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BACKGROUND As the world’s population ages, the number of people living with chronic low back pain (CLBP) is increasing. CLBP places significant strain on people living with the condition and the healthcare services supporting them. Mobile health apps offer a promising way to alleviate some of this burden. However more research is needed to understand who might benefit from a mobile app to self-manage CLBP, why and under what circumstances. OBJECTIVE This study evaluated and refined existing theories on how mobile apps can support self-management of chronic low back pain (CLBP) in a real-world setting. The aim was to identify key contextual factors that generate mechanisms which explain why the app works for some people with chronic low back pain and not for others and under what circumstances METHODS A realist evaluation using one-on-one telephone interviews with participants who used the Curable app for three months to self-manage CLBP. Realist interviews, conducted in a teacher-learner cycle, explored programme theories from a prior realist synthesis. Abductive and retroductive analysis generated context-mechanism-outcome configurations (CMOCs) explaining who benefits from the app, why, and under what circumstances. RESULTS Sixteen original CMOCs were tested and refined using the analysis of nine interviews with people with CLBP who trailed the Curable app. This resulted in twenty final CMOC’s supporting three programme theories around the concepts of empowerment, burden of care, and timing. These theories suggest that: 1) personalised and accessible apps can empower patients when introduced alongside existing care, 2) apps may reduce the burden of self-management by offering ongoing support and communication with healthcare professionals, and 3) while early app introduction has potential benefits, it is essential for patients to feel validated and accept the chronicity of their condition first. CONCLUSIONS A self-management app if personalised and flexible to adapt to a user's fluctuating capacity and needs can be an empowering tool to self-mange CLBP. However, to prevent feelings of abandonment these apps should be introduced as an adjunct to ongoing care and not as a replacement.
Hunter et al. (Thu,) studied this question.