title: Mobile-Web app to self-manage low back pain: randomized controlled trial.
abstract: BACKGROUND
  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.
  
  
  OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
  
  
  BACKGROUND
  Clinicaltrials.gov NCT01950091; http://clinicaltrials.gov/ct2/show/NCT01950091 (Archived by WebCite at http://www.webcitation.org/6TwZucX77).
authors.affiliation: ORCAS, Eugene, OR, United States.
authors.forename: A Blair
authors.identifier: http://orcid.org/0000-0002-1678-8475
authors.initials: AB
authors.lastname: Irvine
authors.forename: Holly
authors.identifier: http://orcid.org/0000-0002-0003-3203
authors.initials: H
authors.lastname: Russell
authors.forename: Michael
authors.identifier: http://orcid.org/0000-0002-9995-9785
authors.initials: M
authors.lastname: Manocchia
authors.forename: David E
authors.identifier: http://orcid.org/0000-0002-7988-1087
authors.initials: DE
authors.lastname: Mino
authors.forename: Terri
authors.identifier: http://orcid.org/0000-0001-8339-0494
authors.initials: T
authors.lastname: Cox Glassen
authors.forename: Rebecca
authors.identifier: http://orcid.org/0000-0002-0770-0312
authors.initials: R
authors.lastname: Morgan
authors.forename: Jeff M
authors.identifier: http://orcid.org/0000-0002-4986-2512
authors.initials: JM
authors.lastname: Gau
authors.forename: Amelia J
authors.identifier: http://orcid.org/0000-0001-5845-2681
authors.initials: AJ
authors.lastname: Birney
authors.forename: Dennis V
authors.identifier: http://orcid.org/0000-0002-0366-1619
authors.initials: DV
authors.lastname: Ary
mesh_terms: D000328:Adult; D034742:Electronic Mail; D005260:Female; D006801:Humans; D020407:Internet; D016015:Logistic Models; D017116:Low Back Pain / Q000628:therapy*; D008297:Male; D063731:Mobile Applications; D059408:Pain Management / Q000379:methods; D011788:Quality of Life; D012648:Self Care
keywords: Internet; app; computers; low back pain; mobile; prevention; self-treatment