An Educational and Exercise Mobile Phone–Based Intervention to Elicit Electrophysiological Changes and to Improve Psychological Functioning in Adults With Nonspecific Chronic Low Back Pain (BackFit App): Nonrandomized Clinical Trial
BackgroundConcomitant psychological and cognitive impairments modulate nociceptive processing and contribute to chronic low back pain (CLBP) maintenance, poorly correlated with radiological findings. Clinical practice guidelines recommend self-management and multidisciplinary...
| Main Authors: | , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
JMIR Publications
2022-03-01
|
| Series: | JMIR mHealth and uHealth |
| Online Access: | https://mhealth.jmir.org/2022/3/e29171 |
| _version_ | 1797735289110659072 |
|---|---|
| author | Carolina Sitges Juan L Terrasa Nuria García-Dopico Joan Segur-Ferrer Olga Velasco-Roldán Jaume Crespí-Palmer Ana María González-Roldán Pedro Montoya |
| author_facet | Carolina Sitges Juan L Terrasa Nuria García-Dopico Joan Segur-Ferrer Olga Velasco-Roldán Jaume Crespí-Palmer Ana María González-Roldán Pedro Montoya |
| author_sort | Carolina Sitges |
| collection | DOAJ |
| description |
BackgroundConcomitant psychological and cognitive impairments modulate nociceptive processing and contribute to chronic low back pain (CLBP) maintenance, poorly correlated with radiological findings. Clinical practice guidelines recommend self-management and multidisciplinary educational and exercise-based interventions. However, these recommendations are based on self-reported measurements, which lack evidence of related electrophysiological changes. Furthermore, current mobile health (mHealth) tools for self-management are of low quality and scarce evidence. Thus, it is necessary to increase knowledge on mHealth and electrophysiological changes elicited by current evidence-based interventions.
ObjectiveThe aim of this study is to investigate changes elicited by a self-managed educational and exercise-based 4-week mHealth intervention (BackFit app) in electroencephalographic and electrocardiographic activity, pressure pain thresholds (PPTs), pain, disability, and psychological and cognitive functioning in CLBP versus the same intervention in a face-to-face modality.
MethodsA 2-arm parallel nonrandomized clinical trial was conducted at the University of the Balearic Islands (Palma, Spain). A total of 50 patients with nonspecific CLBP were assigned to a self-managed group (23/50, 46%; mean age 45.00, SD 9.13 years; 10/23, 43% men) or a face-to-face group (27/50, 54%; mean age 48.63, SD 7.54 years; 7/27, 26% men). The primary outcomes were electroencephalographic activity (at rest and during a modified version of the Eriksen flanker task) and heart rate variability (at rest), PPTs, and pressure pain intensity ratings. The secondary outcomes were pain, disability, psychological functioning (mood, anxiety, kinesiophobia, pain catastrophizing, and fear-avoidance beliefs), and cognitive performance (percentage of hits and reaction times).
ResultsAfter the intervention, frequency analysis of electroencephalographic resting-state data showed increased beta-2 (16-23 Hz; 0.0020 vs 0.0024; P=.02) and beta-3 (23-30 Hz; 0.0013 vs 0.0018; P=.03) activity. In addition, source analyses revealed higher power density of beta (16-30 Hz) at the anterior cingulate cortex and alpha (8-12 Hz) at the postcentral gyrus and lower power density of delta (2-4 Hz) at the cuneus and precuneus. Both groups also improved depression (7.74 vs 5.15; P=.01), kinesiophobia (22.91 vs 20.87; P=.002), activity avoidance (14.49 vs 12.86; P<.001), helplessness (6.38 vs 4.74; P=.02), fear-avoidance beliefs (35 vs 29.11; P=.03), and avoidance of physical activity (12.07 vs 9.28; P=.01) scores, but there was an increase in the disability score (6.08 vs 7.5; P=.01). No significant differences between the groups or sessions were found in heart rate variability resting-state data, electroencephalographic data from the Eriksen flanker task, PPTs, subjective ratings, or cognitive performance.
ConclusionsBoth intervention modalities increased mainly beta activity at rest and improved psychological functioning. Given the limitations of our study, conclusions must be drawn carefully and further research will be needed. Nevertheless, to the best of our knowledge, this is the first study reporting electroencephalographic changes in patients with CLBP after an mHealth intervention.
Trial RegistrationClinicalTrials.gov NCT04576611; https://clinicaltrials.gov/ct2/show/NCT04576611 |
| first_indexed | 2024-03-12T12:55:54Z |
| format | Article |
| id | doaj.art-c1a2eb68fa9640f89bfd67093c283253 |
| institution | Directory Open Access Journal |
| issn | 2291-5222 |
| language | English |
| last_indexed | 2024-03-12T12:55:54Z |
| publishDate | 2022-03-01 |
| publisher | JMIR Publications |
| record_format | Article |
| series | JMIR mHealth and uHealth |
| spelling | doaj.art-c1a2eb68fa9640f89bfd67093c2832532023-08-28T21:04:50ZengJMIR PublicationsJMIR mHealth and uHealth2291-52222022-03-01103e2917110.2196/29171An Educational and Exercise Mobile Phone–Based Intervention to Elicit Electrophysiological Changes and to Improve Psychological Functioning in Adults With Nonspecific Chronic Low Back Pain (BackFit App): Nonrandomized Clinical TrialCarolina Sitgeshttps://orcid.org/0000-0003-3830-2859Juan L Terrasahttps://orcid.org/0000-0003-4138-8737Nuria García-Dopicohttps://orcid.org/0000-0003-2040-6713Joan Segur-Ferrerhttps://orcid.org/0000-0001-8305-5127Olga Velasco-Roldánhttps://orcid.org/0000-0003-2376-433XJaume Crespí-Palmerhttps://orcid.org/0000-0001-7070-1548Ana María González-Roldánhttps://orcid.org/0000-0002-1990-8620Pedro Montoyahttps://orcid.org/0000-0001-8652-948X BackgroundConcomitant psychological and cognitive impairments modulate nociceptive processing and contribute to chronic low back pain (CLBP) maintenance, poorly correlated with radiological findings. Clinical practice guidelines recommend self-management and multidisciplinary educational and exercise-based interventions. However, these recommendations are based on self-reported measurements, which lack evidence of related electrophysiological changes. Furthermore, current mobile health (mHealth) tools for self-management are of low quality and scarce evidence. Thus, it is necessary to increase knowledge on mHealth and electrophysiological changes elicited by current evidence-based interventions. ObjectiveThe aim of this study is to investigate changes elicited by a self-managed educational and exercise-based 4-week mHealth intervention (BackFit app) in electroencephalographic and electrocardiographic activity, pressure pain thresholds (PPTs), pain, disability, and psychological and cognitive functioning in CLBP versus the same intervention in a face-to-face modality. MethodsA 2-arm parallel nonrandomized clinical trial was conducted at the University of the Balearic Islands (Palma, Spain). A total of 50 patients with nonspecific CLBP were assigned to a self-managed group (23/50, 46%; mean age 45.00, SD 9.13 years; 10/23, 43% men) or a face-to-face group (27/50, 54%; mean age 48.63, SD 7.54 years; 7/27, 26% men). The primary outcomes were electroencephalographic activity (at rest and during a modified version of the Eriksen flanker task) and heart rate variability (at rest), PPTs, and pressure pain intensity ratings. The secondary outcomes were pain, disability, psychological functioning (mood, anxiety, kinesiophobia, pain catastrophizing, and fear-avoidance beliefs), and cognitive performance (percentage of hits and reaction times). ResultsAfter the intervention, frequency analysis of electroencephalographic resting-state data showed increased beta-2 (16-23 Hz; 0.0020 vs 0.0024; P=.02) and beta-3 (23-30 Hz; 0.0013 vs 0.0018; P=.03) activity. In addition, source analyses revealed higher power density of beta (16-30 Hz) at the anterior cingulate cortex and alpha (8-12 Hz) at the postcentral gyrus and lower power density of delta (2-4 Hz) at the cuneus and precuneus. Both groups also improved depression (7.74 vs 5.15; P=.01), kinesiophobia (22.91 vs 20.87; P=.002), activity avoidance (14.49 vs 12.86; P<.001), helplessness (6.38 vs 4.74; P=.02), fear-avoidance beliefs (35 vs 29.11; P=.03), and avoidance of physical activity (12.07 vs 9.28; P=.01) scores, but there was an increase in the disability score (6.08 vs 7.5; P=.01). No significant differences between the groups or sessions were found in heart rate variability resting-state data, electroencephalographic data from the Eriksen flanker task, PPTs, subjective ratings, or cognitive performance. ConclusionsBoth intervention modalities increased mainly beta activity at rest and improved psychological functioning. Given the limitations of our study, conclusions must be drawn carefully and further research will be needed. Nevertheless, to the best of our knowledge, this is the first study reporting electroencephalographic changes in patients with CLBP after an mHealth intervention. Trial RegistrationClinicalTrials.gov NCT04576611; https://clinicaltrials.gov/ct2/show/NCT04576611https://mhealth.jmir.org/2022/3/e29171 |
| spellingShingle | Carolina Sitges Juan L Terrasa Nuria García-Dopico Joan Segur-Ferrer Olga Velasco-Roldán Jaume Crespí-Palmer Ana María González-Roldán Pedro Montoya An Educational and Exercise Mobile Phone–Based Intervention to Elicit Electrophysiological Changes and to Improve Psychological Functioning in Adults With Nonspecific Chronic Low Back Pain (BackFit App): Nonrandomized Clinical Trial JMIR mHealth and uHealth |
| title | An Educational and Exercise Mobile Phone–Based Intervention to Elicit Electrophysiological Changes and to Improve Psychological Functioning in Adults With Nonspecific Chronic Low Back Pain (BackFit App): Nonrandomized Clinical Trial |
| title_full | An Educational and Exercise Mobile Phone–Based Intervention to Elicit Electrophysiological Changes and to Improve Psychological Functioning in Adults With Nonspecific Chronic Low Back Pain (BackFit App): Nonrandomized Clinical Trial |
| title_fullStr | An Educational and Exercise Mobile Phone–Based Intervention to Elicit Electrophysiological Changes and to Improve Psychological Functioning in Adults With Nonspecific Chronic Low Back Pain (BackFit App): Nonrandomized Clinical Trial |
| title_full_unstemmed | An Educational and Exercise Mobile Phone–Based Intervention to Elicit Electrophysiological Changes and to Improve Psychological Functioning in Adults With Nonspecific Chronic Low Back Pain (BackFit App): Nonrandomized Clinical Trial |
| title_short | An Educational and Exercise Mobile Phone–Based Intervention to Elicit Electrophysiological Changes and to Improve Psychological Functioning in Adults With Nonspecific Chronic Low Back Pain (BackFit App): Nonrandomized Clinical Trial |
| title_sort | educational and exercise mobile phone based intervention to elicit electrophysiological changes and to improve psychological functioning in adults with nonspecific chronic low back pain backfit app nonrandomized clinical trial |
| url | https://mhealth.jmir.org/2022/3/e29171 |
| work_keys_str_mv | AT carolinasitges aneducationalandexercisemobilephonebasedinterventiontoelicitelectrophysiologicalchangesandtoimprovepsychologicalfunctioninginadultswithnonspecificchroniclowbackpainbackfitappnonrandomizedclinicaltrial AT juanlterrasa aneducationalandexercisemobilephonebasedinterventiontoelicitelectrophysiologicalchangesandtoimprovepsychologicalfunctioninginadultswithnonspecificchroniclowbackpainbackfitappnonrandomizedclinicaltrial AT nuriagarciadopico aneducationalandexercisemobilephonebasedinterventiontoelicitelectrophysiologicalchangesandtoimprovepsychologicalfunctioninginadultswithnonspecificchroniclowbackpainbackfitappnonrandomizedclinicaltrial AT joansegurferrer aneducationalandexercisemobilephonebasedinterventiontoelicitelectrophysiologicalchangesandtoimprovepsychologicalfunctioninginadultswithnonspecificchroniclowbackpainbackfitappnonrandomizedclinicaltrial AT olgavelascoroldan aneducationalandexercisemobilephonebasedinterventiontoelicitelectrophysiologicalchangesandtoimprovepsychologicalfunctioninginadultswithnonspecificchroniclowbackpainbackfitappnonrandomizedclinicaltrial AT jaumecrespipalmer aneducationalandexercisemobilephonebasedinterventiontoelicitelectrophysiologicalchangesandtoimprovepsychologicalfunctioninginadultswithnonspecificchroniclowbackpainbackfitappnonrandomizedclinicaltrial AT anamariagonzalezroldan aneducationalandexercisemobilephonebasedinterventiontoelicitelectrophysiologicalchangesandtoimprovepsychologicalfunctioninginadultswithnonspecificchroniclowbackpainbackfitappnonrandomizedclinicaltrial AT pedromontoya aneducationalandexercisemobilephonebasedinterventiontoelicitelectrophysiologicalchangesandtoimprovepsychologicalfunctioninginadultswithnonspecificchroniclowbackpainbackfitappnonrandomizedclinicaltrial AT carolinasitges educationalandexercisemobilephonebasedinterventiontoelicitelectrophysiologicalchangesandtoimprovepsychologicalfunctioninginadultswithnonspecificchroniclowbackpainbackfitappnonrandomizedclinicaltrial AT juanlterrasa educationalandexercisemobilephonebasedinterventiontoelicitelectrophysiologicalchangesandtoimprovepsychologicalfunctioninginadultswithnonspecificchroniclowbackpainbackfitappnonrandomizedclinicaltrial AT nuriagarciadopico educationalandexercisemobilephonebasedinterventiontoelicitelectrophysiologicalchangesandtoimprovepsychologicalfunctioninginadultswithnonspecificchroniclowbackpainbackfitappnonrandomizedclinicaltrial AT joansegurferrer educationalandexercisemobilephonebasedinterventiontoelicitelectrophysiologicalchangesandtoimprovepsychologicalfunctioninginadultswithnonspecificchroniclowbackpainbackfitappnonrandomizedclinicaltrial AT olgavelascoroldan educationalandexercisemobilephonebasedinterventiontoelicitelectrophysiologicalchangesandtoimprovepsychologicalfunctioninginadultswithnonspecificchroniclowbackpainbackfitappnonrandomizedclinicaltrial AT jaumecrespipalmer educationalandexercisemobilephonebasedinterventiontoelicitelectrophysiologicalchangesandtoimprovepsychologicalfunctioninginadultswithnonspecificchroniclowbackpainbackfitappnonrandomizedclinicaltrial AT anamariagonzalezroldan educationalandexercisemobilephonebasedinterventiontoelicitelectrophysiologicalchangesandtoimprovepsychologicalfunctioninginadultswithnonspecificchroniclowbackpainbackfitappnonrandomizedclinicaltrial AT pedromontoya educationalandexercisemobilephonebasedinterventiontoelicitelectrophysiologicalchangesandtoimprovepsychologicalfunctioninginadultswithnonspecificchroniclowbackpainbackfitappnonrandomizedclinicaltrial |