Using a digital app to support patients with low back pian

This is a primarily an implementation project. We have gained funding which aimed to combined two robustly tested innovations

• STarT Back- stratified care for those with low back pain
• SelfBack app – an app to support those with back pian

These two approaches have been tested through randomised clinical trials. We wanted to combine the two approaches to support those who wish to self manage their back pain, following a consultation with a clinician. The project has been divided into three phases

• Implementation though First Contact Practitioners in Primary Care teams
• Implementation through Community Physiotherapy and Pain Teams
• Implementation through Urgent and Emergency Care Centre

We have involved our PwA partners at every stage of this work. Initially 5 members of our Keele Research User Group tested the SelfBack app and gave feedback to developers. One said the app

‘was like having a friend in your pocket’.

Our project had 5 overall workstreams and a core steering group, our people with arthritis are represented in all of these meetings.

We identified people to be involved through our Patient and Public Research User group at Keele University and via our patient MSK Empowerment and Engagement Lead in our local community Trust.

We have supported our PwA through ensuring we have clarity of our purpose, have an agreed set of standards on how we work together, creation of agenda that allow for task completion but also for building connections, trust and relationships. We have co-created resource such as videos, posters and leaflets alongside PwA.

Can you give more examples of how you worked with them?

Please see our website to see the range of materials we have crated with PwA to support our work.

We have a commitment to communicate in lay language for the benefit of all.

We have also identified’ Digital Angel’s within our community trust. They have gained funding to support people who would like to use the app but are data poor. We will be working with then going forward to increase the reach of our project.

1.                Implementation though First Contact Practitioners in Primary care teams

a.      The app was picked up by half pf the people it was offered to

b.      We developed the data and governance to support the use of the app

c.      We used the Keele MIDAS study as a control group and found people that used the app were younger, more likely to be male, in work and have greater level of health literacy

d.      We published our work and our PwA was a co-author

                                                      i.      STEVENSON, K., HADLEY‐BARROWS, T., EVANS, N., CAMPBELL, L., SOUTHAM, J., CHUDYK, A., ELLINGTON, D., JEEVES, B., JENSON, C., KLEBERG, S., BIRKINSHAW, H., MAIR, F., DZIEDZIC, K., PEAT, George, JORDAN, K. P., YU, D., BAILEY, J., BRAYBOOKE, A., MALLEN, C. D. and HILL, Jonathan C. (2024). The SelfSTarT intervention for low back pain patients presenting to first contact physiotherapists: A mixed methods service evaluationfor low back pain patients presenting to first contact physiotherapists: A mixed methods service evaluation. Musculoskeletal Care, 22 (1): e1876.

e.      Create a positive working group involving PwA, industry partners, clinician and operational managers

2.                Implementation through Community Physiotherapy and Pain Teams

a.      We developed the data and governance to support the use of the app in this context

b.      Within 6 month it was live and had been taken up by 56 patients

c.      PwA were actively engaged in training materials to support the roll out and were active participant in the project steering groups

3.                Implementation through Urgent and Emergency Care Centre

a.      This element of the project is underway

We gained funding through two competitive bids (NHS England Adoption Funds and Integrated Care System Funding). This gave the group confidence to apply for future funding and created meaningful relationships for future collaborations. 

Always build in the skill, and time to ensure any governance, data and clinical safety case testing can be undertaken in a timely way. Ensure clarity of the project aims and everyone roles. Be available for contact in between key project meetings.

Consider who are your key stakeholders to ensure your research/implementation can be undertaken and ensure their engagement at the earliest stage. Ensure time is given to undertake tasks but also build relationships.

Our challenges were twofold

·        Data governance and clinical safety case testing

o   We overcame by having a team that included digital expertise including  Clinical Safety Officer

·        Change in clinical practice and behaviour

o   We supported this with clinical champions, PwA supporting training materials, meeting the app developer