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Lower back pain app: an exercise programme for the management of low back
pain

Article  in  British Journal of Sports Medicine · September 2017

DOI: 10.1136/bjsports-2017-098131

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1
Discipline of Physiotherapy,
Faculty of Health Sciences, The
University of Sydney, Sydney,
New South Wales, Australia
2
Musculoskeletal Health Sydney,
School of Public Health, The
University of Sydney, Sydney,
New South Wales, Australia
Correspondence to
Marina B Pinheiro, Faculty of
Health Sciences, The University
of Sydney, Sydney NSW 2141,
Australia;
m
​ arina.​pinheiro@​sydney.​edu.​au
Accepted 31 August 2017
To cite: Pinheiro MB,
Machado GC.
Br J Sports Med Published
Online First: [please include
Day Month Year]. doi:10.1136/
bjsports-2017-098131
Lower back pain app: an exercise programme for the
management of low back pain
Marina B Pinheiro,1 Gustavo C Machado2
Name of the mobile application
Lower Back Pain App.
Category
Medical.
Platform
Android 2.1 or later, iOS 8.0 or later.
Cost
US$1.49.
About the app
We have recently conducted a systematic review
of smartphone apps for the self-management of
low back pain.1 Of the 61 included apps, ‘Lower
Back Pain App’ had the highest quality score (mean
3.94, range 0–5), as assessed using the Mobile
Application Rating Scale (MARS).2 This app
offers a 10-week exercise programme that aims to
improve low back pain symptoms. Before starting
the exercise programme, users are required to
answer three screening questions addressing leg
pain symptoms (numbness), mechanism of injury
(accident or trauma), age (<20 years, or >50
years) and pain characteristics (constant pain at
Pinheiro MB, Machado GC. Br J Sports Med 2017;0:1–2. doi:10.1136/bjsports-2017-098131
Mobile app user guides
night). Where the answer is ‘yes’ for any of the
questions, a ‘pop-up’ warning message recom-
mends users to seek medical advice as to whether
the exercise programme is suitable for them. The
app provides information about the anatomy of
the lumbar spine, epidemiology of low back pain
and common personal (eg, weight, stress) and
work-related (eg, lifting, unexpected movements)
risk factors related to pain onset. At the start of
the exercise programme, users are asked to rate
their pain intensity on a sliding scale of 1 (‘no or
minimum  pain’) to 10 (‘maximum pain’). Pain is
monitored throughout the exercise programme
and users are required to rate their pain intensity
again at weeks 3 and 10. At each week, the app
offers three exercises to be performed once or twice
daily. The exercise programme initially focuses on
spinal mobility, then stability and finally on muscle
strengthening. Each exercise is accompanied by a
text description and a high-resolution instructional
video. At the end of the programme, an additional
3-week ‘maintenance phase’ is offered with similar
exercises. A physiotherapist developed the exer-
cises, and the app is available in three different
languages (English, Dutch and Spanish).
   1
 Mobile app user guides
Use in clinical practice
Self-management interventions and exercises are both recom-
mended in the most recent National Institute for Health and Care
Excellence guidelines for low back pain.3 Exercise, however, is
often underprescribed and frequently overlooked by clinicians.4
Adherence to exercise programmes is also a challenge for many
patients with low back pain. Clinicians can use this app to support
exercise prescription and recommend a simple and general home-
based exercise programme for their patients suffering from low
back pain. This app is also a potentially useful way to improve
exercise adherence by motivating patients to remain active and to
increase their daily physical activity levels at a low cost. Since the
exercises offered by this app are not customisable and this app has
not been investigated for its effectiveness, clinicians should decide
whether they are suitable for the individual patient. The multiple
measures of pain intensity throughout the exercise programme also
provides feedback to patients and clinicians on symptom progres-
sion and suitability of the programme.
Pros
►► Easy-to-use interface, low cost to download and no subscrip-
tion costs.
►► No advertisements and no internet access is required.
►► Text description and high-resolution instructional videos
explaining the exercises.
►► Monitoring of pain intensity throughout the exercise
programme.
►► Minimal equipment required to perform the exercises.
2 Pinheiro MB, Machado GC. Br J Sports Med 2017;0:1–2. doi:10.1136/bjsports-2017-098131
View publication stats
Cons
►► The app has not been tested for effectiveness in reducing the
symptoms of low back pain.
►► It is unknown whether researchers, app users or people with
low back pain were involved in the development of this app.
►► The app lacks evidence-based educational content.
►► The exercises cannot be individualised to the patients’ needs
or ability.
►► The app lacks engaging features that could promote greater
adherence to the programme.
Contributors  MBP and GCM tested the app. MBP wrote the first draft of the
manuscript. Both authors approved the final version of the manuscript.
Competing interests  None declared.
Provenance and peer review  Not commissioned; externally peer reviewed.
© Article author(s) (or their employer(s) unless otherwise stated in the text of the
article) 2017. All rights reserved. No commercial use is permitted unless otherwise
expressly granted.
References
1 Machado GC, Pinheiro MB, Lee H, et al. Smartphone apps for the self-management
of low back pain: A systematic review. Best Pract Res Clin Rheumatol 2017 (Epub
ahead of print).
2 Stoyanov SR, Hides L, Kavanagh DJ, et al. Mobile app rating scale: a new tool for
assessing the quality of health mobile apps. JMIR Mhealth Uhealth
2015;3:e27.
3 National Institute for Health and Care Excellence (NICE). Low back pain and sciatica in
over 16s: assessment and management. London: NICE, 2016.
4 Hoffmann TC, Maher CG, Briffa T, et al. Prescribing exercise interventions for patients
with chronic conditions. CMAJ 2016;188:510–8.