Digital Therapeutic Care and Decision Support Interventions for People With Low Back Pain: Systematic Review.

Most of the evidence is weak. Five of the 6 non-randomised studies were judged at serious risk of bias, largely because of how participants were selected into groups and because outcome data were missing. The studies were mostly small: 8 of the 12 had fewer than 200 participants and 5 of the 12 had fewer than 85 people in the app group. The participants were very similar to each other, mainly female, young to middle-aged and of normal to moderate weight. No study reported participants' ethnicity or other health conditions, so the results may not carry over to your caseload. Four of the 12 studies had no control group, and in 5 of the 8 that did, the comparison group was not given treatment that current guidelines recommend, so some of the apparent benefit could be natural recovery. Ten of the 12 studies did not follow people up over the long term. How app use and dropout were counted varied so much between studies that the figures cannot be compared directly, and the authors say they could not confirm some of the reported engagement levels because the reporting was unclear. The review was not registered in advance and the authors state that this, along with their search choices, means bias cannot be ruled out. They deliberately made no clinical recommendations from it, and say they are cautious about drawing clinical implications. In some studies participants kept receiving their usual treatment alongside the app and the review says this was not described in detail, so the app's own contribution is unclear. The review could not determine how long an app needs to be used, or how many exercise or education modules are needed for a benefit.

The authors declared no conflicts of interest. No funding statement appears in the text supplied.

Do not read "all 12 studies found positive effects" as proof these apps work. In every study that comparison was against the participants' own starting scores, and 4 of the 12 studies had no control group at all. Where groups were compared directly, 2 of the 6 randomised trials found no significant difference in pain between the app and the comparison group, and the authors themselves declined to make clinical recommendations.