Feasibility of a Gamified Mobile-Based Self-Management Intervention for Individuals With Nonspecific Chronic Lower Back Pain.

Background: Existing research fails to address the complex nature of nonspecific chronic lower back pain (cLBP ) despite its detrimental effect on economic, societal, and medical expenditures.

Objectives: We developed a nurse-led, mobile-delivered self-management intervention-Problem-Solving Pain to Enhance Living Well (PROPEL-M)-and evaluated its usability, feasibility, and initial efficacy for South Korean adults with nonspecific cLBP.

Methods: This study was composed of two phases: (a) lab and field usability testing for a gamified mobile device application; and (b) a pilot study employing a one-arm pre-test and post-test design among adults aged 18-60 years with nonspecific cLBP. During the 2-week PROPEL-M intervention, participants used the gamified PROPEL application to watch 12 educational videos, engage in pain-relief activities and record daily pain and interference scores, and also participate in weekly yoga sessions and nurse consultations. In addition, participants wore a Fitbit for activity tracking, completed surveys, and underwent a quantitative sensory test to assess pain sensitivity. Blood samples were obtained for RNA sequencing.

Results: The PROPEL gamified mobile application was refined during two-stage usability testing. In a pilot trial, 19 participants were recruited, all of whom completed the study. Satisfaction with the PROPEL-M, encompassing the application, yoga sessions, and nurse consultations, was rated as excellent. No adverse events were reported. Moreover, significant reductions were observed in the worst pain, average pain, current pain, and pain interference between baseline and the 2-week follow-up. We also found an increase in the heat-pain threshold (HPT) at the pain site, measured by increasing thermal stimuli from 32 °C until pain was rated 50 on a 0-100 scale.

Discussion: The feasibility of the PROPEL-M was favorable despite concerns about the participants' burden associated with multidimensional data collection and diverse study-related activities. In the short term, the PROPEL-M demonstrated beneficial effects on pain intensity, interference, and HPT, suggesting reduced sensitivity to heat stimuli. Comprehensive data on pain phenotypes and physical activity patterns collected through the PROPEL-M can support nurses in developing individualized self-management strategies, which may be further enhanced through nurse-led consultations.