Digital support for self-management of low back pain – an approach that fits all? - Secondary analysis of the selfBACK randomized controlled trial

Research Aim/Objective:
The aim was to investigate if the effect of the selfBACK intervention is modified by type of
recruitment clinic, age, gender or education.
Research Methods:
The present study presents a sub-group analysis of the selfBACK randomized controlled trial,
including 461 participants with low back pain recruited from primary care practitioners
(physiotherapists, chiropractors and general practitioners (GP)) in Denmark and Norway and an
outpatient clinic in Denmark. Participants were randomized to an intervention group (n=232)
receiving the selfBACK program in addition to usual care or to a control group (n=229) receiving
usual care alone. Stratified analysis according to type of recruitment clinic, age, gender and
education were performed on outcomes from the core set outcomes for clinical low back pain trials
including pain related disability, pain intensity and pain self-efficacy. Results from 3- and 9- months
follow-up are presented.
Results:
At 9 months the effect of selfBACK on pain disability was larger in the oldest age-group compared to
the younger groups (P>0.042, for all comparisons). No differences were observed at 3 months.
Further, participants recruited at chiropractors (3 months+ 9 months, P>0.022, for both
comparisons) and the out-patient clinic (9 months, P= 0.002) had a larger improvement in pain
intensity compared to participants recruited at GPs. The participants recruited from GPs were
younger compared to the other recruitment sites. Gender or education of the included participants
did not modify the effect of selfBACK for any of the outcomes.
Discussion:
Overall, the demographics of the included participants did not seem to modify the effect of the
selfBACK intervention. Our results therefore indicate that the selfBACK intervention is suitable for
all, irrespective of age, sex and socioeconomic position. However, older participants may have a
larger effect of selfBACK compared to younger participants. Identifying subgroups that benefit more
or less from digital health interventions may help to target interventions in the future.