Delivering self-management for LBP via a digital solution in primary care

Purpose

Most low back pain (LBP) does not need specific or specialist treatment and will often resolve if people follow simple evidence-based advice. Access to this advice is inconsistent with people often self-managing via untrusted resources online. Using digital technology to provide immediate day-by-day support whilst connecting people to their local MSK pathway and support services, has the potential to deliver trusted evidence-based advice in a consistent and standardised way. We are introducing a self-management solution (getUBetter) into the routine care of patients with LBP. Implementation should lead to quicker recovery, better outcomes, and a reduction in overall healthcare spend.

Approach

This evaluation focused on the 'pre-implementation' phase of delivering a digital self-management solution and embedding it into the local MSK pathway. Pre-implementation evaluation initially concentrated on the following metrics:-

  1. Analysis of the understandability and actionability for the information provided via the app using the Patient Education Materials Assessment Tool for Audiovisual Materials (PEMAT-A/V)
  2. Staff experience of using the app to facilitate the patient pathway using a staff experience questionnaire
  3. Patient experience of using the app and mapping their recovery journey using a patient experience questionnaire.

Outcomes

Results:

  1. Understandability and actionability: 10 clinicians/experts and 10 patients scored the app. In total it scored 60% understandability and 75% actionability
  2. Staff reported overall positive results of using the app. Most found it was easy to give to patients but challenging to explain the context especially if time was tight. Staff felt patients sometimes struggled to understand the concept. Some pointed out this was due to a combination of both clinicians and patients' beliefs about best care being delivered by traditional face to face consultation. Despite this most respondents felt it enhanced the patient pathway.
  3. The vast majority of users found the app helpful and agreed that it was a much quicker way to access information to help them self manage. A few preferred to see a clinician as well as self managing the app. Only one didn´t want to use the app.

Cost and savings

The pre-implementation phase did not evaluate cost or savings.

Implications

The getUbetter app is an effective way of delivering early evidence based information, advice, and guidance to help people self-manage their back pain. There are some improvements needed to make the app more understandable and to make the goals and actions of the app clearer. Clinical and patient experience was positive, but it is clear that the context of delivering back pain treatment in this manner needs to be fully communicated.

This was an analysis of early implementation of self-management delivered by a digital app for back pain. As such it has highlighted key issues and themes, which when addressed should enhance delivery of this model of care. If successful this project has the potential to redefine the management of LBP and the way patients with LBP interact with the health system.

Top three learning points

  1. Formal tools to assess patient information are key to producing content that is readable, can be understood and have clinically useful actions.
  2. Healthcare staff need support to shift their mind set from delivering self-management via traditional means (paper hand-outs and face-to-face) to smartphone using and web based platforms
  3. Healthcare users like anything that speeds up access to information that can help them self-manage. Only a minority prefer to wait to see a human. Most people want both i.e early access to trusted information on the web/smartphone and a later appointment with a clinician.

Fund acknowledgements

Wandsworth CCG funded 3500 getUbetter licences. The evaluation was not funded.

Additional notes

This work was presented at Physiotherapy UK 2018.

For further information about the work contact Ben Wanless and Carey McClellan