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Mobile App-Supported Self-Management for Chronic Low Back Pain: Realist Evaluation.

Rebecca Hunter1,2, Trish Gorely1, Michelle Beattie1

  • 1Centre for Rural Health Sciences, University of the Highlands and Islands, Raigmore Hospital, Old Perth Road, Inverness, IV2 3JH, United Kingdom, 44 01463 279805.

JMIR Mhealth and Uhealth
|February 17, 2026
PubMed
Summary

Mobile health apps can empower chronic low back pain (CLBP) patients. Success hinges on personalized content, appropriate timing, and trust, complementing clinical care.

Keywords:
back painchronic low back paindigital healthdigital interventiondigital technologymHealthmobile appmobile healthrealist evaluationself-managementsmartphone

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Area of Science:

  • Digital health interventions
  • Chronic pain management
  • Health services research

Background:

  • Chronic low back pain (CLBP) prevalence is rising globally, increasing healthcare burdens.
  • Mobile health (mHealth) apps offer scalable self-management solutions for CLBP.
  • Limited understanding exists on how mHealth apps function in real-world CLBP self-management.

Purpose of the Study:

  • To test and refine program theories on mobile app effectiveness for CLBP self-management.
  • To identify contextual factors and mechanisms influencing digital intervention success or failure.
  • To understand how, why, and for whom mHealth tools work in chronic pain.

Main Methods:

  • Realist evaluation employing one-on-one telephone interviews with 9 participants using the Curable app.
  • Teacher-learner cycle in interviews to explore, test, and refine program theories.
  • Abductive and retroductive analysis to develop context-mechanism-outcome configurations (CMOCs).

Main Results:

  • 20 CMOCs refined theories on empowerment, self-management burden, and timing.
  • App empowerment linked to credible knowledge; engagement varied by user beliefs.
  • App utility depended on proactive delivery and low-demand interfaces; timing and trust influenced engagement.

Conclusions:

  • Mobile apps like Curable can enhance CLBP self-management and continuity of care.
  • Success factors include personalization, timing, and relational dynamics.
  • mHealth tools should supplement, not replace, ongoing clinical support to avoid patient abandonment.