Five digital technologies can be used in the NHS while more evidence is generated to manage non-specific low back pain in people 16 years and over. The technologies are:
getUBetter
Hinge Health
Kaia
Pathway through Pain
SelfBack.
These technologies can be used once they have appropriate regulatory approval and meet the standards within NHS England's Digital Technology Assessment Criteria (DTAC).
The companies must confirm that agreements are in place to generate the evidence (as outlined in NICE's evidence generation plan). They must contact NICE annually to confirm that evidence is being generated and analysed as planned. NICE may withdraw the guidance for a technology if these conditions are not met.
At the end of the evidence generation period (about 3 years), the companies should submit the evidence to NICE in a form that can be used for decision making. NICE will review the evidence and assess if the technologies can be routinely adopted in the NHS.
More research is needed on 5 digital technologies to manage non-specific low back pain in people 16 years and over. The technologies are:
Ascenti Reach
Digital Therapist
Flok Health
Phio Engage
Joint Academy.
Evidence generation and more research are needed on:
pain and disability using the same outcome measure (Musculoskeletal Health Questionnaire)
quality of life using the same outcome measure (EQ‑5D‑5L)
patient characteristics (such as type of back pain and severity)
time until return to normal daily activity
treatment adherence, that is, the number of people:
using a technology at baseline, 30 days and between 6 months and 1 year
who stop using a technology and their reasons for stopping
adverse events related to using the technology
healthcare resource use, including:
GP appointments
physiotherapy appointments
emergency department visits
how many people have self-referred for the technology and how many have been referred by a healthcare practitioner
the position of the technology in the care pathway
patients' views on the effects of the technologies collected using a qualitative survey or through interviews.
Potential benefits of use in the NHS with evidence generation
Access: Digital technologies for managing non-specific low back pain provide access to rapid advice and offer another treatment option. They will particularly benefit anyone who needs more flexible access to treatment or prefers a digitally enabled therapy over face-to-face therapy.
Clinical benefit: Clinical evidence suggests that digital technologies for managing non-specific low back pain may reduce pain and improve ability to function in everyday life.
Resources: These technologies could potentially reduce waiting lists, referrals for physiotherapy, the number of physiotherapy appointments and GP visits, medication use and the need for surgery.
Considerations
Unmet need: Provision of services for low back pain varies across the UK. Some people may be on a waiting list to access treatment. So, there is an opportunity to integrate digital technology to increase access and reduce waiting lists by promoting supported self-management.
Costs: Early results from the economic modelling suggest that the technologies used alongside standard care may be cost effective compared with standard care alone. The potential cost effectiveness or cost saving will be affected by how they are used in the clinical pathway. This guidance will be reviewed within 3 years and the recommendations may change. Take this into account when negotiating the length of contracts and licence costs.
Information governance: Local NHS hospitals and trusts should have appropriate information governance policies for using these technologies.
Patient outcomes: Consistent quality-of-life measures should be used.
Workforce: Local NHS hospital and trusts should verify that companies have an appropriate physiotherapy workforce available. This should have the right level of capabilities for the technologies that provide clinical support or offer physiotherapy services.
Equality: Digitally enabled therapies may not be accessible to everyone. People are less likely to benefit and may prefer another treatment option if:
their access to equipment or an internet connection is limited
they are less comfortable or skilled at using digital technologies
English is not their first language.
Key gaps in the evidence
It is difficult to compare technologies because a wide range of outcome measures were used. Also, some outcomes were not well-reported, such as work productivity, and patient experience and satisfaction.
There was limited evidence on how the technologies affect psychological management, quality of life, attendance at emergency departments, and referral rates to other services such as imaging, physiotherapy or surgery.
Overall, more evidence is needed on:
the clinical effectiveness of digital technologies for low back pain
technology uptake and rate of adherence
healthcare resource use.
The evidence generation plan gives further information on the prioritised evidence gaps and outcomes, ongoing studies and potential real-world data sources. It includes how the evidence gaps could be resolved through real-world evidence studies.