Health care professional’s role in the randomized controlled trial of the selfBACK app – a mixed-methods process evaluation

Problem

The selfBACK artificial intelligence-based app was developed and designed to support people to self-manage their low back pain (LBP), as an adjunct to usual care. Its effectiveness to reduce pain-related disability was tested in a randomised controlled trial (RCT; n=461) in Norway and Denmark. The selfBACK intervention group (n=229) had lower LBP-related disability at 3 months compared to usual care alone (n=232), and app benefits were sustained throughout the 9-month follow-up period. Participants to the trial were recruited via primary care (Norway and Denmark) and an outpatient spine clinic (Denmark); a total of 57 Norwegian health care professionals ((HCPs) physiotherapists and GPs) and 39 Danish chiropractor and spinal clinics actively recruited to the RCT. Here we explore the role that HCPs played in the RCT recruitment process and their perceptions of selfBACK.

Approach

A mixed-methods approach involving quantitative and qualitative data collection was used. Quantitative data consisted of trial recruitment logs and a vignette-based survey showing examples of patient scenarios to gather opinions on the appropriateness of the self-management plans, this was completed by 73 recruiting HCPs (27 (37.0%) physiotherapists, 32 (43.8%) chiropractors, 14 (19.2%) GPs). Qualitative data included trial procedure documents, interviews with 19 clinicians, and free-text responses in the survey. A purposive sampling strategy was used to recruit HCPs with different levels of patient recruitment rates. Interviews were conducted in native language and transcribed verbatim. Analysis is underpinned by the Normalization Process Theory. Analysis is ongoing and here we present preliminary findings, which will be completed before the conference.

Findings

Of the survey, approximately 60% of the HCPs agreed that the five presented self-management plans would be a good supplement to usual care, but two thirds of physiotherapists disagreed with planned exercises. Findings from interviews suggest that HCPs found the recruitment procedures straightforward, however, HCPs with high recruitment rates reported that they undertook additional measures to aid recruitment, e.g. placing of study materials in the reception area. HCPs considered selfBACK to be a useful clinical tool: with GPs suggesting that it is a much-needed alternative to medication and referral to physiotherapy; whereas chiropractors and physiotherapists perceived the app as supplementary to usual care.

Consequences

Preliminary analysis suggests that selfBACK recruitment procedures were appropriate and that overall, the content and need for selfBACK was supported by HCPs. However, we need to explore further about physiotherapists views of the recommended exercises within the selfBACK app.