Digital health technology in Low Back Pain management: the Dress-KINESIS's paradigm

Low back pain (LBP) carries a high risk of chronicization, greatly impacting the demand for care. We present a new mHealth tool, the Dress-KINESIS (D-K), designed within the participatory health framework, (a) to collect data about LBP risk factors, treatments and costs, (b) to propose self-manageable plans of activity on a scientific basis and (c) to share evidence-based prevention recommendations. Population-based information collected through the D-K allows us to characterize user's severity level at the baseline and along the proposed cycles of activity. Subjects are grouped into levels of limitation identified according to the abilities in coping with daily living activities (Oswestry score, OS) and some others, identified through the Low Back and Lower Extremities scale. Subjects with severe disability status (OS>40%) are excluded from D-K use, as well as subjects presenting co-morbidities. Referring to the Treatment-Based Classification system, the D-K proposes tailored programs including two sections of activity, to be performed for 3 days a week, during 3 cycles of activity (3 weeks for each cycle). One section comprises exercises aimed at strengthening the core muscles and the deep abdominal muscles, promoting respiratory control and increasing the range of motion of the spine and joints as well as overall body flexibility. The other includes aerobic activities and stretching movements, to limit bone loss and metabolic syndrome. Exercises are classified based on aim, starting position, type of movement, target muscles and effort intensity, in order to personalize the individual workouts by level of limitation and between different cycles of exercise. Before starting with exercise protocol, users perform 1 week of exercise feasibility testing to tailor their workout sessions. In each cycle transition, users are guided based on a set of standardized progression criteria. Comparison between a traditional rehabilitation approach for non-specific LBP patients with one involving the D-K support, shows that the system's efficiency could be increased. This agrees with the European agenda for research and innovation which promotes scientific solutions developed by engaging citizens in the research cycle to improve communities' resilience.