosocial framework are encouraged, however, applying this holistic multimodal approach in physical therapy practice (i.e., chiropractic and physiotherapy) is challenging. To explore the problem of delivering a biopsychosocially informed package of care in physical therapy practice a recent randomised control trial (RCT) called 'Mind Your Back' was conducted to evaluate the effectiveness of a combined physical and internet-delivered psychological intervention (psychologically informed physical treatments) compared to standard treatment for improving disability and self-efficacy in people with chronic LBP. The results of the trial indicated no difference between the two intervention groups. Although high-quality RCTs are considered gold standard for effectiveness of interventions, qualitative research methods embedded within a process evaluation framework are also used to reveal other issues and important information that help to explain clinical trial results, and to further the field of digital health interventions research. Therefore, within a process evaluation framework, the aim is to explore participants experiences of the interventions received throughout the Mind Your Back trial which led to a null result.
In-line with recommendations for a process evaluation this study used in-depth interviews and qualitative thematic analysis with participants of both arms of the trial 5-6 months after study completion. Semi-structured telephone interviews were conducted with twenty-five participants to explore their experiences of taking part in the Mind Your Back trial. Interviews were conducted in November 2017, transcribed verbatim and data analysed thematically.
Two main themes were identified: (1) Personalised support and therapeutic alliance are important, and (2) MoodGYM lacked relevant, personalised and tailored support.
It is important to deliver tailored digital health supports that is personalised and fosters a therapeutic alliance.
在慢性病（如背痛）的情况下，鼓励在生物心理社会框架内使用针对身体、社会和心理方面的干预措施，但在物理治疗实践中应用这种整体多模式方法（即脊医和物理治疗）具有挑战性。为了探索在物理治疗实践中提供生物心理社会信息包护理的问题，最近进行了一项名为“Mind Your Back”的随机对照试验（RCT），以评估联合物理和互联网提供的心理干预（心理知情的物理治疗）与标准治疗相比在改善慢性 LBP 患者的残疾和自我效能方面的效果。试验结果表明两组干预之间没有差异。虽然高质量的 RCT 被认为是干预效果的金标准，但在过程评估框架内嵌入的定性研究方法也用于揭示其他问题和重要信息，以帮助解释临床试验结果，并进一步推动数字健康干预研究领域。因此，在过程评估框架内，目的是探索参与者在整个“Mind Your Back”试验中接受的干预措施的体验，这导致了无效结果。
根据过程评估的建议，本研究使用深度访谈和定性主题分析，在试验完成后 5-6 个月对试验的两个臂的参与者进行了研究。对 25 名参与者进行了半结构化电话访谈，以探讨他们参与“Mind Your Back”试验的经验。访谈于 2017 年 11 月进行，逐字转录并进行主题分析。
确定了两个主要主题：（1）个性化支持和治疗联盟很重要，（2）MoodGYM 缺乏相关、个性化和量身定制的支持。
提供个性化和培养治疗联盟的定制数字健康支持非常重要。
