Digital self-care in the management of spine musculoskeletal disorders: A systematic review and meta-analysis.
Zulamar Aguiar Cargnin, Dulcinéia Ghizoni Schneider, Joanito Niquini Rosa-Junior
PMID 37194893WHAT IT FOUND
Digital self-care programmes produced small reductions in pain and disability for chronic low back pain compared with control groups.
Benefits were modest and not clear for neck pain, so use them as an addition to usual treatment.
Key findings
01For chronic low back pain, digital care reduced pain after intervention, at three to six months, and at nine to twelve months, with small to moderate effects.
02For low back pain, digital care reduced functional disability after intervention, at medium term, and at long term, with small significant effects.
03The evidence was strongest for chronic low back pain; neck pain trials were too heterogeneous for a pooled estimate, and most included trials were medium quality.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
Twenty-one of the 25 trials were medium quality, and concealed allocation, participant blinding, therapist blinding, adequate monitoring, and intention-to-treat analysis were often missing. Nine of the 25 studies had fewer than 100 participants, which can reduce statistical power. The review focused mainly on chronic low back pain; only three studies were about neck pain and they were too heterogeneous to pool. Pain and functional disability were not the primary outcomes in all studies, and several secondary findings could make results look more positive than the main evidence. The programmes often combined physical exercise, health education, cognitive behavioural therapy, physiotherapy, and ergonomic guidance, so the review cannot say which component produced the benefit. Follow-up varied from 1 to 12 months, some effects disappeared during monitoring, and loss to follow-up was high in at least one study. Most interventions did not report adverse effects, so safety information is incomplete.
The easy way to misread this
Do not read the overall reductions as proof digital care works for all spine pain. Neck pain trials were too different to combine, and significant improvements occurred in 12 of 22 pain comparisons and 10 of 21 disability comparisons.