Low back pain (LBP) affects up to 80% of the global population at some point in their lifetime and is one of the leading causes of disability worldwide. People with LBP are recommended to self-manage their symptoms for example by undertaking education and exercise but this can be challenging without support. Digital health interventions (DHIs) provide an opportunity to support self-management of LBP and there is some evidence to suggest such interventions can be effective in reducing pain and back pain-related disability. Further, they may be important in reinforcing healthcare providers’ (HCPs) advice on self-management.
The implementation of DHIs for LBP has been studied from patients’ perspectives.However, less is known about HCPs’ engagement in the implementation of DHIs and their views on using such tools in their clinical practice. This is important to understand since HCPs often signpost patients to DHIs, and HCP views can significantly influence patients’ views on self-management activities. Known barriers to recruitment in pragmatic trials are the recruiting HCPs’ lack of experience with research procedures and high workloads or competing tasks. Whether similar or more complex barriers exist regarding the recruitment of patients to randomized controlled trials (RCTs) of DHIs and specifically a DHI for LBP remains unclear.
We evaluated the effectiveness of a knowledge-based artificial intelligence-based app (selfBACK) in an RCT in primary care settings in Denmark and Norway. The selfBACK app was developed to support individually tailored and evidence-based self-management of LBP. Results of the RCT indicated a small but favourable effect of the app-based intervention compared with usual care on LBP-related disability among patients receiving primary care. A process evaluation was conducted alongside the RCT to understand the implementation of selfBACK viewed from the perspective of both patients and HCPs who recruited patients to the study.
