A personalized online intervention to enhance back pain-related self-efficacy: A two-arm randomized controlled trial
Paul Hüsing1, Mareike Busmann1, Bernd Löwe1
1Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20251, Hamburg, Germany.
Objective:
Low back pain (LBP) affects daily functioning and strains healthcare systems. Cognitive, behavioral, and emotional factors contribute to its persistence, yet these factors are often neglected in standard care. Personalized digital interventions containing psychoeducational information on relevant biopsychosocial aspects may thus improve outcomes when applied to patients in an early stage. This trial examined whether a brief, personalized animated psychoeducational video-tailored to individual risk profiles based on patient-reported outcome measures (PROMs) and covering biopsychosocial contributors to LBP (depression, catastrophizing, health anxiety, fear of movement, pain endurance behavior, expectations, trauma, emotion regulation)-improves pain-related self-efficacy in adults with acute and subacute low back pain (0-12 weeks).
Methods:
In this two-arm randomized controlled trial, participants with back pain (duration <12 weeks) and resulting impairment were randomized to receive either a personalized animated video (intervention) or care as usual (control). Videos comprised modules (≈2-3.5 min per module) selected from eight possible topics based on baseline PROM cut-offs. Outcomes were assessed at baseline, 4 weeks and 12 weeks. Primary analysis used mixed ANOVA to examine changes in pain-related self-efficacy (FESS) over time and between groups; secondary outcomes on biopsychosocial factors were tested with repeated measures ANOVAs and group-adjusted ANCOVAs.
Results:
75 participants were included in the analysis. Pain-related self-efficacy improved significantly over time, F(2, 148) = 6.435, p = .002, but without significant group differences, F(2, 148) = 2.146, p = .121. Most secondary outcomes also improved (all p < .001), except pain avoidance-endurance behavior, but analyses did not yield significant differences between intervention and control group (all p > .05. Participants rated the intervention as credible (M = 8.36), with moderate ratings for personal fit and symptom benefit. No adverse events were reported.
Conclusion:
Although brief exposure may have limited the impact, the intervention was well-received. Future research should explore integrating personalized psychoeducation into multimodal treatments, emphasizing the importance of individualized approaches for this diverse patient population.
Summary:
A brief personalized online intervention improved back-pain self-efficacy, without being superior to an untreated control group. High acceptance seems promising for future multimodal use.
