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Bottom line
Some mobile apps may help people self-manage chronic low back pain as a complement to in-person care, but most lack robust evidence-based content, provider involvement, and key features, so they should not replace professional treatment.
Moderate evidencePublished
Evidence hierarchy
Study participants
Mobile apps available in Brazil for self-management of chronic low back pain in adults
Study Summary
This systematic review identified and assessed 17 mobile applications available in Brazil (Apple Store and Google Play) that support self-management of chronic low back pain in adults. Apps were rated with the Self-Management Support Assessment Tool (SMS-14) and the Institute for Healthcare Informatics Functionality Score (IMS). Several apps — Pathways, Branch, Pancea, Pain Navigator and Curable — met most self-management support skills, while Curable, Branch and MoovBuddy had the most functionality features. The authors conclude that some apps could complement (not replace) in-person care, but most lack robust evidence-based content, provider partnership, social support and cultural relevance, and face barriers including cost, language, security and privacy.
Key Findings
| Finding | Detail | Impact |
|---|---|---|
| Seventeen apps were selected and most offered around seven self-management skills | The 17 apps averaged a score of 6.9 (±2.7, median 7, range 3–11) on the SMS-14 self-management support scale. The most prevalent self-management skills were activity pacing, biomechanical/aerobic exercises, breathing/relaxation, meditation/mindfulness and self-tailoring. | High |
| A small set of apps met the majority of self-management support skills | Pathways (n=11; 78.6%), Branch (n=11; 78.6%), Pancea (n=11; 78.6%), Pain Navigator (n=10; 71.4%) and Curable (n=9; 64.3%) scored highest on SMS-14. Pathways and Branch met all seven self-efficacy-building items. | High |
| Functionality scores were moderate, led by Curable, Branch and MoovBuddy | On the IMS functionality scale the mean number of features was 7.4 (±2.1, median 8, range 3–10). Curable, Branch and MoovBuddy each had ten features. The most common functions were instruct (100%), record (94.1%) and evaluate (88.2%); least common were share and guide (each 29.4%) and intervene (47.0%). | Medium |
| English-language apps scored significantly higher on self-management support | Kruskal-Wallis testing showed a significant difference in SMS-14 scores by language (p=0.016); English apps (mean 8.5, SD 2.22) scored higher than apps with language options (mean 5, SD 1.67), which the authors note is a barrier for users who do not read English. | Medium |
| Few apps were clinically tested or developed with healthcare partnerships | Only two apps (Manage My Pain and Pain Navigator) were tested in clinical research; about 82.3% were developed without academic or health-institution partnerships. No app addressed cultural relevance with culturally adapted information. | High |
| User star ratings did not correlate with app quality | Spearman correlation found no significant relationship between SMS-14/IMS scores and file size, star rating, monthly cost, or number of user reviewers; the highest-scoring apps were not necessarily the best rated by users (mean rating 4.4 ±0.5). | Medium |
The 17 apps averaged a score of 6.9 (±2.7, median 7, range 3–11) on the SMS-14 self-management support scale. The most prevalent self-management skills were activity pacing, biomechanical/aerobic exercises, breathing/relaxation, meditation/mindfulness and self-tailoring.
Pathways (n=11; 78.6%), Branch (n=11; 78.6%), Pancea (n=11; 78.6%), Pain Navigator (n=10; 71.4%) and Curable (n=9; 64.3%) scored highest on SMS-14. Pathways and Branch met all seven self-efficacy-building items.
On the IMS functionality scale the mean number of features was 7.4 (±2.1, median 8, range 3–10). Curable, Branch and MoovBuddy each had ten features. The most common functions were instruct (100%), record (94.1%) and evaluate (88.2%); least common were share and guide (each 29.4%) and intervene (47.0%).
Kruskal-Wallis testing showed a significant difference in SMS-14 scores by language (p=0.016); English apps (mean 8.5, SD 2.22) scored higher than apps with language options (mean 5, SD 1.67), which the authors note is a barrier for users who do not read English.
Only two apps (Manage My Pain and Pain Navigator) were tested in clinical research; about 82.3% were developed without academic or health-institution partnerships. No app addressed cultural relevance with culturally adapted information.
Spearman correlation found no significant relationship between SMS-14/IMS scores and file size, star rating, monthly cost, or number of user reviewers; the highest-scoring apps were not necessarily the best rated by users (mean rating 4.4 ±0.5).
Strengths
- Used two structured, named appraisal instruments (SMS-14 and IMS) to assess both self-management support and functionality
- Prospectively registered protocol (PROSPERO CRD42022382686)
- Assessed inter-rater agreement between two judges and reached consensus on discordant items
- Searched both major commercial app platforms (Apple Store and Google Play)
- Examined practical real-world factors such as cost, downloads, language, privacy policies and health warnings
Limitations
- Only assessed apps available on digital platforms in Brazil, so apps in other countries were not captured
- The rapidly changing app market means results may not reflect the latest updates or newly released apps
- Some paid apps with subscriptions limited access to all features during evaluation
- The assessment instruments (SMS-14, IMS) have not yet been validated in Brazil, and SMS-14 used a yes/no score without assessing depth or quality of content
- Apps not using the word 'pain' in their title or description may have been missed
- The study does not recommend which specific app to use
Key Takeaways for Patients
What This Means for You
- 01A few well-designed apps (such as Pathways, Branch, Pancea, Pain Navigator and Curable) may help you learn skills like staying active, pacing activities, relaxation, mindfulness and pain education for chronic low back pain.
- 02Apps are best used as a complement to in-person care, not as a replacement for seeing a healthcare provider.
- 03High user star ratings do not necessarily mean an app is high quality or evidence-based, so popularity alone is not a reliable guide.
- 04Most apps were only available in English and few were tested in real patients, so look for apps with evidence-based content and, ideally, ask a healthcare provider before starting.
- 05Consider barriers such as subscription cost, language, and how the app handles your privacy and data before relying on it long-term.
Read the Full Paper
Access the complete peer-reviewed study from Revista da Escola de Enfermagem da USP (Rev Esc Enferm USP)
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