An AI-based tailored self-management app adjunct to usual care did not significantly improve musculoskeletal health at 3 months compared with usual care alone (adjusted mean difference 0.62; P=.60).
RCT (n=294)
3 parallel groups
Does an AI-based self-management app improve musculoskeletal health in adults with neck and/or low back pain referred to specialist care?
An AI-based self-management app adjunct to usual care did not significantly improve musculoskeletal health compared to usual care alone or a non-tailored web-based intervention in patients with neck or low back pain.
Effect estimate: adjusted mean difference 0.62 (95% CI -1.66 to 2.90)
p-value: p=.60
Importance Self-management is a key element in the care of persistent neck and low back pain. Individually tailored self-management support delivered via a smartphone app in a specialist care setting has not been tested. Objective To determine the effect of individually tailored self-management support delivered via an artificial intelligence–based app (SELFBACK) adjunct to usual care vs usual care alone or nontailored web-based self-management support (e-Help) on musculoskeletal health. Design, Setting, and Participants This randomized clinical trial recruited adults 18 years or older with neck and/or low back pain who had been referred to and accepted on a waiting list for specialist care at a multidisciplinary hospital outpatient clinic for back, neck, and shoulder rehabilitation. Participants were enrolled from July 9, 2020, to April 29, 2021. Of 377 patients assessed for eligibility, 76 did not complete the baseline questionnaire, and 7 did not meet the eligibility criteria (ie, did not own a smartphone, were unable to take part in exercise, or had language barriers); the remaining 294 patients were included in the study and randomized to 3 parallel groups, with follow-up of 6 months. Interventions Participants were randomly assigned to receive app-based individually tailored self-management support in addition to usual care (app group), web-based nontailored self-management support in addition to usual care (e-Help group), or usual care alone (usual care group). Main Outcomes and Measures The primary outcome was change in musculoskeletal health measured by the Musculoskeletal Health Questionnaire (MSK-HQ) at 3 months. Secondary outcomes included change in musculoskeletal health measured by the MSK-HQ at 6 weeks and 6 months and pain-related disability, pain intensity, pain-related cognition, and health-related quality of life at 6 weeks, 3 months, and 6 months. Results Among 294 participants (mean SD age, 50.6 14.9 years; 173 women 58.8%), 99 were randomized to the app group, 98 to the e-Help group, and 97 to the usual care group. At 3 months, 243 participants (82.7%) had complete data on the primary outcome. In the intention-to-treat analysis at 3 months, the adjusted mean difference in MSK-HQ score between the app and usual care groups was 0.62 points (95% CI, −1.66 to 2.90 points; P = .60). The adjusted mean difference between the app and e-Help groups was 1.08 points (95% CI, −1.24 to 3.41 points; P = .36). Conclusions and Relevance In this randomized clinical trial, individually tailored self-management support delivered via an artificial intelligence–based app adjunct to usual care was not significantly more effective in improving musculoskeletal health than usual care alone or web-based nontailored self-management support in patients with neck and/or low back pain referred to specialist care. Further research is needed to investigate the utility of implementing digitally supported self-management interventions in the specialist care setting and to identify instruments that capture changes in self-management behavior. Trial Registration ClinicalTrials.gov Identifier: NCT04463043
Marcuzzi et al. (Tue,) conducted a rct in neck and/or low back pain (n=294). artificial intelligence-based app (SELFBACK) adjunct to usual care vs. usual care alone or web-based nontailored self-management support (e-Help) was evaluated on change in musculoskeletal health measured by the Musculoskeletal Health Questionnaire (MSK-HQ) at 3 months (adjusted mean difference 0.62, 95% CI -1.66 to 2.90, p=.60). An AI-based tailored self-management app adjunct to usual care did not significantly improve musculoskeletal health at 3 months compared with usual care alone (adjusted mean difference 0.62; P=.60).