Back on track - digital health applications to treat back pain of rheumatic patients? Results of a qualitative interview study.
Digital health applications
Implementation science
Non specific low back pain
Rheumatology
eHealth, DTx, digital treatment, telemedicine
Journal
Rheumatology international
ISSN: 1437-160X
Titre abrégé: Rheumatol Int
Pays: Germany
ID NLM: 8206885
Informations de publication
Date de publication:
28 Sep 2024
28 Sep 2024
Historique:
received:
16
08
2024
accepted:
16
09
2024
medline:
28
9
2024
pubmed:
28
9
2024
entrez:
28
9
2024
Statut:
aheadofprint
Résumé
Non-specific low back pain (NLBP) is prevalent among patients with rheumatic conditions. Digital health applications (DiGAs) provide reimbursed, personalized home treatment for patients, promising to overcome limitations of traditional healthcare systems. However, the adoption and effectiveness of back pain-specific DiGAs in rheumatology are not well understood. This study aims to explore the experiences and perspectives of a diverse group of rheumatology stakeholders regarding the use of DiGAs for back pain management. Qualitative interviews and a focus group discussion were conducted with a wide range of stakeholders including rheumatic patients, rheumatologists, nurses and DiGA producers. The data were analysed using qualitative content analysis. The study included 15 interviews (10 rheumatic patients, 4 rheumatologists, 1 DiGA producer) and 1 focus group with mixed participants (n = 12). Most stakeholders valued the instant access to personalized and effective back pain treatment provided by DiGAs. Patients appreciated the flexibility and ease of use of DiGAs which can be used anywhere and anytime. Concerns were raised about insufficient guidance regarding correct execution of exercises, which was seen as potentially dangerous and unsettling for patients. Healthcare professionals (HCPs) highlighted barriers, such as the lack of reimbursement, time constraints, and inadequate DiGA-specific education as barriers to prescribing DiGAs. Additionally, poor patient onboarding often led to delays, increased skepticism, and premature discontinuation of therapy. Stakeholders emphasized the challenges of current care driven by a shortage of HCPs and generally supported usage of back pain DiGAs. Various barriers and solution approaches were identified to enhance the performance, usability, and implementation of DiGAs in rheumatology.
Identifiants
pubmed: 39340666
doi: 10.1007/s00296-024-05726-x
pii: 10.1007/s00296-024-05726-x
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2024. The Author(s).
Références
Meucci RD, Fassa AG, Faria NM (2015) Prevalence of chronic low back pain: systematic review. Rev Saude Publica 49:1. https://doi.org/10.1590/S0034-8910.2015049005874
doi: 10.1590/S0034-8910.2015049005874
pubmed: 26487293
pmcid: 4603263
Baykara RA, Bozgeyik Z, Akgul O, Ozgocmen S (2013) Low back pain in patients with rheumatoid arthritis: clinical characteristics and impact of low back pain on functional ability and health-related quality of life. J Back Musculoskelet Rehabil 26(4):367–374. https://doi.org/10.3233/BMR-130393
doi: 10.3233/BMR-130393
pubmed: 23948822
Wenig CM, Schmidt CO, Kohlmann T, Schweikert B (2009) Costs of back pain in Germany. Eur J Pain 13(3):280–286. https://doi.org/10.1016/j.ejpain.2008.04.005
doi: 10.1016/j.ejpain.2008.04.005
pubmed: 18524652
Qaseem A, Wilt TJ, McLean RM, Forciea MA, Clinical Guidelines Committee of the American College of Physicians (2017) Noninvasive treatments for acute, subacute, and chronic low back pain: a clinical practice guideline from the American College of Physicians. Ann Intern Med 166(7):514–530. https://doi.org/10.7326/M16-2367
doi: 10.7326/M16-2367
pubmed: 28192789
Weise H, Zenner B, Schmiedchen B, Benning L, Bulitta M, Schmitz D, Weise K (2022) The effect of an app-based home exercise program on self-reported pain intensity in unspecific and degenerative back pain: pragmatic open-label randomized controlled trial. J Med Internet Res 24(10). https://doi.org/10.2196/41899
Fuchs F, Morf H, Mohn J et al (2023) Diagnostic delay stages and pre-diagnostic treatment in patients with suspected rheumatic diseases before special care consultation: results of a multicenter-based study. Rheumatol Int 43:495–502. https://doi.org/10.1007/s00296-022-05223-z
doi: 10.1007/s00296-022-05223-z
pubmed: 36214864
Miloslavsky EM, Bolster MB (2020) Addressing the rheumatology workforce shortage: a multifaceted approach. Semin Arthritis Rheum 50(4):791–796. https://doi.org/10.1016/j.semarthrit.2020.05.009
doi: 10.1016/j.semarthrit.2020.05.009
pubmed: 32540672
pmcid: 7255118
Bundesinstitut für Arzneimittel und Medizinprodukte (2024) Verzeichnis digitaler Gesundheitsanwendungen (DiGA). Accessed 30 June 2024. https://diga.bfarm.de/de/verzeichnis
Richter JG, Chehab G, Stachwitz P et al (2022) One year of digital health applications (DiGA) in Germany - Rheumatologists’ perspectives. Front Med (Lausanne) 9:1000668. https://doi.org/10.3389/fmed.2022.1000668
doi: 10.3389/fmed.2022.1000668
pubmed: 36388899
pmcid: 9640713
Labinsky H, Gupta L, Raimondo MG et al (2023) Real-world usage of digital health applications (DiGA) in rheumatology: results from a German patient survey. Rheumatol Int 43:713–719. https://doi.org/10.1007/s00296-022-05261-7
doi: 10.1007/s00296-022-05261-7
pubmed: 36543961
Weise H, Zenner B, Schmiedchen B et al (2023) Correction: the Effect of an app-based Home Exercise Program on Self-reported Pain Intensity in unspecific and degenerative back Pain: pragmatic open-label Randomized Controlled Trial. J Med Internet Res 25. https://doi.org/10.2196/46512
Priebe JA, Kerkemeyer L, Haas KK et al (2024) Medical app treatment of non-specific low back Pain in the 12-month cluster-randomized controlled trial Rise-uP: where clinical superiority meets cost savings. J Pain Res 17:2239–2255. https://doi.org/10.2147/JPR.S473250
doi: 10.2147/JPR.S473250
pubmed: 38952994
pmcid: 11215667
Toelle TR, Utpadel-Fischler DA, Haas KK et al (2019) App-based multidisciplinary back pain treatment versus combined physiotherapy plus online education: a randomized controlled trial. Npj Digit Med 2:34. https://doi.org/10.1038/s41746-019-0109-x
doi: 10.1038/s41746-019-0109-x
pubmed: 31304380
pmcid: 6550294
Lin J, Paganini S, Sander L et al (2017) An internet-based intervention for Chronic Pain. Dtsch Arztebl Int 114(41):681–688. https://doi.org/10.3238/arztebl.2017.0681
doi: 10.3238/arztebl.2017.0681
pubmed: 29082858
pmcid: 5672594
Priebe JA, Haas KK, Moreno Sanchez LF et al (2020) Digital Treatment of Back Pain versus Standard of Care: the cluster-randomized controlled trial, Rise-uP. J Pain Res 13:1823–1838. https://doi.org/10.2147/JPR.S260761
doi: 10.2147/JPR.S260761
pubmed: 32765057
pmcid: 7381830
Patton MQ (2002) Qualitative research and evaluation methods. SAGE, Thousand Oaks, London, New Delhi
Kuckartz U (2012) Qualitative inhaltsanalyse: Methoden, Praxis, Computerunterstützung. Beltz Juventa, Weinheim
Tong A, Sainsbury P, Craig J (2007) Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care 19(6):349–357. https://doi.org/10.1093/intqhc/mzm042
doi: 10.1093/intqhc/mzm042
pubmed: 17872937
Dahlhausen F, Zinner M, Bieske L et al (2022) There’s an app for that, but nobody’s using it: insights on improving patient access and adherence to digital therapeutics in Germany. Digit Health 8:20552076221104672. https://doi.org/10.1177/20552076221104672
doi: 10.1177/20552076221104672
pubmed: 35811758
pmcid: 9260569
Knitza J, Muehlensiepen F, Kuhn S (2023) Digital health applications: toward a lifecycle and pay-for-performance approach. Digit Health J 1(3):393–394. https://doi.org/10.1016/j.mcpdig.2023.07.001
doi: 10.1016/j.mcpdig.2023.07.001
Posselt J, Klawunn R, Dierks ML (2023) Verordnung Digitaler Gesundheitsanwendungen (DiGA) an Menschen Mit Depressiven Erkrankungen: Ergebnisse Einer Qualitativen Studie. Z Allg Med 99:145–150. https://doi.org/10.1007/s44266-023-00034-2
doi: 10.1007/s44266-023-00034-2
Hasenöhrl T, Windschnurer T, Dorotka R et al (2020) Prescription of individual therapeutic exercises via smartphone app for patients suffering from non-specific back pain. Wien Klin Wochenschr 132:115–123. https://doi.org/10.1007/s00508-020-01616-x
doi: 10.1007/s00508-020-01616-x
pubmed: 32060724
pmcid: 7080705
López-Marcos JJ, Díaz-Arribas MJ, Valera-Calero JA et al (2024) The added value of Face-to-Face Supervision to a Therapeutic Exercise-based app in the management of patients with chronic low back Pain: a Randomized Clinical Trial. Sensors 24:567. https://doi.org/10.3390/s24020567
doi: 10.3390/s24020567
pubmed: 38257659
pmcid: 10819225
Treanor CJ, Kouvonen A, Lallukka T et al (2021) Acceptability of computerized cognitive behavioral therapy for adults: Umbrella Review. JMIR Ment Health 8(7). https://doi.org/10.2196/23091
Paul L, McDonald MT, McConnachie A et al (2024) Online physiotherapy for people with axial spondyloarthritis: quantitative and qualitative data from a cohort study. Rheumatol Int 44(1):145–156. https://doi.org/10.1007/s00296-023-05456-6
doi: 10.1007/s00296-023-05456-6
pubmed: 37733042
Strunz PP, Le Maire M, Heusinger T et al (2024) The exercise-app Axia for axial spondyloarthritis enhances the home-based exercise frequency in axial spondyloarthritis patients - a cross-sectional survey. Rheumatol Int 44(6):1143–1154. https://doi.org/10.1007/s00296-024-05600-w
doi: 10.1007/s00296-024-05600-w
pubmed: 38683351
pmcid: 11108939