Digital self-care in the management of spine musculoskeletal disorders: A systematic review and meta-analysis

Cargnin, Zulamar Aguiar; Schneider, Dulcinéia Ghizoni; Rosa-Junior, Joanito Niquini

doi:10.1590/1518-8345.6423.3908

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Review Article • Rev. Latino-Am. Enfermagem 31 • 2023 • https://doi.org/10.1590/1518-8345.6423.3909 linkcopy

Digital self-care in the management of spine musculoskeletal disorders: A systematic review and meta-analysis

Authorship SCIMAGO INSTITUTIONS RANKINGS

Objective: to analyze the effectiveness of digital self-care in the management of pain and functional disability among people with spine musculoskeletal disorders.

Method: a systematic literature review, developed with the PRISMA checklist, of randomized clinical trials of people with spine musculoskeletal disorders and digital interventions accessed by means of computers, smartphones or other portable devices. Databases researched: National Library of Medicine, Excerpta Médica dataBASE, SciVerse Scopus, Literatura Latino-Americana e do Caribe em Ciências da Saúde, Science Citation Indexes, Cumulative Index to Nursing and Allied Health Literature and Physiotherapy Evidence Database. The descriptive synthesis of the results and by means of meta-analyses (fixed-effects model) was performed with the Review Manager software. The methodological quality was evaluated with the Physiotherapy Evidence Database scale.

Results: a total of 25 trials were selected (5,142 participants), which showed statistically significant improvements (p <0.05) in 54% (12/22) in the pain levels and 47% (10/21) in functional disability in the Intervention Group. The meta-analyses showed moderate effects on pain intensity and small effects on functional disability. There was a predominance of medium quality studies.

Conclusion: the digital care interventions showed a beneficial result in pain intensity and in functional disability, mainly for chronic low back pain. Digital care emerges as promising to support self-management of the spine musculoskeletal conditions. PROSPERO registry number CRD42021282102.

Descriptors:
Low Back Pain; Neck Pain; Back Pain; Self-Management; Pain Management; Internet

Highlights:

(1) The digital interventions were not inferior to in-person care.

(2) Digital care is promising to support self-management.

(3) There is a need to standardize the report of results in clinical trials.

(4) Better quality studies are required.

(5) Attention should be paid in strategies to support user acceptance and adherence.

Data base

Search strategy

LILACS * (strategy in Portuguese, Spanish and English)

Scopus †, Web of Science ‡, CINAHL §, Embase || (only the strategy in English)

((“Terapia assistida por computador” OR “intervenção digital” OR “intervenção baseada na Web” OR “Intervenção Baseada em Internet” OR “Intervenção Online” OR “Intervenção da Internet” OR “Terapia por exercício” OR “Exercício Terapêutico” OR “Exercício de Reabilitação” OR “saúde digital” OR “Ciber Saúde” OR “Ciber-Saúde” OR Cibersaúde OR “e-Saúde” OR “eSaúde” OR “Medicina 2.0” OR “mSaúde” OR “Saúde 2.0” OR “Saúde Conectada” OR “Saúde Digital” OR “Saúde Eletrônica” OR “Saúde Móvel” OR “Saúde Onipresente” OR “Saúde Pervasiva” OR “Saúde Ubíqua” OR Telemedicina OR “Tele-Serviços em Saúde” OR Teleassistência OR telecuidado OR Telecura OR Telessaúde OR “Telesserviços de Saúde” OR “Telesserviços em Saúde” OR “Telesserviços na Saúde” OR “uSaúde” OR internet OR telerreabilitação OR “Reabilitação à Distância” OR “aplicativo móvel” OR “Aplicativos Eletrônicos Portáteis” OR “Aplicativos de Software Portáteis” OR “Aplicativos em Dispositivos Móveis” OR “Aplicativos para Dispositivos Móveis” OR “Apps Móveis” OR “Aplicativos Móveis” OR “telefones celulares” OR Smartphone OR Smartfone OR Smartfones OR “Telefone Celular Inteligente” OR “Telefone Inteligente” OR “Telefone Móvel Inteligente” OR “Telefones Celulares Inteligentes” OR “Telefones Inteligentes” OR “Telefones Móveis Inteligente” OR “Terapia assistida por computador”) AND (“Manejo da dor” OR Autocuidado OR “Auto gerenciamento” OR “Auto Gerenciamento” OR “Auto Gestão” OR “AutoGerenciamento” OR “Auto-Gestão” OR Autogerenciamento OR Autogestão) AND (“distúrbios musculoesqueléticos de coluna” OR Cervicalgia OR “Dor Cervical” OR “Dor na Nuca” OR “Dor no Pescoço” OR “dor dorsal” OR “dor lombar” OR Lombalgia OR Lumbago OR “dor nas costas” OR Dorsopatia))

((“Terapia assistida por computador” OR Internet OR “Intervención basada en la Internet” OR “terapia por ejercicio” OR “Ejercicio Terapéutico” OR “Ejercicio de Rehabilitación” OR Telemedicina OR “Medicina 2.0” OR “Ciber Salud” OR “Ciber-Salud” OR Cibersalud OR eSalud OR mSalud OR “Salud 2.0” OR “Salud Conectada” OR “Salud Digital” OR “Salud Electrónica” OR “Salud Móvil” OR “Salud Mueble” OR “Salud Omnipresente” OR “Salud Pervasiva” OR “Salud Ubicua” OR Teleasistencia OR Telecuidado OR Telecura OR Telesalud OR “Teleservicios de Salud” OR “Teleservicios Sanitarios” OR “uSalud” OR telerreabilitación OR Telerehabilitación OR “aplicación movil” OR “Aplicaciones Móviles” OR “Aplicaciones Electrónicas Portátiles” OR “Aplicaciones de Software Portátiles” OR “Teléfonos celulares” OR “Teléfono Inteligente” OR Smartfone OR Smartfones OR Smartphone OR Smartphones OR “Teléfono Celular Inteligente” OR “Teléfono Móvil Inteligente” OR “Teléfonos Celulares Inteligentes” OR “Teléfonos Inteligentes” OR “Teléfonos Móviles Inteligentes”) AND (“Manejo del dolor” OR Autocuidado OR Automanejo) AND (“trastornos musculoesqueléticos espinales” OR “Dolor de Espalda” OR “Dolor de la región lumbar” OR “Dolor de cuello” OR “Cuello Doloroso” OR “Dolor Cervical” OR Lombalgia OR Lumbago))

((“Computer Assisted Therapy” OR “Computer-Assisted Therapies” OR “Computer-Assisted Therapy” OR “digital intervention” OR “Web-based Interventions” OR “Internet-Based Intervention” OR “Internet-Based Interventions” OR “Web-based Intervention” OR “Web based Intervention” OR “Online Intervention” OR “Online Interventions” OR “Internet Intervention” OR “Internet Interventions” OR “Exercise therapy” OR “Remedial Exercise” OR “Remedial Exercises” OR “Exercise Therapies” OR “Rehabilitation Exercise” OR “Rehabilitation Exercises” OR “Telemedicine” OR “e-Health” OR “Connected Health” OR “Digital Health” OR “eHealth” OR “Health 2.0” OR “Health Tele-Services” OR “Health Teleservices” OR “Medicine 2.0” OR “mHealth” OR “mHealth Alliance” OR “Mobile Health” OR “Pervasive Computing Technologies for Healthcare” OR “Pervasive Health” OR “Telecare” OR “Telecure” OR “Telehealth” OR “Teleservices in the Health Sector” OR “u-Health” OR “Ubiquitous Health” OR “Internet” OR “Telerehabilitation” OR “Telehabilitation” OR “Telerehabilitations” OR “Tele-rehabilitation” OR “Tele rehabilitation” OR “Tele-rehabilitations” OR “Remote Rehabilitation” OR “Remote Rehabilitations” OR “Virtual Rehabilitation” OR “Virtual Rehabilitations” OR “Mobile Applications” OR “Mobile App” OR “Mobile Application” OR “Mobile Apps” OR “Portable Electronic App” OR “Portable Electronic Application” OR “Portable Electronic Applications” OR “Portable Electronic Apps” OR “Portable Software App” OR “Portable Software Application” OR “Portable Software Applications” OR “Portable Software Apps” OR “Smartphone” OR “Mobile Phone” OR “Smart Phone” OR “Smart Phones” OR “Smartphones” OR “Smartphone” OR “Mobile Phone” OR “Smart Phone” OR “Smart Phones” OR “Smartphones”) AND (“Pain Management” OR “Pain Managements” OR “Self Care” OR “SelfCare” OR “Self Management” OR “Self-Management”) AND (“spinal musculoskeletal disorders” OR “neck pain” OR “Neck Ache” OR “Neck Aches” OR “Cervicalgia” OR “Cervicalgias” OR “Cervicodynia” OR “Cervicodynias” OR “Neckache” OR “Neckaches” OR “Cervical Pain” OR “Cervical Pains” OR “low back pain” OR “Back Pains” OR “Lumbago” OR “back pain” OR “Backache” OR “Backaches” OR “Back Ache” OR “Back Aches” OR “Vertebrogenic Pain Syndrome” OR “Vertebrogenic Pain Syndromes”))

PubMed¶

((“Therapy, Computer-Assisted”[Mesh] OR “Computer Assisted Therapy” [Title/Abstract] OR “Computer-Assisted Therapies”[Title/Abstract] OR “Computer-Assisted Therapy”[Title/Abstract] OR “digital intervention” [Title/Abstract] OR “Internet-Based Intervention”[Mesh] OR “Web-based Interventions”[Title/Abstract] OR “Internet-Based Intervention” [Title/Abstract] OR “Internet-Based Interventions”[Title/Abstract] OR “Web-based Intervention”[Title/Abstract] OR “Web based Intervention” [Title/Abstract] OR “Online Intervention”[Title/Abstract] OR “Online Interventions”[Title/Abstract] OR “Internet Intervention” [Title/Abstract] OR “Internet Interventions”[Title/Abstract] OR “Exercise Therapy”[Mesh] OR “Exercise therapy”[Title/Abstract] OR “Remedial Exercise”[Title/Abstract] OR “Remedial Exercises” [Title/Abstract] OR “Exercise Therapies”[Title/Abstract] OR “Rehabilitation Exercise”[Title/Abstract] OR “Rehabilitation Exercises”[Title/Abstract] OR “Telemedicine”[Mesh] OR “Telemedicine” [Title/Abstract] OR “e-Health”[Title/Abstract] OR “Connected Health” [Title/Abstract] OR “Digital Health”[Title/Abstract] OR “eHealth” [Title/Abstract] OR “Health 2.0”[Title/Abstract] OR “Health TeleServices”[Title/Abstract] OR “Health Teleservices”[Title/Abstract] OR “Medicine 2.0”[Title/Abstract] OR “mHealth”[Title/Abstract] OR “mHealth Alliance”[Title/Abstract] OR “Mobile Health”[Title/Abstract] OR “Pervasive Computing Technologies for Healthcare”[Title/Abstract] OR “Pervasive Health”[Title/Abstract] OR “Telecare”[Title/Abstract] OR “Telecure”[Title/Abstract] OR “Telehealth”[Title/Abstract] OR “Teleservices in the Health Sector”[Title/Abstract] OR “u-Health” [Title/Abstract] OR “Ubiquitous Health”[Title/Abstract] OR “Internet” [Title/Abstract] OR “Telerehabilitation”[Mesh] OR “Telerehabilitation” [Title/Abstract] OR “Telehabilitation”[Title/Abstract] OR “Telerehabilitations”[Title/Abstract] OR “Tele-rehabilitation” [Title/Abstract] OR “Tele rehabilitation”[Title/Abstract] OR “Telerehabilitations”[Title/Abstract] OR “Remote Rehabilitation” [Title/Abstract] OR “Remote Rehabilitations”[Title/Abstract] OR “Virtual Rehabilitation”[Title/Abstract] OR “Virtual Rehabilitations” [Title/Abstract] OR “Mobile Applications”[Mesh] OR “Mobile Applications”[Title/Abstract] OR “Mobile App”[Title/Abstract] OR “Mobile Application”[Title/Abstract] OR “Mobile Apps”[Title/Abstract] OR “Portable Electronic App”[Title/Abstract] OR “Portable Electronic Application”[Title/Abstract] OR “Portable Electronic Applications” [Title/Abstract] OR “Portable Electronic Apps”[Title/Abstract] OR “Portable Software App”[Title/Abstract] OR “Portable Software Application”[Title/Abstract] OR “Portable Software Applications” [Title/Abstract] OR “Portable Software Apps”[Title/Abstract] OR “Smartphone”[Mesh] OR “Smartphone”[Title/Abstract] OR “Mobile Phone” [Title/Abstract] OR “Smart Phone”[Title/Abstract] OR “Smart Phones” [Title/Abstract] OR “Smartphones”[Title/Abstract]) AND (“Pain Management”[Mesh] OR “Pain Management”[Title/Abstract] OR “Pain Managements”[Title/Abstract] OR “Self Care”[Title/Abstract] OR “SelfCare”[Title/Abstract] OR “Self Management”[Title/Abstract] OR “SelfManagement”[Title/Abstract] OR “Self Care”[Mesh] OR “Self-Management” [Mesh]) AND (“spinal musculoskeletal disorders”[Title/Abstract] OR “Neck Pain”[Mesh] OR “neck pain”[Title/Abstract] OR “Neck Ache” [Title/Abstract] OR “Neck Aches”[Title/Abstract] OR “Cervicalgia” [Title/Abstract] OR “Cervicalgias”[Title/Abstract] OR “Cervicodynia” [Title/Abstract] OR “Cervicodynias”[Title/Abstract] OR “Neckache” [Title/Abstract] OR “Neckaches”[Title/Abstract] OR “Cervical Pain” [Title/Abstract] OR “Cervical Pains”[Title/Abstract] OR “Low Back Pain”[Mesh] OR “low back pain”[Title/Abstract] OR “Back Pains” [Title/Abstract] OR “Lumbago”[Title/Abstract] OR “Back Pain”[Mesh] OR “back pain”[Title/Abstract] OR “Backache”[Title/Abstract] OR “Backaches”[Title/Abstract] OR “Back Ache”[Title/Abstract] OR “Back Aches”[Title/Abstract] OR “Vertebrogenic Pain Syndrome” [Title/Abstract] OR “Vertebrogenic Pain Syndromes”[Title/Abstract]))

PEDro **

Digital Intervention AND Back Pain

Study	Sample	Instruments and results	PEDro * score and quality classification
1 Toelli, et al., 2019 ( 2)	94	Numeric Pain Scale (↔) † Hanover Functional Ability Questionnaire (↔) †	5/10 Medium
2 Shebib, et al., 2019 ( 6)	177	Oswestry Disability Index +(↑) ‡ Analogue Visual Scale +(↑) ‡	6/10 Medium
3 Suman, et al., 2019 ( 7)	779	Roland Morris Questionnaire (↔) †	7/10 Medium
4 Hodges, et al., 2021 ( 8)	440	Analogue Visual Scale (↔) † Roland Morris Questionnaire (↔) †	6/10 Medium
5 Moessner; Schiltenwolf; Neubauer, 2012 ( 14)	45	Roland Morris Questionnaire +(↑) ‡ Numeric Pain Scale (↔) †	5/10 Medium
6 Abadiyan, et al., 2021 ( 15)	60	Analogue Visual Scale +(↑) ‡ Cervical Disability Index +(↑) ‡	7/10 Medium
7 Almhdawi, et al., 2020 ( 16)	41	Analogue Visual Scale +(↑) ‡ Oswestry Disability Index +(↑) ‡	6/10 Medium
8 Lara Palomo, et al., 2022 ( 17)	74	Roland Morris Questionnaire +(↑) ‡ Oswestry Disability Index +(↑) ‡ Analogue Visual Scale +(↑) ‡	8/10 Medium
9 Zadro, et al., 2019 ( 18)	60	Roland Morris Questionnaire (↔) † Numeric Pain Scale +(↑) ‡	8/10 High
10 Amorim, et al., 2019 ( 19)	68	Numeric Pain Scale (↔) † Roland Morris Questionnaire (↔) †	7/10 Medium
11 Petrozzi, et al., 2019 ( 20)	108	Roland Morris Questionnaire +(↔) § Numeric Pain Scale (↔) †	7/10 Medium
12 Garcia, et al., 2021 ( 21)	179	Numeric Pain Scale +(↑) ‡	6/10 Medium
13 Sandal, et al., 2021 ( 22)	461	Numeric Pain Scale +(↑) ‡ Roland Morris Questionnaire +(↑) ‡	8/10 High
14 Carpenter, et al., 2012 ( 23)	141	Questionnaire (Pain) (↔) † Roland Morris Questionnaire +(↑) ‡	5/10 Medium
15 Chiauzzi, et al.,2010 ( 24)	209	Brief Pain Inventory +(↔) § Oswestry Disability Index (↔) †	6/10 Medium
16 Heapy, et al., 2017 ( 25)	125	Numeric Pain Scale +(↔) § Roland Morris Questionnaire +(↔) §	6/10 Medium
17 Ervine, et al., 2015 ( 26)	597	Questionnaire (Pain) +(↑) ‡ Dartmouth CO-OP \|\| (functioning, well-being and quality of life) +(↑) ‡	6/10 Medium
18 Krein, et al., 2013 ( 27)	229	Numeric Pain Scale +(↔) § Roland Morris Questionnaire +(↑) ‡	7/10 Medium
19 Licciardone; Pandya, 2020 ( 28)	102	Numeric Pain Scale (↔) † Roland Morris Questionnaire +(↔) §	5/10 Medium
20 Lorig, et al., 2002 ( 29)	580	Numeric Pain Scale +(↑) ‡ Roland Morris Questionnaire +(↑) ‡	5/10 Medium
21 Iles, et al., 2011 ( 30)	30	Specific functional scale +(↑) ‡ Oswestry Disability Index +(↔) §	7/10 Medium
22 Pach, et al., 2022 ( 31)	220	Numeric Pain Scale +(↔) §	7/10 Medium
23 del Pozo Cruz, et al., 2012 ( 32)	100	Correlation between pain, disability, quality of life and progression to chronicity.	7/10 Medium
24 Chhabra; Sharma; Verma, 2018 ( 33)	93	Numeric Pain Scale +(↔) § Oswestry Disability Index +(↑) ‡	8/10 High
25 Gialanella, et al., 2017 ( 34)	100	Analogue Visual Scale +(↑) ‡ Cervical Disability Index +(↑) ‡	5/10 Medium

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Escola de Enfermagem de Ribeirão Preto / Universidade de São Paulo Av. Bandeirantes, 3900, 14040-902 Ribeirão Preto SP Brazil, Tel.: +55 (16) 3315-3387 / 3315-4407 - Ribeirão Preto - SP - Brazil
E-mail: rlae@eerp.usp.br

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[tfn1b] ^*
LILACS = Literatura Latinoamericana y del Caribe en Ciencias de la Salud

[tfn2b] ^†
Scopus = SciVerse Scopus

[tfn3b] ^‡
Web of Science = Science Citation Indexes

[tfn4b] ^§
CINAHL = Cummulative Index to Nursing and Allied Health Literature

[tfn5b] ^||
Embase = Excerpta Médica dataBASE

[tfn6b] ^¶
PubMed = US National Library of Medicine

[tfn7b] ^**
PEDro = Physiotherapy Evidence Database