Evaluation of the Impact of a Smartphone App on Adherence to an Exercise Program in People With Chronic Low Back Pain: Randomized Controlled Trial
Bibliographic record
Abstract
Abstract Background The benefits of multidisciplinary rehabilitation programs on pain and function in people with chronic low back pain (CLBP) are fairly well documented in the literature. However, these positive effects tend to fade over time due to low long-term patient adherence. Objective The study aimed to evaluate the impact of a smartphone app on adherence to an exercise program for people with CLBP at 6 months. The secondary aims were to assess the effectiveness of the app on pain, disability, fears, and beliefs related to physical activity, physical capacity, and qualitative adherence (correctness of exercise execution) at 6 months. Methods A total of 110 people with CLBP were included and randomized into 2 groups: 54 in the intervention group (IG) who received education on the use of the app in addition to usual care (a 3-week multidisciplinary rehabilitation program with self-management education) and 56 in the control group (CG) who received only usual care. Part B of the Exercise Adherence Rating Scale was used as the primary outcome to assess adherence to the 6-month exercise program. Secondary outcomes were pain (Numeric Rating Scale), disability (Oswestry Disability Index), barriers and facilitators to performing physical activity (Evaluation of Physical Activity Perception), physical capacity (battery of tests), and qualitative adherence (correctness of exercise execution). Statistical analyses were performed according to the intention-to-treat principle. A linear mixed model compared the primary end point between the groups at 6 months. Results A total of 71 of 110 participants (n=35 in the CG vs n=36 in the IG) were evaluated at 6 months. We did not observe any significant difference in the Exercise Adherence Rating Scale score between the CG and the IG (group difference 0.01, 95% CI −2.4 to 2.4; P =.97). The same findings were found for pain, disability, and barriers and facilitators to physical activity, except for the motivation criterion. The 6-Minute Walk Test (group difference [log] 0.06, 95% CI 0.01-0.12; P =.06), cycle ergometer (group difference 9.30, 95% CI 0.48-18.13; P =.04), Ito (group difference [log] 0.31, 95% CI 0.01-0.62; P =.04), plank (group difference [log] 0.29, 95% CI 0.03-0.54; P =.03), and qualitative adherence (IG mean 12.6, SD 1.3 vs CG mean 11.4, SD 1.4; P =.02) differed between the groups in favor of the IG. All outcomes improved from baseline to 6 months in the IG but not in the CG. Conclusions The smartphone app did not impact adherence to an exercise program at 6 months in individuals with CLBP. Similar results were found for pain and function. Nevertheless, the app could be a useful self-management tool in view of the positive effects on physical capacity and qualitative adherence.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.006 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.004 | 0.004 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.011 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".