Evaluation of the Impact of a Smartphone App on Adherence to an Exercise Program in People With Chronic Low Back Pain: Randomized Controlled Trial.

Background: The benefits of multidisciplinary rehabilitation programs on pain and function in people with chronic low back pain (CLBP) are fairly well documented in the literature. However, these positive effects tend to fade over time due to low long-term patient adherence. Objective: The study aimed to evaluate the impact of a smartphone app on adherence to an exercise program for people with CLBP at 6 months. The secondary aims were to assess the effectiveness of the app on pain, disability, fears, and beliefs related to physical activity, physical capacity, and qualitative adherence (correctness of exercise execution) at 6 months. Methods: A total of 110 people with CLBP were included and randomized into 2 groups: 54 in the intervention group (IG) who received education on the use of the app in addition to usual care (a 3-week multidisciplinary rehabilitation program with self-management education) and 56 in the control group (CG) who received only usual care. Part B of the Exercise Adherence Rating Scale was used as the primary outcome to assess adherence to the 6-month exercise program. Secondary outcomes were pain (Numeric Rating Scale), disability (Oswestry Disability Index), barriers and facilitators to performing physical activity (Evaluation of Physical Activity Perception), physical capacity (battery of tests), and qualitative adherence (correctness of exercise execution). Statistical analyses were performed according to the intention-to-treat principle. A linear mixed model compared the primary end point between the groups at 6 months. Results: A total of 71 of 110 participants (n=35 in the CG vs n=36 in the IG) were evaluated at 6 months. We did not observe any significant difference in the Exercise Adherence Rating Scale score between the CG and the IG (group difference 0.01, 95% CI -2.4 to 2.4; P=.97). The same findings were found for pain, disability, and barriers and facilitators to physical activity, except for the motivation criterion. The 6-Minute Walk Test (group difference [log] 0.06, 95% CI 0.01-0.12; P=.06), cycle ergometer (group difference 9.30, 95% CI 0.48-18.13; P=.04), Ito (group difference [log] 0.31, 95% CI 0.01-0.62; P=.04), plank (group difference [log] 0.29, 95% CI 0.03-0.54; P=.03), and qualitative adherence (IG mean 12.6, SD 1.3 vs CG mean 11.4, SD 1.4; P=.02) differed between the groups in favor of the IG. All outcomes improved from baseline to 6 months in the IG but not in the CG. Conclusions: The smartphone app did not impact adherence to an exercise program at 6 months in individuals with CLBP. Similar results were found for pain and function. Nevertheless, the app could be a useful self-management tool in view of the positive effects on physical capacity and qualitative adherence.