The MyRelief Digital Educational Self-Management Program for Persistent Low Back Pain: Feasibility Uncontrolled Trial

Low back pain (LBP) is a leading cause of work absence globally. Digital interventions have the potential to increase access to self-management support for individuals with persistent LBP.

This study aims to evaluate the feasibility, usability, and acceptability of a digital educational program (MyRelief) designed to support self-management strategies for people with persistent LBP.

A prospective uncontrolled feasibility study was conducted across 4 countries (Italy, Portugal, Sweden, and the United Kingdom) between 2020 and 2021. Adults in employment with nonspecific persistent LBP (>3 mo) with access to the internet were eligible to participate. Participants were given access to MyRelief, an 8-unit evidence-based educational self-management program. The feasibility of the MyRelief program was assessed using recruitment rates, an a priori success threshold of >70% of the target sample (50 participants), and a retention <35% dropout rate. Pre- and postintervention measures of functional disability were assessed using the Oswestry Disability Index (ODI), and health-related quality of life using the 5-level EuroQol questionnaire. Additional postintervention measures included the Patient Enablement Instrument and the System Usability Scale. Quantitative data were analyzed descriptively, and qualitative feedback was analyzed using a reflexive analytical approach.

The recruitment feasibility threshold was met, and 40/50 (80%) participants (19 male and 21 female; mean age 57 years) were enrolled in the study. A total of 17 participants (11 male and 6 female) completed both the baseline and 12-week follow-up questionnaires. This represented a retention rate of 42.5% (17/40) and a dropout rate of 57.5%, which did not meet the a priori criteria of <35% dropouts. Approximately half of the participants presented with low baseline disability scores (mean ODI 24.0; 95% CI 18-31) with no significant change at follow-up (mean ODI 23.9; 95% CI 16-31). The 5-level EuroQol questionnaire scores improved from 0.68 (95% CI 0.608-0.76) to 0.72 (95% CI 0.66-0.79), indicating a clinically significant change. Patient Enablement Instrument scores postintervention were high (mean 5.31), indicating good perceived enablement. The mean System Usability Scale score was 72.4 (95% CI 67.5-73.3), indicating a good level of perceived ease-of-use. Overall, the quality of outcome measure completion was high (100%). Qualitative feedback indicated areas for improvement relating to challenges around access and navigation within the website.

The MyRelief study demonstrated feasibility in terms of recruitment but not retention. However, low baseline disability levels are not representative of the wider persistent LBP population. Future studies should broaden recruitment strategies, in particular, by recruiting from health care settings to improve representativeness. Although usability met industry standards, qualitative feedback suggests that navigation and accessibility require further optimization to better align with end user preferences for digital health interventions.