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Apps for self-assessing back pain 'as effective as paper methods'

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Patients can assess their own back pain using an app on their phone or tablet as effectively as current paper methods, according to UK researchers.

They noted that back pain was the number one cause of disability globally, affecting up to 84% of people at some point in their lives and costing the UK economy billions of pounds each year.

“The potential of using digital technology in healthcare settings is quite extraordinary”

Robert Froud

They said their study demonstrated that digital versions of established back pain measurements for assessing back pain were just as reliable and responsive.

Their findings opened up the possibility for the use of mobile apps for routine measurements, they said, as digital versions of assessments would be cheaper, greener and more popular with patients.

The researchers, from the University of Warwick, added that they viewed their study as a necessary first step in the greater use of digital media in clinical settings.

They noted that for health issues that cannot be readily measured, such as pain and depression, clinicians would often use self-assessment to monitor change. In most cases, they highlighted that this will take the form of a paper-based assessment.

“We may be able to detect that particular treatment approaches are working better for certain types of people”

Robert Froud

As a result, the researchers created mobile app versions of the most commonly-used measures in back pain trials – the Roland Morris Disability Questionnaire (RMDQ), visual analogue scale (VAS) of pain intensity, and numerical rating scale (NRS).

Reliability and responsiveness were used as factors to determine whether their apps were measuring in the way that they should be.

Reliability refers to the result of the measure not changing when nothing has changed, while responsiveness refers to a change in the result when a measurable factor has changed.

The study, published in the Journal of Medical Internet Research, included 442 participants who were assessed at one and six weeks.

The researchers divided participants in the study into groups depending on whether they had recorded a change in their pain.

Patients who had received treatment for their condition and improved tested the responsiveness of the apps. Those with chronic pain, and less likely to improve, tested the apps for reliability.

The study authors concluded that the electronic outcome figures were “within the ranges of values reported in the literature for their paper counterparts and are adequate for measuring changes in a low back pain population”.

They also highlighted that digital tests had a number of advantages over paper-based ones, including lower cost and carbon footprint, better information security and improving the patient experience.

Lead author Dr Robert Froud said: “We have taken existing outcome measures and shown that they can be migrated to digital media and used in that format just as effectively as their paper-based versions.

“Our intention is to develop technology that allows people to securely complete these kinds of assessments on their own phones and tablets in a way that is safe, secure and accurate,” he said.

“If you can accurately monitor in clinical practice what’s happening to patients’ health, then analytically there is a lot that could be done with the data that will benefit patients,” said Dr Froud.

“For example, we may be able to detect that particular treatment approaches are working better for certain types of people,” he said. “We hear a lot about machine learning, but a learning healthcare system is perhaps next.

“The implications are quite big because we can aim to scale up,” he said. “It opens up potential for the development of new instruments and dynamic instruments that adapt to the answers that a user gives.”

He added: “The potential of using digital technology in healthcare settings is quite extraordinary but you can’t do any of that without first having assessments that work robustly and well.”

Earlier this month, a Royal College of Physicians report – titled Outpatients: The future – Adding value through sustainability – called for greater use of already available technology in healthcare.

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