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:10.1590/1518-8345.6423.3909

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Revista Latino-Americana de Enfermagem

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

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 ^* * LILACS = Literatura Latinoamericana y del Caribe en Ciencias de la Salud (strategy in Portuguese, Spanish and English)

Scopus ^† † Scopus = SciVerse Scopus , Web of Science ^‡ ‡ Web of Science = Science Citation Indexes , CINAHL ^§ § CINAHL = Cummulative Index to Nursing and Allied Health Literature , Embase ^|| || Embase = Excerpta Médica dataBASE (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 ^** ** PEDro = Physiotherapy Evidence Database

Digital Intervention AND Back Pain

Study	Sample	Instruments and results	PEDro ^* * PEDro = Physiotherapy Evidence Database score and quality classification
1 Toelli, et al., 2019 ( 2Toelle TR, Utpadel-Fischler DA, Haas KK, Priebe JA. App-based multidisciplinary back pain treatment versus combined physiotherapy plus online education: a randomized controlled trial. NPJ Digit Med [Internet]. 2019 May 3 [cited 2022 Feb 19];2:34. Available from: https://www.nature.com/articles/s41746-019-0109-x#author-information https://www.nature.com/articles/s41746-0... )	94	Numeric Pain Scale (↔) ^† † (↔) No difference between the groups Hanover Functional Ability Questionnaire (↔) ^† † (↔) No difference between the groups	5/10 Medium
2 Shebib, et al., 2019 ( 6Shebib R, Bailey JF, Smittenaar P, Perez DA, Mecklenburg G, Hunter S. Randomized controlled trial of a 12-week digital care program in improving low back pain. NPJ Digit Med [Internet]. 2019 Jan 7 [cited 2022 May 2];2(1):1-8. Available from: https://www.nature.com/articles/s41746-018-0076-7 https://www.nature.com/articles/s41746-0... )	177	Oswestry Disability Index +(↑) ^‡ ‡ + (↑) Positive and significant effects in relation to the Control Group Analogue Visual Scale +(↑) ^‡ ‡ + (↑) Positive and significant effects in relation to the Control Group	6/10 Medium
3 Suman, et al., 2019 ( 7Suman A, Schaafsma FG, van Dongen JM, Elders PJM, Buchbinder R, van Tulder MW, et al. Effectiveness and cost-utility of a multifaceted eHealth strategy to improve back pain beliefs of patients with non-specific low back pain: a cluster randomised trial. BMJ Open. 2019 Dec 5;9(12):e030879. https://doi.org/10.1136/bmjopen-2019-030879 https://doi.org/10.1136/bmjopen-2019-030... )	779	Roland Morris Questionnaire (↔) ^† † (↔) No difference between the groups	7/10 Medium
4 Hodges, et al., 2021 ( 8Hodges PW, Hall L, Setchell J, French S, Kasza J, Bennell K, et al. Effect of a consumer-focused website for low back pain on health literacy, treatment choices, and clinical outcomes: randomized controlled trial. J Med Internet Res. 2021 Jun 15;23(6):e27860. https://doi.org/10.2196/27860 https://doi.org/10.2196/27860... )	440	Analogue Visual Scale (↔) ^† † (↔) No difference between the groups Roland Morris Questionnaire (↔) ^† † (↔) No difference between the groups	6/10 Medium
5 Moessner; Schiltenwolf; Neubauer, 2012 ( 14Moessner M, Schiltenwolf M, Neubauer E. Internet-based aftercare for patients with back pain - a pilot study. Telemed J E Health. 2012 Jul-Aug;18(6):413-9. https://doi.org/10.1089/tmj.2011.0221 https://doi.org/10.1089/tmj.2011.0221... )	45	Roland Morris Questionnaire +(↑) ^‡ ‡ + (↑) Positive and significant effects in relation to the Control Group Numeric Pain Scale (↔) ^† † (↔) No difference between the groups	5/10 Medium
6 Abadiyan, et al., 2021 ( 15Abadiyan F, Hadadnezhad M, Khosrokiani Z, Letafatkar A, Akhshik H. Adding a smartphone app to global postural re-education to improve neck pain, posture, quality of life, and endurance in people with nonspecific neck pain: a randomized controlled trial. Trials. 2021 Apr 12;22(1):274. https://doi.org/10.1186/s13063-021-05214-8 https://doi.org/10.1186/s13063-021-05214... )	60	Analogue Visual Scale +(↑) ^‡ ‡ + (↑) Positive and significant effects in relation to the Control Group Cervical Disability Index +(↑) ^‡ ‡ + (↑) Positive and significant effects in relation to the Control Group	7/10 Medium
7 Almhdawi, et al., 2020 ( 16Almhdawi KA, Obeidat DS, Kanaan SF, Oteir AO, Mansour ZM, Alrabbaei H. Efficacy of an innovative smartphone application for office workers with chronic non-specific low back pain: a pilot randomized controlled trial. Clin Rehabil. 2020 Oct;34(10):1282-91. https://doi.org/10.1177/0269215520937757 https://doi.org/10.1177/0269215520937757... )	41	Analogue Visual Scale +(↑) ^‡ ‡ + (↑) Positive and significant effects in relation to the Control Group Oswestry Disability Index +(↑) ^‡ ‡ + (↑) Positive and significant effects in relation to the Control Group	6/10 Medium
8 Lara Palomo, et al., 2022 ( 17Lara-Palomo IC, Antequera-Soler E, Matarán-Peñarrocha GA, Fernández-Sánchez M, García-López H, Castro-Sánchez AM, et al. Comparison of the effectiveness of an e-health program versus a home rehabilitation program in patients with chronic low back pain: a double blind randomized controlled trial. Digit Health [Internet]. 2022 Jan 28 [cited 2022 Feb 27];8:20552076221074482. Available from: https://pubmed.ncbi.nlm.nih.gov/35111332/ https://pubmed.ncbi.nlm.nih.gov/35111332... )	74	Roland Morris Questionnaire +(↑) ^‡ ‡ + (↑) Positive and significant effects in relation to the Control Group Oswestry Disability Index +(↑) ^‡ ‡ + (↑) Positive and significant effects in relation to the Control Group Analogue Visual Scale +(↑) ^‡ ‡ + (↑) Positive and significant effects in relation to the Control Group	8/10 Medium
9 Zadro, et al., 2019 ( 18Zadro JR, Shirley D, Simic M, Mousavi SJ, Ceprnja D, Maka K, et al. Video-game–based exercises for older people with chronic low back pain: a randomized controlledtable trial (GAMEBACK). Phys Ther. 2019 Jan 1;99(1):14-27. https://doi.org/10.1093/ptj/pzy112 https://doi.org/10.1093/ptj/pzy112... )	60	Roland Morris Questionnaire (↔) ^† † (↔) No difference between the groups Numeric Pain Scale +(↑) ^‡ ‡ + (↑) Positive and significant effects in relation to the Control Group	8/10 High
10 Amorim, et al., 2019 ( 19Amorim AB, Pappas E, Simic M, Ferreira ML, Jennings M, Tiedemann A, et al. Integrating Mobile-health, health coaching, and physical activity to reduce the burden of chronic low back pain trial (IMPACT): a pilot randomised controlled trial. BMC Musculoskelet Disord [Internet]. 2019 Feb 11 [cited 2022 Apr 24];20(1):71. Available from: https://doi.org/10.1186/s12891-019-2454-y https://doi.org/10.1186/s12891-019-2454-... )	68	Numeric Pain Scale (↔) ^† † (↔) No difference between the groups Roland Morris Questionnaire (↔) ^† † (↔) No difference between the groups	7/10 Medium
11 Petrozzi, et al., 2019 ( 20Petrozzi MJ, Leaver A, Ferreira PH, Rubinstein SM, Jones MK, Mackey MG. Addition of MoodGYM to physical treatments for chronic low back pain: a randomized controlled trial. Chiropr Man Therap. 2019 Oct 25;27(1):54. https://doi.org/10.1186/s12998-019-0277-4 https://doi.org/10.1186/s12998-019-0277-... )	108	Roland Morris Questionnaire +(↔) ^§ § + (↔) Positive and non-significant effects in relation to the Control Group Numeric Pain Scale (↔) ^† † (↔) No difference between the groups	7/10 Medium
12 Garcia, et al., 2021 ( 21Garcia LM, Birckhead BJ, Krishnamurthy P, Sackman J, Mackey IG, Louis RG, et al. An 8-week self-administered at-home behavioral skills-based virtual reality program for chronic low back pain: double-blind, randomized, placebo-controlled trial conducted during COVID-19. J Med Internet Res. 2021 Feb 22;23(2):e26292. https://doi.org/10.2196/26292 https://doi.org/10.2196/26292... )	179	Numeric Pain Scale +(↑) ^‡ ‡ + (↑) Positive and significant effects in relation to the Control Group	6/10 Medium
13 Sandal, et al., 2021 ( 22Sandal LF, Bach K, Øverås CK, Svendsen MJ, Dalager T, Jensen JSD, et al. Effectiveness of app-delivered, tailored self-management support for adults with lower back pain–related disability. JAMA Intern Med. 2021 Oct 1;181(10):1288-96. https://doi.org/10.1001/jamainternmed.2021.4097 https://doi.org/10.1001/jamainternmed.20... )	461	Numeric Pain Scale +(↑) ^‡ ‡ + (↑) Positive and significant effects in relation to the Control Group Roland Morris Questionnaire +(↑) ^‡ ‡ + (↑) Positive and significant effects in relation to the Control Group	8/10 High
14 Carpenter, et al., 2012 ( 23Carpenter KM, Stoner SA, Mundt JM, Stoelb B. An online self-help cbt intervention for chronic lower back pain. Clin J Pain. 2012 Jan;28(1):14-22. https://doi.org/10.1097/AJP.0b013e31822363db https://doi.org/10.1097/AJP.0b013e318223... )	141	Questionnaire (Pain) (↔) ^† † (↔) No difference between the groups Roland Morris Questionnaire +(↑) ^‡ ‡ + (↑) Positive and significant effects in relation to the Control Group	5/10 Medium
15 Chiauzzi, et al.,2010 ( 24Chiauzzi E, Pujol LA, Wood M, Bond K, Black R, Yiu E, et al. painACTION-back pain: a self-management website for people with chronic back pain. Pain Med. 2010 Jul;11(7):1044-58. https://doi.org/10.1111/j.1526-4637.2010.00879.x https://doi.org/10.1111/j.1526-4637.2010... )	209	Brief Pain Inventory +(↔) ^§ § + (↔) Positive and non-significant effects in relation to the Control Group Oswestry Disability Index (↔) ^† † (↔) No difference between the groups	6/10 Medium
16 Heapy, et al., 2017 ( 25Heapy AA, Higgins DM, Goulet JL, LaChappelle KM, Driscoll MA, Czlapinski RA, et al. interactive voice response–based self-management for chronic back pain: the COPES noninferiority randomized trial. JAMA Inter Med. 2017 Jun 1;177(6):765-73. https://doi.org/10.1001/jamainternmed.2017.0223 https://doi.org/10.1001/jamainternmed.20... )	125	Numeric Pain Scale +(↔) ^§ § + (↔) Positive and non-significant effects in relation to the Control Group Roland Morris Questionnaire +(↔) ^§ § + (↔) Positive and non-significant effects in relation to the Control Group	6/10 Medium
17 Ervine, et al., 2015 ( 26Irvine AB, Russell H, Manocchia M, Mino DE, Glassen TC, Morgan R, et al. Mobile-web app to self-manage low back pain: randomized controlled trial. J Med Internet Res [Internet]. 2015 Jan 2 [cited 2022 Feb 19];17(1):e3130. Available from: https://www.jmir.org/2015/1/e1/ https://www.jmir.org/2015/1/e1/... )	597	Questionnaire (Pain) +(↑) ^‡ ‡ + (↑) Positive and significant effects in relation to the Control Group Dartmouth CO-OP ^\|\| \|\| Dartmouth CO-OP = Dartmouth Primary Care Cooperative Information Project (functioning, well-being and quality of life) +(↑) ^‡ ‡ + (↑) Positive and significant effects in relation to the Control Group	6/10 Medium
18 Krein, et al., 2013 ( 27Krein SL, Kadri R, Hughes M, Kerr EA, Piette JD, Holleman R, et al. Pedometer-based internet-mediated intervention for adults with chronic low back pain: randomized controlled trial. J Med Internet Res. 2013 Aug 19;15(8):e2605. https://doi.org/10.2196/jmir.2605 https://doi.org/10.2196/jmir.2605... )	229	Numeric Pain Scale +(↔) ^§ § + (↔) Positive and non-significant effects in relation to the Control Group Roland Morris Questionnaire +(↑) ^‡ ‡ + (↑) Positive and significant effects in relation to the Control Group	7/10 Medium
19 Licciardone; Pandya, 2020 ( 28Licciardone JC, Pandya V. Feasibility trial of an ehealth intervention for health-related quality of life: implications for managing patients with chronic pain during the COVID-19 pandemic. Healthcare. 2020 Oct 1;8(4):381. https://doi.org/10.3390/healthcare8040381 https://doi.org/10.3390/healthcare804038... )	102	Numeric Pain Scale (↔) ^† † (↔) No difference between the groups Roland Morris Questionnaire +(↔) ^§ § + (↔) Positive and non-significant effects in relation to the Control Group	5/10 Medium
20 Lorig, et al., 2002 ( 29Lorig KR, Laurent DD, Deyo RA, Marnell ME, Minor MA, Ritter PL. Can a back pain e-mail discussion group improve health status and lower health care costs? Arch Intern Med. 2002 Apr 8;162(7):792-6. https://doi.org/10.1001/archinte.162.7.792 https://doi.org/10.1001/archinte.162.7.7... )	580	Numeric Pain Scale +(↑) ^‡ ‡ + (↑) Positive and significant effects in relation to the Control Group Roland Morris Questionnaire +(↑) ^‡ ‡ + (↑) Positive and significant effects in relation to the Control Group	5/10 Medium
21 Iles, et al., 2011 ( 30Iles R, Taylor NF, Davidson M, O’Halloran P. Telephone coaching can increase activity levels for people with non-chronic low back pain: a randomised trial. J Physiother [Internet]. 2011 [cited 2022 Feb 3];57(4):231-8. Available from: https://www.ncbi.nlm.nih.gov/pubmed/22093121 https://www.ncbi.nlm.nih.gov/pubmed/2209... )	30	Specific functional scale +(↑) ^‡ ‡ + (↑) Positive and significant effects in relation to the Control Group Oswestry Disability Index +(↔) ^§ § + (↔) Positive and non-significant effects in relation to the Control Group	7/10 Medium
22 Pach, et al., 2022 ( 31Pach D, Blödt S, Wang J, Keller T, Bergmann B, Rogge AA, et al. App-based relaxation exercises for patients with chronic neck pain: pragmatic randomized trial. JMIR MHealth UHealth. 2022 Jan 7;10(1):e31482. https://doi.org/10.2196/31482 https://doi.org/10.2196/31482... )	220	Numeric Pain Scale +(↔) ^§ § + (↔) Positive and non-significant effects in relation to the Control Group	7/10 Medium
23 del Pozo Cruz, et al., 2012 ( 32del Pozo-Cruz B, Parraca JA, del Pozo-Cruz J, Adsuar JC, Hill J, Gusi N. An occupational, internet-based intervention to prevent chronicity in subacute lower back pain: a randomised controlled trial. J Rehabil Med [Internet]. 2012 Jun 1 [cited 2021 Dec 1];44(7):581-7. Available from: https://pubmed.ncbi.nlm.nih.gov/22674240/ https://pubmed.ncbi.nlm.nih.gov/22674240... )	100	Correlation between pain, disability, quality of life and progression to chronicity.	7/10 Medium
24 Chhabra; Sharma; Verma, 2018 ( 33Chhabra HS, Sharma S, Verma S. Smartphone app in self-management of chronic low back pain: a randomized controlled trial. Eur Spine J. 2018 Oct 15;27(11):2862-74. https://doi.org/10.1007/s00586-018-5788-5 https://doi.org/10.1007/s00586-018-5788-... )	93	Numeric Pain Scale +(↔) ^§ § + (↔) Positive and non-significant effects in relation to the Control Group Oswestry Disability Index +(↑) ^‡ ‡ + (↑) Positive and significant effects in relation to the Control Group	8/10 High
25 Gialanella, et al., 2017 ( 34Gialanella B, Ettori T, Faustini S, Baratti D, Bernocchi P, Comini L, et al. Home-based telemedicine in patients with chronic neck pain. Am J Phys Med Rehabil. 2017 May;96(5):327-32. https://doi.org/10.1097/PHM.0000000000000610 https://doi.org/10.1097/PHM.000000000000... )	100	Analogue Visual Scale +(↑) ^‡ ‡ + (↑) Positive and significant effects in relation to the Control Group Cervical Disability Index +(↑) ^‡ ‡ + (↑) Positive and significant effects in relation to the Control Group	5/10 Medium

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[1] Corresponding author:
E-mail: zulamar.aguiar@gmail.com https://orcid.org/0000-0002-2731-5323