An mHealth App for Self-Management of Chronic Lower Back Pain (Limbr): Pilot Study

This is a pilot study by Selter A et al which was recently published in the Journal of International Medical Research, investigating the use of a mobile app (Limbr) for the management of low back pain.

The app was created because of the widespread and continued rise in mobile phone usage across the US, and the increasing evidence to support that self-management is the ideal way to manage chronic conditions. The combination would then increase adherence to exercise therapy which we know to be effective at helping manage back pain.

Not only would the app provide written exercises with images, but it would include video tutorials, personalisable visual self-reported tools, health coach support and sensor assisted passive activity tracking.

The study itself was a single arm trial involving a convenience sample of 93 adults between Jan 2016 – Feb 2-17, who had a diagnosis of discogenic back pain. Patients needed to have axial symptoms lasting at least 3 months and confirmation of diagnosis by MRI. Patients were excluded if they had trauma or history of surgery as well as concurrent pathology which would explain axial symptoms. These patients would then use the Limbr App for 3 months which meant that they had to do 3 daily  self-reported pain scoring entries and medication/coping mechanism sessions and their back exercise video tutorials. Their activity was also measured by their phones.

At the end of the 3 months the results showed a significant attrition rate of 62%, the authors argue that this is similar to other web-based treatment packages however this is higher than all others mentioned in their article. A feature which users did find beneficial was the reminder (push notifications) they received to do their exercises. In terms of the health coach tool embedded within the app, the vast majority of messages were technical questions about the app not about the exercises or health questions at all. As you’d imagine those who completed the full 3 months of the programme rated the app as beneficial and helped their ADLs.

Clinical Implications

Limr is still in the early stages of development and until attrition rates are addressed it is not the tool you should use to help your patients manage their LBP as their are better alternatives out there.