Health Coaching: A New Link between Mobile Health Tech and Chronic Pain Treatment?
Over 500 million people worldwide suffer from lower back pain, making it the most prevalent cause of disability globally.1 Chronic lower back pain can severely inhibit daily activities including work and exercise, and is often recurring over long periods of time. As such, healthcare utilization is extremely high among patients with lower back pain which places a heavy economic burden on society. Likewise, increased absences from work contribute further to this issue. Many treatments for the condition exist, including exercise therapy and some surgeries. However, while these treatments are often effective in reducing lower back pain and related outcomes, improvements tend to drop off sharply once treatment is completed.2 This phenomenon is due to a variety of factors including lack of patient motivation and trust of healthcare professionals. Diagnoses typically lack the specificity required to instill confidence in the patient and make the most effective treatment options clear. This article summarizes the findings of a 2019 study in the BMC Musculoskeletal Disorders Journal that examined the impact of a combination health coaching and mobile fitness treatment program on chronic lower back pain and pain-related outcomes.
What is health coaching, and what makes it more effective than traditional treatment? How does mobile fitness technology work into the equation?
Health coaching interventions are designed to address the aforementioned factors that contribute to poor results in traditional treatment programs. Typical health coaching programs consist of regular, patient-centered coaching sessions which encourage the patient to develop and attain their own health-related goals. The patient’s health coach provides insight and guidance throughout the process, although specific care is taken to generate patient-specific treatment plans rather making the generalized recommendations common in other treatment formats. Health coaching is based on behavior change theory, and the main goal of coaching interventions is to create lasting positive effects on the health and behavior of the patient.
Mobile health and fitness technology aims to accomplish a similar goal. Smartphone apps and websites increase the accessibility of treatment with on-demand, individualized information and support that standard treatment options lack. Additionally, mobile health technology has been found to increase physical activity in patients with musculoskeletal pain including lower back pain.3 Due to these similar aims, it is logical to incorporate mobile health strategies into health coaching programs to create a well-rounded and effective treatment option.
How effective is this approach for helping patients with lower back pain?
This particular study aimed to assess the impact of the combined health coaching and mobile health intervention on pain levels, limitations due to pain, and care-seeking among patients with chronic lower back pain. Out of a sample size of 68 participants, 34 were assigned to an intervention group with the rest making up a control group. While both groups received a standard physical activity and sedentary behavior booklet and a brief informational session about the benefits of staying physically active (treatment as usual), the intervention group then went on to receive multiple sessions of individualized coaching with a trained professional. These sessions included an initial in-person meeting with a coach to develop a personalized physical activity plan, followed by six months of meetings by phone to discuss progress, barriers, or changes to the plan. Additionally, the mobile fitness tracker Fitbit was used in conjunction with a smartphone app developed for the study called IMPACT. Together, these two pieces of mobile health technology allowed the participants to track their goals, report on their progress, and receive personalized health tips related to their goals. Much of the information from the app was used to guide future coaching sessions.
Intervention Impact on Primary Outcomes
Care-seeking was reduced by over 38% at follow-up in the intervention group, although this difference did not reach statistical significance. This resulted in a 3% reduction in care-seeking per week compared to the control group. There were almost no differences between the two groups in activity limitation, with an average weekly reduction of about 1% in the intervention group compared to controls. Similarly, there was no difference between groups in pain levels and no discernible effect over time.
Intervention Impact on Secondary Outcomes
Other outcomes considered in the study included self-reported walking and physical activity levels, and goal attainment. In the intervention group, the amount of time spent walking was significantly higher at follow-up. Likewise, goal attainment in the intervention group was 65% compared to only 22% in the control group. However, no significant differences were found between groups in any other outcomes.
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How are these results relevant to physical therapy?
Although the impact on primary outcomes was relatively small and did not reach statistical significance, the results point to health coaching and mobile health technologies as promising alternatives or replacements for typical treatment. With more research and larger sample sizes, it is possible that the picture may become clearer. In the short-term, the coaching intervention did have a significant impact on some health behaviors including walking time and physical activity goal attainment. These outcomes also suggest that coaching interventions warrant further attention. Ultimately, the study presents proof that health coaching and mobile health technology offer a new and potentially superior alternative to traditional treatment options.
REFERENCES:
- What low back pain is and why we need to pay attention. Hartvigsen J, Hancock MJ, Kongsted A, Louw Q, Ferreira ML, Genevay S, Hoy D, Karppinen J, Pransky G, Sieper J, Smeets RJ, Underwood M, Lancet Low Back Pain Series Working Group. Lancet. 2018 Jun 9; 391(10137):2356-2367.
- Comparison of general exercise, motor control exercise and spinal manipulative therapy for chronic low back pain: A randomized trial. Ferreira ML, Ferreira PH, Latimer J, Herbert RD, Hodges PW, Jennings MD, Maher CG, Refshauge KM Pain. 2007 Sep; 131(1-2):31-7.
- Internet-based aftercare for patients with back pain-a pilot study. Moessner M, Schiltenwolf M, Neubauer E Telemed J E Health. 2012 Jul-Aug; 18(6):413-9.
