Supporting self-management of low back pain with an internet intervention in primary care: The SupportBack 2 randomised controlled trial

Conference:

SAPC ASM 2022 - UCLan

Talk Code:

2A.3

Presenter:

Adam W A Geraghty

Twitter:

@AdamWAGeraghty

Co-authors:

Adam Geraghty, Lisa Roberts, Jonathan Hill, Nadine Foster, Beth Stuart, Lucy Yardley, Elaine Hay, David Turner, Gareth Griffiths, Frances Webley, Lorraine Durcan, Alannah Morgan, Stephanie Hughes, Sarah Bathers, Stephanie Butler-Walley, Simon Wathall, Gemma Mansell, Linda Leigh, Paul Little

Author institutions:

University of Southampton, Keele University, The University of Queensland and Metro North Health, University of East Anglia, Aston University.

Problem

Low back pain (LBP) is a highly prevalent symptom and a leading cause of disability globally. Most patients are managed in primary care, where NICE guidelines recommend provision of advice to self-manage and stay active. Internet delivered interventions may provide a route to rapid support for behavioural self-management that could be widely applied within primary care. Although evidence is emerging that more complex technologies (mobile apps linked to digital wristbands) can have some impact on LBP-related disability, there is a need to determine the clinical and cost-effectiveness of highly accessible, web-based support for self-management for LBP.

Approach

‘SupportBack’ is an intervention accessible from any device with an internet connection (computers, tablets, phones) developed specifically for primary care. It was designed to support self-management through a focus on physical activity and behavioural advice on a range of LBP-related topics (e.g. sleep and mood), offering a tailored self-management programme over 6 weeks. Additionally, a brief physiotherapist telephone support protocol was developed that could be integrated with the internet programme, creating a combined intervention. The aim of the SupportBack 2 multicentre randomised controlled trial (RCT) was to determine the clinical and cost-effectiveness of the SupportBack interventions in reducing LBP-related physical disability in primary care patients, with nested process, qualitative and health economic evaluations. Participants were randomised to 1 of 3 arms: 1) Usual care + internet intervention + physiotherapy telephone support, 2) Usual care + internet intervention, 3) Usual care alone. Utilising a repeated measures design, the primary outcome for the trial was disability over 12 months using the Roland Morris Disability Questionnaire (RMDQ) with measures at 6 weeks, 3, 6 and 12 months. Secondary outcomes included pain intensity, quality-of-life, and patient experience.

Findings

The trial involved 179 primary care practices, with 826 participants randomised (from November 2018 to November 2020), making it the largest of its kind internationally. Analysis is ongoing, comparing each intervention arm to usual care and results will be presented at the conference.

Consequences

To our knowledge, the SupportBack 2 RCT is the first full trial of its kind in LBP within UK primary care. The trial will extend knowledge regarding the effectiveness of highly accessible internet interventions to support self-management in people with LBP consulting in primary care.

Submitted by:

Adam Geraghty

Funding acknowledgement:

This trial was funded by the National Institute for Health Research (NIHR) Health Technology Programme (HTA, project number: 16/111/78). The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the Health Technology Assessment Programme, NIHR, NHS or the Department of Health.