Digital technologies for managing non-specific low back pain: early value assessment

  • Health technology evaluation
  • HTE16
  • Published: 

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2 The technologies

2.1

Digital technologies for managing low back pain (LBP) could provide:

  • rapid access to specialist advice and guidance

  • remote pain management support, including physical activity recommendations

  • psychological therapies through web-based applications and digital platforms.

    They could offer greater flexibility because people can work through the recommendations in their own time with varying levels of support. Digital technologies for managing LBP are not homogenous and have different focuses based on the characteristics of the person with LBP. For example, some technologies are designed for acute LBP, some for chronic LBP and some for a mixture of both.

2.2

NICE has assessed 12 digital technologies for managing non-specific LBP. The assessment included technologies that offer physical, psychological or both types of LBP management. The criteria for including technologies in this assessment are in the final scope on the NICE website. The included technologies are:

  • ACT for PAIN (Pain Medicine Specialist Ltd)

  • Ascenti Reach (Ascenti)

  • Digital Therapist (Sword Health)

  • Flok Health (Flok Health Ltd)

  • getUBetter (getUBetter)

  • Hinge Health (Hinge Health)

  • Joint Academy (Arthro Therapeutics)

  • Kaia (Kaia Health)

  • Pathway through Pain (Wellmind Health)

  • Phio Engage (EQL)

  • SelfBack (SelfBack ApS)

  • SupportBack (University of Southampton).

    Evidence was submitted for Physitrack (Physitrack PLC), but the committee could not make a recommendation because the technology was deemed out of NICE's scope. ACT for PAIN and Pathway through Pain only provide psychological management for chronic LBP. ACT for PAIN is not a regulated medical device, so it was deemed ineligible for inclusion in the recommendations. The regulatory status for SupportBack is unknown and the company did not respond to requests for information. Evidence was identified and assessed for SupportBack, but the technology has been excluded from the recommendations. See table 2.1 in the external assessment group (EAG) assessment report and table 2.1 in the EAG assessment report addendum for details of the technologies.

Care pathway

2.3

The target population for this assessment is people 16 years and over with non-specific LBP. The condition can either be acute (that is, lasting less than 3 months) or chronic (that is, lasting 3 months or more). NICE's guideline on low back pain and sciatica in over 16s recommends considering several non-pharmacological interventions for treating LBP. These include self-management, exercise, manual therapies, psychological therapies, combined physical and psychological programmes, and return to work programmes. It recommends that these interventions are tailored to someone's specific needs, preferences and capabilities.

2.5

Digital technologies for managing LBP would be offered after clinical assessment and diagnosis, or through self-referral, as an addition to non-pharmacological treatment for LBP. Technologies eligible for self-referral will be those with integrated assessment and risk stratification. This is to ensure that red flags that may indicate a serious underlying cause are identified. Technologies that provide psychological support only may not be suitable for people with acute LBP because their pain has lasted less than 3 months.

The comparator

2.6

The comparator is standard care for managing non-specific LBP. Digital technologies would be used in addition to standard care. Standard care varies significantly across primary and community care.