Only one back pain app trial in six showed a benefit

Low back pain is a common cause of disability and is ranked as the most burdensome health condition globally. Clinical guidelines consistently recommend self-management, built on better knowledge, symptom monitoring and physical activity, as a cost-effective strategy for handling it. With interest in digital health growing, apps and websites now promise to deliver that support at scale, to anyone with a phone. The question this review set out to answer is whether interactive digital tools actually improve outcomes for people with low back pain, what these interventions contain, and which components, if any, are linked with benefit.

Researchers searched nine bibliographic databases plus reference and citation lists, covering 2000 to March 2016, for randomised trials of interactive digital self-management interventions in adults with low back pain. Two reviewers independently screened titles, abstracts and full texts, extracted the data and assessed risk of bias, with a third reviewer settling disagreements. From 7014 references, 11 papers describing 9 studies were included: 6 completed trials and 3 protocols for future trials. The completed trials enrolled 2706 participants in total, ranging from 114 to 1343 per study, and the findings were synthesised narratively.

Only one of the six completed trials reported between-group differences favouring the digital intervention. The studies varied considerably in what the interventions were, how they were delivered, how low back pain was defined and which outcomes were measured, which made comparison difficult. Reporting of the components and theories behind each intervention was patchy. Participants were generally white, middle aged and educated to college level or higher, and in five of the six trial reports the majority were female. None of the studies showed evidence of harm, and no study reported anything on cost-effectiveness.

Self-management itself is firmly embedded in clinical guidelines; what this review tests is the digital delivery of it, and there the evidence comes out weak. The literature was so mixed that the authors could not work out what might work best, for whom, or in what circumstances. Because participants came from such a narrow demographic, whether these tools help a wider population remains uncertain. The three registered protocols identified suggest more trials were on the way, which may eventually sharpen the picture.

If you have back pain and are eyeing an app, this is a reason to hold the marketing claims at arm's length: the trial record so far is thin and mostly unconvincing, with a single trial showing benefit. On the other hand, no harms were seen across any of the studies, so the concern is wasted effort and money rather than danger. The self-management principles these apps package, staying informed, tracking symptoms and keeping active, remain the guideline-backed core however they are delivered.