Usability and acceptability of an app (SELFBACK) to support self-management of low back pain: mixed methods study.

Self-management is the key recommendation for managing non-specific low back pain (LBP). However, there are well-documented barriers to self-management, therefore methods of facilitating adherence are required. Smartphone apps are increasingly being used to provide feedback and reinforcement to support self-management of long-term conditions such as LBP. The aim of this study was to assess the usability and acceptability of the selfBACK smartphone app, designed to support and facilitate self-management of non-specific LBP. The app provides weekly self-management plans, comprising physical activity, strength/flexibility exercises, and patient education. The plans are tailored to the patient's characteristics and symptom progress by using case-based reasoning methodology. The study was carried out in two stages, using a mixed-methods approach. All participants undertook surveys and semi-structured telephone interviews were conducted with a subgroup of participants. Stage 1 assessed an app version with only the physical activity component and a web-questionnaire that collects information necessary for tailoring the self-management plans. The physical activity component included monitoring of steps recorded by a wristband, goal-setting, and a scheme for sending personalised, timely and motivational notifications to the user's smartphone. Findings from stage 1 were used to refine the app and inform further development. Stage 2 investigated an app version that incorporated three self-management components (physical activity, exercises and education). A total of sixteen participants (age range 23-71 years) with ongoing or chronic non-specific LBP were included in stage 1, and eleven participants (age range 32-56) were included in stage 2. In stage 1, 94% of participants reported that the baseline questionnaire was easy to answer and 84% found completion time to be acceptable. Overall, participants were positive about the usability of the physical activity component but only 31% found the app functions to be well integrated. 90% of the participants were satisfied with the notifications and 80% perceived the notifications to be personalised. In stage 2, all participants reported that the web-questionnaire was easy to answer and the completion time acceptable. The physical activity and exercise components were rated useful by 80%, while 60% rated the educational component useful. Overall, participants were satisfied with the usability of the app; however, only 50% found the functions to be well integrated and 20% found them to be inconsistent. Overall, 80% of participants reported it to be useful for self-management. The interviews largely reinforced the survey findings in both stages. This study has demonstrated that participants considered the selfBACK app to be acceptable and usable, and that they thought it would be useful for supporting self-management of LBP. However, we identified some limitations and suggestions, which will be useful in guiding further development of the selfBACK app and other mHealth interventions