A decision support system to improve self-management of non-specific low back pain

The recent global burden of disease study showed that low back pain is the most significant contributor to years lived with disability and disability-adjusted life years in Europe. Moreover, non- specific low back pain is the fourth most common diagnosis seen in primary care. Every year, about 1 of 15 people in the European population will consult their general practitioner with low back pain. Accordingly, low back pain is one of the most common reasons for activity limitation, sick leave, and work disability.

European evidence-based guidelines for the management of non-specific low back pain were developed by an expert working group in 2005. In short, the expert working group concluded that the most well-documented and effective approach to manage low back pain is to discourage bed rest (acute stage), initial use of medication as indicated (acute stage), reassure the patient about the favourable prognosis (acute stage), advise the patient to stay active both on and off work (acute, sub- acute and chronic stage), and advise strength and/or stretching exercise (sub-acute and chronic stage). These guidelines have later been adopted and refined by several European countries to offer the best practice and advice to manage low back pain.

This project aims to develop a decision support system - selfBACK - that will be used by the patient him/herself to facilitate, improve and reinforce self-management of low back pain. Specifically, selfBACK will be designed to assist the patient in deciding and reinforcing the appropriate actions to manage own low back pain after consulting a health care professional in primary care.

A decision support system to facilitate, improve and reinforce self-management of non-specific low back pain

The decision support will be conveyed to the patient via a smartphone app in the form of advice for self-management. This advice will be tailored to each person based on the symptom state and a range of patient characteristics, including information from a physical activity-detecting wristband worn by the patient.

The selfBACK system is a predictive case-based reasoning system, which is a computer model that is based on existing cases. It is the first of its kind, utilizing background data about the patient, patient self-monitoring of pain and functional ability, along with continuous recording of the patient's physical activity and sleep by a wristband, to deduce tailored and personalized recommendations for self-management of low back pain. The wristband will communicate with the developed smartphone app, which will enable the data analysis and personalised decision support. With selfBACK, the patient will be equipped with a tool that is far beyond the state-of-the-art to facilitate, improve and reinforce self-management of non-specific low back pain. A recent study showed that 283 pain-related apps are available in the main app shops App Store, Blackberry App World, Google Play, Nokia Store and Windows Phone Store. However, none of these apps have documented effects by scientific publications and none include a decision support system. It is therefore an urgent need to make personal device systems available that address health issues with a documented effect. To give a general idea of the predicted cost-benefit, we estimate that the total cost of using selfBACK will range between 120-150 EUR per patient (including the activity detecting wristband, app and brief education to enable safe use of selfBACK). The effectiveness of selfBACK in preventing recurrence of episodes with low back pain and disability has yet to be proven but the potential cost-benefit is without doubt substantial.

selfBACK project partners: an international team of researchers and SMEs

The selfBACK consortium is carefully composed in order to include the necessary expertise and facilities needed to carry out the tasks needed for developing the selfBACK system and to test its effectiveness in a randomised controlled trial. The consortium consists of seven partners, evenly balanced between the medical field and the technical innovation development. Seven partners compose the consortium and the principal investigators at the beneficiaries are international experts covering extensive experience with technological development and running of trials.

NTNU Glasgow University Robert Gordon University Kiolis NFA Health Leads University of South Denmark

selfBACK facts

Project Coordinator: Paul Jarle Mork, NTNU

Duration: 60 month (Jan 2016 - Dec 2020)

Grant: 4.92 Million EUR

Funding Scheme: Research and Innovation action

Acronym: selfBACK

Title: A decision support system for self-management of low back pain

Activity: PHC-28-2015 Predictive modelling RIA

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