An exploration of the feasibility of a digital self-management intervention for women with pregnancy-related lumbopelvic pain

Moffatt, Maria (2022) An exploration of the feasibility of a digital self-management intervention for women with pregnancy-related lumbopelvic pain. Doctoral thesis (PhD), Manchester Metropolitan University.

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Abstract

Background: Pregnancy-related lumbopelvic pain (PLPP) is a common condition resulting in reduced function and health-related quality of life. Many women with PLPP self-manage the condition, and evidence suggests that improved information provision may facilitate this. Digital technology offers opportunities to deliver health information to large audiences with minimal clinical time commitment. A digital intervention to support the self-management of PLPP is therefore worthy of consideration. Aim: This research aimed to explore the feasibility of a digital self-management intervention for women with PLPP. Study design: A systematised review was undertaken to inform the design of a mixed-methods study using an exploratory sequential design. Methods: Systematised review: RCTs examining the effectiveness of digital interventions for the management or self-management of low back pain (LBP), pelvic girdle pain (PGP), or lumbopelvic pain (LPP) were included. A narrative synthesis was undertaken. Phase 1: Semi-structured interviews with NHS service users and focus groups with NHS-based physiotherapists and midwives. Phase 2: Development of an app-based intervention to support the self-management of PLPP using the Behaviour Change Wheel approach. Phase 3: Retrospective quantitative analysis of pseudonymised app user engagement data from March 2020 to November 2021. Findings: Systematised review: 26 RCTs were included. No RCTs testing digital interventions for PGP or LPP could be located. No included trials explicitly stated the inclusion of pregnant women. Six of the 26 included RCTs reported the effectiveness of digital interventions in improving pain and disability in individuals with LBP. Effective interventions included mobile/tablet apps, social media, and multimodal interventions. Two of the six trials reporting effective interventions were at high risk of bias. Phase 1: Seven NHS service users and ten clinicians (six midwives and four physiotherapists) viewed the use of digital technologies for information provision positively. A preference for apps for information provision was reported, and clinicians were willing to integrate digital interventions into their practice. Service users highlighted their PLPP-related information needs. Phase 3: 167 NHS service users were invited to use the app during the study period; 106 (63.5%) chose to register for use. Thirty-five engaged with the self-monitoring feature on a single occasion; five engaged with this feature more than once. Two users engaged with the goal-setting function. No users exchanged any in-app messages with their clinicians. Conclusions: The systematised review highlighted the lack of attention given to women with PLPP in the digital self-management literature and underscored the need for targeted intervention development and evaluation for this population. The findings of this review also suggested that mobile apps may be worthy of consideration for intervention delivery for women with PLPP. Phase 1 found a high level of acceptability and a willingness of clinicians to integrate a digital intervention into practice. Overall, uptake of and engagement with the app aligned with expectations. Implementation of the app demonstrated practicability in an NHS setting. Further work is needed to understand the levels of engagement reported and whether in-app information met users’ needs.