Comprehensive Summary
Promoting effective self-management of neck and low back pain could significantly reduce the societal and healthcare burden of these conditions. Marcuzzi et al. investigated the effectiveness of an AI-based smartphone app delivering individually tailored self-management support alongside usual care to improve musculoskeletal health. The authors conducted a randomized clinical trial with adults referred to specialist rehabilitation care due to neck and/or low back pain. A total of 294 participants were randomly assigned to one of three groups: 99 received AI-based app support plus usual care, 98 received non-tailored web-based self-management support plus usual care, and 97 received usual care alone. Musculoskeletal health was accessed by the Musculoskeletal Health Questionnaire (MSK-HQ) at 6 weeks, 3 months, and 6 months. App engagement was suboptimal, with 29.3% of participants never accessing it. No statistically significant differences were observed between groups. However, at 3 months, an improvement of at least 4 points on the MSK-HQ was reported by 44.2% of participants in the usual care group, 46.8% in the web-based support group, and 59% in the app group. These results suggest that combining usual care with app-delivered individually tailored self-management support does not significantly enhance musculoskeletal health in patients with neck and/or low back pain referred to specialist care. While a previous randomized clinical trial demonstrated app-based support reduced pain-related disability among people with low back pain, differences in study design, primary vs. specialist care settings, and symptom complexity may explain the divergent results.
Outcomes and Implications
Neck and low back pain are among the leading causes of years lived with disability, accounting for at least 264 million lost workdays annually in the USA. One way to decrease the societal and specialist care burden of such conditions is to promote effective self-management tailored to individual needs and capacities. In this randomized clinical trial, Marcuzzi et al. reported no significant differences in musculoskeletal health among patients receiving usual care alone, usual care and web-based support, or usual care supplemented with individually tailored AI-based support via a smartphone app. However, a previous randomized trial in primary care settings reported improvements in pain-related disability among people with low back pain using app-based support, raising questions about the effectiveness, delivery, and implementation strategies for self-management interventions. Further research is needed to address these questions, with the potential to improve the quality of care and patient outcomes.