scholarly journals Digital Therapeutic Care and Decision Support Interventions for People With Low Back Pain: Systematic Review

10.2196/26612 ◽  
2021 ◽  
Vol 8 (4) ◽  
pp. e26612
Author(s):  
Daniel Lewkowicz ◽  
Tamara Slosarek ◽  
Sarah Wernicke ◽  
Antonia Winne ◽  
Attila M Wohlbrandt ◽  
...  
Keyword(s):  
Systematic Review ◽  
Low Back Pain ◽  
Back Pain ◽  
Decision Support ◽  
Systematic Reviews ◽  
Real World ◽  
Real Life ◽  
Risk Of Bias ◽  
Low Back ◽  
Attrition Rates

Background Low back pain (LBP) is the leading cause of worldwide years lost because of disability, with a tremendous economic burden for health care systems. Digital therapeutic care (DTC) programs provide a scalable, universally accessible, and low-cost approach to the multidisciplinary treatment of LBP. Moreover, novel decision support interventions such as personalized feedback messages, push notifications, and data-driven activity recommendations amplify DTC by guiding the user through the program while aiming to increase overall engagement and sustainable behavior change. Objective This systematic review aims to synthesize recent scientific literature on the impact of DTC apps for people with LBP and outline the implementation of add-on decision support interventions, including their effect on user retention and attrition rates. Methods We searched bibliographic databases, including MEDLINE, Cochrane Library, Web of Science, and the Physiotherapy Evidence Database, from March 1, 2016, to October 15, 2020, in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and conducted this review based on related previously published systematic reviews. Besides randomized controlled trials (RCTs), we also included study designs with the evidence level of at least a retrospective comparative study. This enables the consideration of real-world user-generated data and provides information regarding the adoption and effectiveness of DTC apps in a real-life setting. For the appraisal of the risk of bias, we used the Risk of Bias 2 Tool and the Risk of Bias in Non-Randomized Studies of Interventions Tool for the RCTs and nonrandomized trials, respectively. The included studies were narratively synthesized regarding primary and secondary outcome measures, DTC components, applied decision support interventions, user retention, and attrition rates. Results We retrieved 1388 citations, of which 12 studies are included in this review. Of the 12 studies, 6 (50%) were RCTs and 6 (50%) were nonrandomized trials. In all included studies, lower pain levels and increased functionality compared with baseline values were observed in the DTC intervention group. A between-group comparison revealed significant improvements in pain and functionality levels in 67% (4/6) of the RCTs. The study population was mostly homogeneous, with predominantly female, young to middle-aged participants of normal to moderate weight. The methodological quality assessment revealed moderate to high risks of biases, especially in the nonrandomized trials. Conclusions This systematic review demonstrates the benefits of DTC for people with LBP. There is also evidence that decision support interventions benefit overall engagement with the app and increase participants’ ability to self-manage their recovery process. Finally, including retrospective evaluation studies of real-world user-generated data in future systematic reviews of digital health intervention trials can reveal new insights into the benefits, challenges, and real-life adoption of DTC programs.

scholarly journals Digital Therapeutic Care and Decision Support Interventions for People With Low Back Pain: Systematic Review (Preprint)

2021 ◽  
Author(s):  
Daniel Lewkowicz ◽  
Tamara Slosarek ◽  
Sarah Wernicke ◽  
Antonia Winne ◽  
Attila M Wohlbrandt ◽  
...  
Keyword(s):  
Systematic Review ◽  
Low Back Pain ◽  
Back Pain ◽  
Decision Support ◽  
Systematic Reviews ◽  
Real World ◽  
Real Life ◽  
Risk Of Bias ◽  
Low Back ◽  
Attrition Rates

BACKGROUND Low back pain (LBP) is the leading cause of worldwide years lost because of disability, with a tremendous economic burden for health care systems. Digital therapeutic care (DTC) programs provide a scalable, universally accessible, and low-cost approach to the multidisciplinary treatment of LBP. Moreover, novel decision support interventions such as personalized feedback messages, push notifications, and data-driven activity recommendations amplify DTC by guiding the user through the program while aiming to increase overall engagement and sustainable behavior change. OBJECTIVE This systematic review aims to synthesize recent scientific literature on the impact of DTC apps for people with LBP and outline the implementation of add-on decision support interventions, including their effect on user retention and attrition rates. METHODS We searched bibliographic databases, including MEDLINE, Cochrane Library, Web of Science, and the Physiotherapy Evidence Database, from March 1, 2016, to October 15, 2020, in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and conducted this review based on related previously published systematic reviews. Besides randomized controlled trials (RCTs), we also included study designs with the evidence level of at least a retrospective comparative study. This enables the consideration of real-world user-generated data and provides information regarding the adoption and effectiveness of DTC apps in a real-life setting. For the appraisal of the risk of bias, we used the Risk of Bias 2 Tool and the Risk of Bias in Non-Randomized Studies of Interventions Tool for the RCTs and nonrandomized trials, respectively. The included studies were narratively synthesized regarding primary and secondary outcome measures, DTC components, applied decision support interventions, user retention, and attrition rates. RESULTS We retrieved 1388 citations, of which 12 studies are included in this review. Of the 12 studies, 6 (50%) were RCTs and 6 (50%) were nonrandomized trials. In all included studies, lower pain levels and increased functionality compared with baseline values were observed in the DTC intervention group. A between-group comparison revealed significant improvements in pain and functionality levels in 67% (4/6) of the RCTs. The study population was mostly homogeneous, with predominantly female, young to middle-aged participants of normal to moderate weight. The methodological quality assessment revealed moderate to high risks of biases, especially in the nonrandomized trials. CONCLUSIONS This systematic review demonstrates the benefits of DTC for people with LBP. There is also evidence that decision support interventions benefit overall engagement with the app and increase participants’ ability to self-manage their recovery process. Finally, including retrospective evaluation studies of real-world user-generated data in future systematic reviews of digital health intervention trials can reveal new insights into the benefits, challenges, and real-life adoption of DTC programs.

scholarly journals Real World Incidence and Prevalence of Low Back Pain: A Systematic Review

2018 ◽  
Vol 21 ◽  
pp. S193 ◽  
Author(s):  
F Fatoye ◽  
T Gebrye ◽  
I Odeyemi
Keyword(s):  
Systematic Review ◽  
Low Back Pain ◽  
Back Pain ◽  
Real World ◽  
Low Back

scholarly journals Psychological interventions for chronic non-specific low back pain: protocol of a systematic review with network meta-analysis

BMJ Open ◽  
2020 ◽  
Vol 10 (9) ◽  
pp. e034996
Author(s):  
Emma Ho ◽  
Manuela Ferreira ◽  
Lingxiao Chen ◽  
Milena Simic ◽  
Claire Ashton-James ◽  
...  
Keyword(s):  
Systematic Review ◽  
Low Back Pain ◽  
Back Pain ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Psychological Interventions ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
Low Back ◽  
Fear Avoidance

IntroductionPsychological factors such as fear avoidance beliefs, depression, anxiety, catastrophic thinking and familial and social stress, have been associated with high disability levels in people with chronic low back pain (LBP). Guidelines endorse the integration of psychological interventions in the management of chronic LBP. However, uncertainty surrounds the comparative effectiveness of different psychological approaches. Network meta-analysis (NMA) allows comparison and ranking of numerous competing interventions for a given outcome of interest. Therefore, we will perform a systematic review with a NMA to determine which type of psychological intervention is most effective for adults with chronic non-specific LBP.Methods and analysisWe will search electronic databases (MEDLINE, Embase, PsycINFO, Cochrane Central Register of Controlled Trials, Web of Science, SCOPUS and CINAHL) from inception until 22 August 2019 for randomised controlled trials comparing psychological interventions to any comparison interventions in adults with chronic non-specific LBP. There will be no restriction on language. The primary outcomes will include physical function and pain intensity, and secondary outcomes will include health-related quality of life, fear avoidance, intervention compliance and safety. Risk of bias will be assessed using the Revised Cochrane risk-of-bias tool for randomised trials (RoB 2) tool and confidence in the evidence will be assessed using the Confidence in NMA (CINeMA) framework. We will conduct a random-effects NMA using a frequentist approach to estimate relative effects for all comparisons between treatments and rank treatments according to the mean rank and surface under the cumulative ranking curve values. All analyses will be performed in Stata.Ethics and disseminationNo ethical approval is required. The research will be published in a peer-reviewed journal.PROSPERO registration numberCRD42019138074.

scholarly journals Neuromuscular adaptations to experimentally induced pain in the lumbar region: protocol for a systematic review and meta-analysis

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Valter Devecchi ◽  
Deborah Falla ◽  
Hélio V. Cabral ◽  
Alessio Gallina
Keyword(s):  
Systematic Review ◽  
Low Back Pain ◽  
Back Pain ◽  
Meta Analysis ◽  
Experimental Pain ◽  
Neuromuscular Control ◽  
Risk Of Bias ◽  
Lumbar Region ◽  
Low Back ◽  
Experimentally Induced

Abstract Background Numerous studies report changes in neuromuscular control in people with low back pain (LBP). However, the relationship between pain and altered neuromuscular control is challenging to unravel given the heterogeneity that exists in clinical populations. One approach commonly adopted to overcome this issue is the use of experimental pain models, but it is currently unclear if the effects of experimental pain are consistent between studies. Therefore, this planned study will systematically evaluate and summarise the effect of experimentally induced pain in the lumbar region on neuromuscular control at sites both locally and remote to the low back. Methods This protocol has been developed following the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P). MEDLINE, EMBASE, CINAHL, ZETOC, Web of Science, and grey literature will be searched up to August 31, 2021. Screening processes (title/abstract and full-text), data extraction, and risk of bias assessment will be conducted by two independent reviewers. Studies investigating the effects of exogenous pain models delivered to the low back region on neuromuscular control in healthy individuals will be included. Muscle activity and body kinematics will be the outcomes of interest. The comparisons of interest will be between baseline or control conditions and the experimental pain condition, as well as between the experimental pain and post-pain conditions. Randomised crossover and non-randomised studies of interventions will be included and their risk of bias will be evaluated with the Cochrane Risk-of-Bias tool or with the Risk Of Bias In Non-randomised Studies of Interventions tool, respectively. A random-effect meta-analysis will be conducted for quantitative synthesis when clinical and methodological consistency is ensured. Quality of evidence will be evaluated using the Grading of Recommendations, Assessment, Development and Evaluation guidelines. Discussion The current review will provide new insights to understand if and what neuromuscular adaptations are caused by pain experimentally induced in the lumbar region. Our findings will reveal which experimental pain model is able to better reproduce adaptations similar to those identified in people with low back pain, possibly contributing to improving our understanding of motor adaptation to low back pain in the long term. Systematic review registration PROSPERO CRD42020220130

scholarly journals Summarizing the Effects of Different Exercise Types in Chronic Low Back Pain – A Systematic Review of Systematic Reviews

2021 ◽  
Author(s):  
Wilhelmus JA Grooten ◽  
Carina Boström ◽  
Åsa Stephansson Dedering ◽  
Marie Halvorsen ◽  
Roman P Kuster ◽  
...  
Keyword(s):  
Systematic Review ◽  
Low Back Pain ◽  
Back Pain ◽  
Resistance Training ◽  
Exercise Therapy ◽  
Systematic Reviews ◽  
Low Back ◽  
Moderate Evidence ◽  
Acute Low Back Pain ◽  
Review Of Reviews

Abstract Background Recently, a review of reviews concluded that exercise therapy of any type makes no difference to the effect on pain or disability in adult patients with acute low back pain (LBP). Whether this is also the case for exercise therapy in chronic LBP is still unknown. Objectives To summarize and synthesize systematic reviews (SR) and meta-analyses (MA) investigating the effects on pain and disability of common exercise types used in chronic LBP. Methods We included systematic reviews from several databases in which ≥ 75% of the studies were RCTs on adults between 18 and 70 years of age suffering from chronic or recurrent LBP for a period of at least 12 weeks. These were grouped into nine exercise types: Aerobic training, Aquatic exercises, Motor control exercises (MCE), Resistance training, Pilates, Sling exercises, Traditional Chinese Exercises (TCE), Walking, and Yoga. The study quality was assessed with AMSTAR-2. For each type of exercise, a narrative analysis was performed, and the levels of evidence for the effects of exercise were assessed through GRADE. Results The wide search resulted in 2,345 studies, and out of the 246 full texts that were screened, 41 SR/MA were included. Of these, 10 SR/MA were of high quality, 15 of moderate, 14 of low, and two of critically low quality. We found low to moderate evidence of mainly short-term and small beneficial effects on pain and disability for MCE, Resistance training, Pilates, TCE, and Yoga compared to no intervention. Few reviews were found for Aerobic, Aquatic, Sling, and Walking exercises, but with promising results. Aquatic exercises seem to be more beneficial compared to land exercises (low level of evidence). Conclusions In line with previous studies but in a broader perspective, this systematic review of reviews showed that there is low to moderate evidence that exercises are effective for reducing pain and disability compared to no or minimal interventions, but that no exercise type is more effective than other conservative interventions (very low to moderate evidence). Systematic review registration number PROSPERO: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=190409

scholarly journals The association between depressive symptoms or depression and health outcomes in adults with low back pain with or without radiculopathy: protocol of a systematic review

2019 ◽  
Vol 8 (1) ◽  
Author(s):  
Jessica J. Wong ◽  
Andrea C. Tricco ◽  
Pierre Côté ◽  
Laura C. Rosella
Keyword(s):  
Systematic Review ◽  
Health Care ◽  
Low Back Pain ◽  
Back Pain ◽  
Depressive Symptoms ◽  
Health Outcomes ◽  
Risk Of Bias ◽  
Considerable Proportion ◽  
Low Back ◽  
The Impact

Abstract Background A considerable proportion of adults with low back pain (LBP) suffer from depressive symptoms or depression. Those with depressive symptoms or depression may be at risk of poorer LBP recovery and require more health care. Understanding the role of prognostic factors for LBP is critically important to guide management and health services delivery. Our objective is to conduct a systematic review to assess the association between depressive symptoms or depression and health outcomes in adults with LBP with or without radiculopathy. Methods Electronic databases including MEDLINE, Embase, CINAHL, and PsycINFO will be searched from inception to April 2019 to identify relevant studies. Additional citations will be identified by searching reference lists of included studies and related systematic reviews. Cohort and case-control studies assessing the association between depressive symptoms/depression and health outcomes in adults aged 16 years and older with LBP with or without radiculopathy will be included. The following will be included: depressive symptoms as measured on standardized questionnaires (e.g., Center for Epidemiologic Studies Depression Scale, Beck Depression Index), and depression as standardized diagnoses (e.g., International Classification of Diseases codes) or self-reported depression diagnosis on standardized questionnaires. Outcomes of interest are standardized measures for pain, disability, overall health status, satisfaction with care, and health care utilization. These are informed by core outcome domains that international expert panels consider important for LBP research. Pairs of reviewers will screen articles retrieved from the search, extract data, and assess risk of bias using the Risk Of Bias In Non-randomized Studies-of Exposures (ROBINS-E) tool. Reviewers will use these criteria to inform their judgment on the internal validity of studies (e.g., low, moderate, or high risk of bias). If studies are deemed homogeneous, a random effects meta-analysis on the association between depressive symptoms and health outcomes will be performed. The results of the included studies will be descriptively outlined if studies are deemed heterogeneous. Discussion The impact of depressive symptoms and depression on health- and health care-related outcomes for LBP with or without radiculopathy will be assessed and quantified. Findings of this systematic review will advance our understanding of LBP prognosis, and guide decision-making and improve quality of care for adults with LBP. Systematic review registration PROSPERO CRD42019130047

scholarly journals Virtual Reality in the Treatment of Adults with Chronic Low Back Pain: A Systematic Review and Meta-Analysis of Randomized Clinical Trials

2021 ◽  
Vol 18 (22) ◽  
pp. 11806
Author(s):  
Beatriz Brea-Gómez ◽  
Irene Torres-Sánchez ◽  
Araceli Ortiz-Rubio ◽  
Andrés Calvache-Mateo ◽  
Irene Cabrera-Martos ◽  
...  
Keyword(s):  
Systematic Review ◽  
Virtual Reality ◽  
Low Back Pain ◽  
Back Pain ◽  
Pain Intensity ◽  
Chronic Low Back Pain ◽  
Randomized Clinical Trials ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Low Back

Virtual reality (VR) can present advantages in the treatment of chronic low back pain. The objective of this systematic review and meta-analysis was to analyze the effectiveness of VR in chronic low back pain. This review was designed according to PRISMA and registered in PROSPERO (CRD42020222129). Four databases (PubMed, Cinahl, Scopus, Web of Science) were searched up to August 2021. Inclusion criteria were defined following PICOS recommendations. Methodological quality was assessed with the Downs and Black scale and the risk of bias with the Cochrane Risk of Bias Assessment Tool. Fourteen studies were included in the systematic review and eleven in the meta-analysis. Significant differences were found in favor of VR compared to no VR in pain intensity postintervention (11 trials; n = 569; SMD = −1.92; 95% CI = −2.73, −1.11; p < 0.00001) and followup (4 trials; n = 240; SDM = −6.34; 95% CI = −9.12, −3.56; p < 0.00001); and kinesiophobia postintervention (3 trials; n = 192; MD = −8.96; 95% CI = −17.52, −0.40; p = 0.04) and followup (2 trials; n = 149; MD = −12.04; 95% CI = −20.58, −3.49; p = 0.006). No significant differences were found in disability. In conclusion, VR can significantly reduce pain intensity and kinesiophobia in patients with chronic low back pain after the intervention and at followup. However, high heterogeneity exists and can influence the consistency of the results.

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