Effectiveness of mobile apps in the rehabilitation of patients with low back pain. A systematic review with meta-analysis of randomized controlled trials.

Abstract

To investigate the effectiveness of mobile apps for the treatment of patients with nonspecific low back pain (LBP). We searched CENTRAL, Embase, CINAHL, MEDLINE, Scopus and PEDro (up to April 2025). We also performed backward and forward citation tracking of included studies. We included randomized controlled trials (RCTs), identified and screened by 2 independent reviewers, in patients with acute, subacute and/or chronic nonspecific LBP, using mobile apps as unique form of treatment or in adjunction to the rehabilitation treatment, compared with rehabilitation alone or other types of apps. We considered pain intensity, physical function, self-efficacy and health-related quality of life as primary outcomes. Two independent reviewers extracted data and performed risk of bias (RoB), which was assessed using the Risk of Bias 2.0 tool. We performed a random-effects meta-analysis for clinically homogeneous RCTs, and we assessed the certainty of evidence using the GRADE approach. We included 15 RCTs (n=3,986), eight of which were included in meta-analyses. Nine RCTs were in patients with chronic LBP, while six included any LBP duration. In a mixed duration LBP population, the use of apps in adjunction to rehabilitation was slightly more effective than rehabilitation alone on pain intensity at long-term (MD: -0.58; 95%CI: -1.00, -0.17; moderate certainty evidence). In a population of chronic LBP, the use of apps was significantly superior compared to rehabilitation alone on short-term pain intensity, but without a clinically relevant effect (MD: -0.74; 95%CI: -1.38, -0.10; very low certainty evidence). The use of an app in adjunction to in-person rehabilitation probably reduces pain intensity at long-term follow-up slightly, but probably not pain intensity at medium-term, and physical function and health-related quality of life at both medium- and long-term follow-up, when compared to rehabilitation alone in a mixed population of LBP.