Supporting self-management of low back pain with internet interventions in primary care (SupportBack 2): A nested qualitative study

Conference:

SAPC ASM 2024 - Bristol

Talk Code:

3F.1

Presenter:

Adam Geraghty

Co-authors:

Adam W A Geraghty, Stephanie Hughes, Lisa C Roberts, Jonathan C Hill, Nadine E Foster, Lucy Yardley, Elaine M Hay, Gemma Mansell, Firoza Davies, Malcolm White, Paul Little.

Author institutions:

University of Southampton, Keele University, The University of Queensland, University of Bristol, Aston University

Problem

Low back pain (LBP) is a highly prevalent symptom and a leading cause of disability globally. In a previous randomised controlled trial (RCT) we found the SupportBack internet intervention designed to support LBP self-management did not significantly reduce LBP-related disability over 12 months compared to usual care, regardless of whether the SupportBack intervention was supplemented by physiotherapist-led telephone support (SupportBack Plus). However, a health-economic evaluation found both SupportBack and SupportBack Plus interventions to be cost-effective, with the unsupported intervention ‘dominating’ usual care, meaning it was both more effective and less costly. The aim of the nested qualitative study was to explore participants’ experiences of the interventions.

Approach

The SupportBack self-management internet intervention was co-designed with people experiencing acute and persistent LBP, focussed on physical activity and behavioural advice delivered through six weekly sessions. For SupportBack Plus, a brief physiotherapist telephone support protocol was added. People with back pain were recruited if they had consulted in primary care without indicators of serious spinal pathology. The nested qualitative study involved telephone interviews with purposively sampled trial participants after 3, 6 and 12 months. Interviews were transcribed verbatim and thematically analysed.

Findings

Forty-seven participants took part in the interviews (15 after 3 months, 14 after 6 months, and 18 after 12 months). Overall, most participants reported finding SupportBack easy to use, and many stressed the usefulness and importance of clear explanations and behavioural support. Those who had increased their activity to manage their LBP, suggested the reassurance provided facilitated their behaviour change. For those that did not increase their activity, some participants reported either being active already, or having tried many of the suggestions before without a positive impact. For those who reported reductions in pain, some suggested the intervention helped them to make the link between increased activity and sustained reductions in pain over time. Where this link could not be made experientially, either through trying activity and experiencing no benefit, or the presence of certain beliefs prohibiting engagement with activity, participants often reported little or no reduction in their symptoms. Generally, the telephone physiotherapist support was reported to be encouraging, reassuring, and enabling of additional tailoring of the SupportBack intervention.

Consequences

The variety of experiences reported highlights the complexity inherent in the broad offer of internet-based self-management support for LBP in primary care. There is a need for further research to continue to inform targeting of these interventions to those most likely to benefit.

Submitted by:

Adam Geraghty

Funding acknowledgement:

This project 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.