title: Experiences of Older Adults With Mobile Phone Text Messaging as Reminders of Home Exercises After Specialized Manual Therapy for Recurrent Low Back Pain: A Qualitative Study.
abstract: BACKGROUND
  Clinical experience of manual therapy for musculoskeletal pain is that patients often suffer from recurrent pain and disorders, but that they do not continue to perform their physical home exercises when they are free from symptoms. The chance of positive long-term effects of manual therapy would probably increase if patients were reminded that they are to continue to perform their exercises. Mobile phone text messaging (short messaging service, SMS) is increasingly used as an innovative intervention to remind patient to exercise. However, there are only a few studies on such interventions in the field of low back pain (LBP). Qualitative studies of patients' experiences of receiving text messages as reminders of home exercises after manual treatment for recurrent LBP have to the best of our knowledge never been published.
  
  
  OBJECTIVE
  The aim of this study was to explore older persons' common experiences of receiving reminders of home exercises through mobile phone text messaging after specialized manual therapy for recurrent LBP.
  
  
  METHODS
  A total of 7 men and 8 women (67-86 years), who had sought specialized manual therapy (Naprapathic manual therapy) for recurrent LBP were included in the study. Individual one-way text messages as reminders of home exercises (to be performed on a daily basis) were sent to each patient every third day for 3 weeks, then once a week for another 2 weeks. Semistructured interviews with 2 broad, open-ended questions were held and data were analyzed with systematic text condensation, based on Giorgi's principles of psychological phenomenological analysis.
  
  
  RESULTS
  The participants appreciated the messages, which were perceived as timely and usable, and also stimulated memorizing. The messages made the participants reflect on the aim of the exercise, value of being reminded, and on their improvement in pain. During the interviews, the participants created their own routines for continued adherence to the exercises.
  
  
  CONCLUSIONS
  It seems plausible that mobile phone text messaging may serve as a useful tool for patient empowerment with regard to recurrent LBP in older persons. Further studies are needed to explore whether future compliance with the exercises will be as large if the participants are not being interviewed.
authors.affiliation: Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Stina Charlotta
authors.identifier: http://orcid.org/0000-0001-5825-3850
authors.initials: SC
authors.lastname: Lilje
authors.affiliation: Department of Health, Blekinge Institute of Technology, Karlskrona, Sweden.
authors.forename: Ewy
authors.identifier: http://orcid.org/0000-0003-3295-4047
authors.initials: E
authors.lastname: Olander
authors.affiliation: Department of Health, Blekinge Institute of Technology, Karlskrona, Sweden.
authors.forename: Johan
authors.identifier: http://orcid.org/0000-0003-4312-2246
authors.initials: J
authors.lastname: Berglund
authors.affiliation: Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.|Scandinavian College of Naprapathic Manual Medicine, Stockholm, Sweden.
authors.forename: Eva
authors.identifier: http://orcid.org/0000-0003-2096-1530
authors.initials: E
authors.lastname: Skillgate
authors.affiliation: Department of Health, Blekinge Institute of Technology, Karlskrona, Sweden.
authors.forename: Peter
authors.identifier: http://orcid.org/0000-0001-9870-8477
authors.initials: P
authors.lastname: Anderberg
keywords: manual therapy; older adults; recurrent low back pain; text messages