These days there are phone apps for dating, banking, travel booking, ordering food… you name it. As a physician, I can even find apps to help me with medication dosing and interactions, or medical information.
In the European Union and United Kingdom, Kaia Health recently created a “back pain app”, which offers video exercises with education, physical therapy and psychological strategies. Users can reportedly chat online with a therapist for motivation and exercise related questions.
Back pain is the global leading cause of disability worldwide. It causes millions of lost work days, leading to a significant economic cost- about $100 billion per year in the United States alone. Additionally, both sedentary and physical demanding occupations have been linked to back pain. Back pain is multi-factorial, being caused by physical, psychological and social factors. Multidisciplinary treatment programs comprising therapy, psychological and educational interventions have been shown to improve back pain, but these comprehensive programs can be costly and time consuming.
The new Kaia App was recently used in a randomized controlled trial where 100 non-specific low back pain patients where randomly assigned to either: 1) the Kaia App for three months or, 2) six weekly sessions of physical therapy with online education. The primary outcome was pain intensity at twelve weeks follow-up. The results indicated that the Kaia App group reported significantly lower pain intensity.
The result of this study is interesting, but probably shouldn’t be taken out of context as an “end all, be all” solution of back pain. The study specifically looked at non-specific back pain, meaning these patients likely were suffering from muscle spasms and unlikely suffering an structural spine problems like a disc herniation or bone spur. In fact one patient who was found to have a disc herniation was eliminated from the study. Of the 498 patients initially thought to be eligible, only 100 fit the criteria, meaning the study focused on a specific subset of back pain patients. Secondly, physical therapy just once a week for 6 weeks may not be sufficient for what a more rigorous therapy regimen may offer. Working with an in-person therapist may be imperative for some patients since the therapist can closely monitor body mechanics, make sure the exercises are being performed correctly, and fine tune the therapy program. And while the control group only underwent six total session of therapy, the app users, on average, used the app 35 days over the 12 week period. That’s a pretty big difference in frequency of treatment between the groups. Third, the study was what we call, “low powered”… it only included 100 people. To really make a definitive statement that a phone app could be superior to in-person physical therapy, thousands of patients would need to be studied. Fourth, other outcome measures, likely functional ability or pain medication use, were no better with the app compared to conventional physical therapy. Lastly, the study population was young millennial’s already well versed to technology. At least in the United States, low back pain is most prevalent in older adults, who may not necessarily know who download a phone app, let alone use one.
Criticism aside, it is interesting that this randomly controlled trial infers a lifeless phone could be better than an in-person therapist for back pain in any subgroup of patients. Criticism resumed, I think there is great utility in interacting with human beings, even if it costs more or takes more time. I would suspect that if a larger study is performed, anthropomorphizing with an inanimate app is unlikely to provide better pain management than conventional therapy for most patients.