Clinical and cost-effectiveness of digital technology for non-specific low back pain across an entire Integrated Care System pathway

Research Question What are the clinical and cost benefits of implementing a digital self-management intervention into low back pain (LBP) clinical pathways, and what factors are impacting current uptake and engagement?

Background Non-specific LBP affects a significant proportion of the UK s population, over a lifetime 84% of people will experience LBP (1) and at any point in time approximately 15% of the UK population have it (1–4).

Evidence demonstrates the value in supporting people to self-manage their non-specific LBP (5–9) as early as possible, and self-management is widely recommended within national guidelines (5–7,10–13).

A recently published Early Value Assessment (EVA) completed by NICE highlighted a real-world evidence gap in the UK of clinical and cost-effectiveness of digital technologies for managing non-specific LBP.

This project will evaluate getUBetter, a digital self-management platform for musculoskeletal conditions including non-specific LBP.

Aim To generate real-world evidence on the clinical and cost-effectiveness of implementing getUBetter into LBP clinical pathways, explore current implementation issues, develop training resources and guidance to enable national adoption, and transferable learning to support broader digital adoption across the NHS.

Objectives 1) Clinical Impact: work package 1a) To gather clinical outcomes and quality of life at 4-timepoints, from patients who use getUBetter and those who do not use getUBetter (including sub-analysis of acute vs chronic non-specific LBP). 2) (Cost Implications: work package 1b) To capture health economic data from both the NHS and patients (patient reported and system-level data) 3) (Implementation issue: work package 2) To understand factors impacting uptake, acceptability, and engagement with getUBetter. 4) (Supporting sustainable national adoption and implementation: work package 3) To co-develop the assets required to enable national adoption and optimal implementation of getUBetter across complex healthcare pathways and disseminate real-world findings to enable generalisable learning for digital technology adoption across the NHS.

Design/Methods We will collect data directly from patients, at system-level, and in-app.

We will carry out a prospective comparative cohort study, system-level health resource use analysis, and process evaluation.

The project will include people with non-specific LBP who use getUBetter in the real world, comparing them with those who receive standard care (do not use getUBetter).

Three work packages: Work package 1 will involve recruiting 1014 patients (40 GP practices across an ICS), collecting clinical and cost outcomes at baseline, 30-days, 6-months, 12-months. We will also collect health resource data at system-level.

Work package 2 will involve interviewing patients (n=40-50), healthcare professionals and commissioners (n=20-25) to understand factors impacting uptake/acceptability/engagement.

Work package 3 will include the development of a training support package to strengthen implementation, and business case to support adoption. Timeline for delivery: 36-months. Anticipated Impact Updated rapid deployment model/ICS transformation model. Generalised learnings across NHS (supporting future innovators).

Business case to support wider getUBetter adoption. Implementation/adoption materials to optimise impact across entire care system.

Dissemination share and learn events with stakeholders. generalisable learnings via NHS channels, videos, NHS playbooks/case studies, conferences, papers, thought leadership and social media. conference presentations and academic papers.