Shizheng Du1, Wen Liu2, Shining Cai3, Yan Hu4, Jianshu Dong5. 1. School of Nursing, Nanjing University of Chinese Medicine, 138 Xianlin Avenue, Nanjing, Nanjing 210023, China; School of Nursing, Fudan University, 305 Fenglin Road, Shanghai 200032, China. Electronic address: dushizheng007@163.com. 2. School of Nursing, Fudan University, 305 Fenglin Road, Shanghai 200032, China. Electronic address: 17111170003@fudan.edu.cn. 3. School of Nursing, Fudan University, 305 Fenglin Road, Shanghai 200032, China. Electronic address: 17111170001@fudan.edu.cn. 4. School of Nursing, Fudan University, 305 Fenglin Road, Shanghai 200032, China. Electronic address: huyan@fudan.edu.cn. 5. Shanghai Health Promotion Center, 358 Jiaozhou Road Building B, Shanghai 200040, China. Electronic address: dongjianshu@shei.org.cn.
Abstract
BACKGROUND: Globally, more than half a billion people are suffering from chronic low back pain, which results in poor quality of life for patients and major welfare cost for society. Currently, e-Health has been considered as a potential strategy to deliver self-management programs for chronic low back pain, but its effects are uncertain. OBJECTIVES: To assess the efficacy on pain intensity and disability of e-Health based self-management programs on chronic low back pain. DESIGN: Systematic review and meta-analysis DATA SOURCES: Searches of Pubmed, the Cochrane Library, Web of Science, Cumulative Index of Nursing and Allied Health Literature, Elsevier, Physiotherapy Evidence Database and ProQuest from inception through 2nd April 2019. REVIEW METHODS: Randomized controlled trials were screened and selected if they examined e-Health based self-management programs on chronic low back pain and assessed pain intensity and disability as primary outcomes. Risks of bias were assessed by two independent reviewers. Evidence quality was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criteria. Meta-analyses were performed to investigate the effects of e-Health based self-management programs on pain intensity and disability for chronic low back pain. Subgroup analyses were conducted. RESULTS: Eight randomized controlled trials were included. For pain intensity, moderate-quality evidence indicated there was a clinically important effect of e-Health based self-management programs for relieving pain both at immediate and short-term follow-ups. For disability, moderate-quality evidence showed there was a clinically important effect of e-Health based self-management programs for improving disability at immediate follow-up, and low-quality of evidence showed no significant difference at short-term follow-ups, but with a favorable trend. The results of subgroup analyses indicated that m-Health based self-management programs showed better immediate effects on both pain and disability than web-Health based programs, and programs with durations ≤ 8 weeks demonstrated a better immediate effect on pain than those with durations >8 weeks, but not on disability. CONCLUSIONS: Generally, e-Health based self-management programs may play a positive role in improving pain and disability within short-term period for chronic low back pain patients. More rigorous trials are warranted to determine the optimal delivery mode, duration, and long-term effect of e-Health based self-management programs.
BACKGROUND: Globally, more than half a billion people are suffering from chronic low back pain, which results in poor quality of life for patients and major welfare cost for society. Currently, e-Health has been considered as a potential strategy to deliver self-management programs for chronic low back pain, but its effects are uncertain. OBJECTIVES: To assess the efficacy on pain intensity and disability of e-Health based self-management programs on chronic low back pain. DESIGN: Systematic review and meta-analysis DATA SOURCES: Searches of Pubmed, the Cochrane Library, Web of Science, Cumulative Index of Nursing and Allied Health Literature, Elsevier, Physiotherapy Evidence Database and ProQuest from inception through 2nd April 2019. REVIEW METHODS: Randomized controlled trials were screened and selected if they examined e-Health based self-management programs on chronic low back pain and assessed pain intensity and disability as primary outcomes. Risks of bias were assessed by two independent reviewers. Evidence quality was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criteria. Meta-analyses were performed to investigate the effects of e-Health based self-management programs on pain intensity and disability for chronic low back pain. Subgroup analyses were conducted. RESULTS: Eight randomized controlled trials were included. For pain intensity, moderate-quality evidence indicated there was a clinically important effect of e-Health based self-management programs for relieving pain both at immediate and short-term follow-ups. For disability, moderate-quality evidence showed there was a clinically important effect of e-Health based self-management programs for improving disability at immediate follow-up, and low-quality of evidence showed no significant difference at short-term follow-ups, but with a favorable trend. The results of subgroup analyses indicated that m-Health based self-management programs showed better immediate effects on both pain and disability than web-Health based programs, and programs with durations ≤ 8 weeks demonstrated a better immediate effect on pain than those with durations >8 weeks, but not on disability. CONCLUSIONS: Generally, e-Health based self-management programs may play a positive role in improving pain and disability within short-term period for chronic low back painpatients. More rigorous trials are warranted to determine the optimal delivery mode, duration, and long-term effect of e-Health based self-management programs.
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