Du S, Liu W, Cai S, et al. The efficacy of e-health in the self-management of chronic low back pain: A meta analysis. Int J Nurs Stud. 2020 Jun;106:103507. doi: 10.1016/j.ijnurstu.2019.103507. Epub 2019 Dec 24. (Systematic review)

BACKGROUND: Globally, more than half a billion people are suffering from chronic low back pain, which results in poor quality of life for patients and major welfare cost for society. Currently, e-Health has been considered as a potential strategy to deliver self-management programs for chronic low back pain, but its effects are uncertain.

OBJECTIVES: To assess the efficacy on pain intensity and disability of e-Health based self-management programs on chronic low back pain.

DESIGN: Systematic review and meta-analysis DATA SOURCES: Searches of Pubmed, the Cochrane Library, Web of Science, Cumulative Index of Nursing and Allied Health Literature, Elsevier, Physiotherapy Evidence Database and ProQuest from inception through 2nd April 2019.

REVIEW METHODS: Randomized controlled trials were screened and selected if they examined e-Health based self-management programs on chronic low back pain and assessed pain intensity and disability as primary outcomes. Risks of bias were assessed by two independent reviewers. Evidence quality was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criteria. Meta-analyses were performed to investigate the effects of e-Health based self-management programs on pain intensity and disability for chronic low back pain. Subgroup analyses were conducted.

RESULTS: Eight randomized controlled trials were included. For pain intensity, moderate-quality evidence indicated there was a clinically important effect of e-Health based self-management programs for relieving pain both at immediate and short-term follow-ups. For disability, moderate-quality evidence showed there was a clinically important effect of e-Health based self-management programs for improving disability at immediate follow-up, and low-quality of evidence showed no significant difference at short-term follow-ups, but with a favorable trend. The results of subgroup analyses indicated that m-Health based self-management programs showed better immediate effects on both pain and disability than web-Health based programs, and programs with durations = 8 weeks demonstrated a better immediate effect on pain than those with durations >8 weeks, but not on disability.

CONCLUSIONS: Generally, e-Health based self-management programs may play a positive role in improving pain and disability within short-term period for chronic low back pain patients. More rigorous trials are warranted to determine the optimal delivery mode, duration, and long-term effect of e-Health based self-management programs.

Discipline Area Score
Physician 6 / 7
Rehab Clinician (OT/PT) 6 / 7
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Comments from MORE raters

Physician rater

I do not think this adds much to practice. I did not think the research was original, and it did not make up for it by being really useful. Although we see a lot of low back pain primary care, and right now we do a lot of telemedicine, this did not even give me reassurance that I was doing okay when I was trying to evaluate patients by phone or video for back pain (which have been doing well the last several months). This is really not very helpful for primary care.

Physician rater

This is a good meta-analysis of ehealth programmes for chronic back pain but the findings are only relevant to short term reductions in pain and disability with no significant difference found after eight weeks. It is difficult to determine the value of such interventions in the context of chronicity.

Rehab Clinician (OT/PT) rater

Very good article with a few good discussion points in light of current COVID19 and other restrictions. The discussion behind e-health and m-health is important with the development of new electronic based programs.
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