A Decision Support System for Self-management of Low Back Pain - PILOTSTUDY

• Pain intensity[ Time Frame: change from baseline to 6 weeks ]
  Pain intensity measured as average and worst within the past week. Measured on a 0 - 10 Numerical Rating Scale with 0 being no pain and 10 being worst pain imaginable. Pain duration measures patients' selfreported length of current pain episode. Pain medication measures the frequency of the non-prescription pain medication use for low back pain.
• The Fear avoidance Belief Questionnaire[ Time Frame: change from baseline to 6 weeks ]
  The FABQ is a 5-item questionnaire, where the participants score their beliefs about their LBP on an ordinal scale ranging from zero [completely disagree] to six [completely agree]
• Pain Self-Efficacy Questionnaire[ Time Frame: change from baseline to 6 weeks ]
  The questionnaire assesses the participant's level of confidence in carrying out specific activities despite their pain [52, 53]. The PSEQ is a 10-item questionnaire scored on an ordinal scale ranging from zero [completely disagree] to six [completely agree].
• Activity limitation[ Time Frame: change from baseline to 6 weeks ]
  Activity Limitation evaluates if LBP has limited work and leisure time activities. The questionnaire consists of two single items with response options "yes" and "no".
• Workability[ Time Frame: change from baseline to 6 weeks ]
  Work Ability is measured by a single-item and rated on an 11-point NRS scale ranging from zero [completely unable to work] to 10 [work ability at its best].
• Saltin-Grimby Physical Activity Level Scale[ Time Frame: change from baseline to 6 weeks ]
  Participants indicate their amount of time per week performing leisure activities with four levels of intensity ranging from sedentary to vigorous physically active
• Patient Specific Functional Scale[ Time Frame: change from baseline to 6 weeks ]
  Participants rate their function on up to two self-selected activities, are asked to rate if they are unable to do or are having difficulty with the their ability to perform self-selected activities regarded as important by the participants themselves
• Sleep[ Time Frame: change from baseline to 6 weeks ]
  Sleep is assessed by self-report using four items concerning problems with falling asleep, waking up repeatedly, waking up too early, and feeling sleepy during the day.
• Perceived Stress Scale[ Time Frame: change from baseline to 6 weeks ]
  a 10-item questionnaire asking about frequency of thoughts and feelings related to perceived stress
• Health-related Quality of Life[ Time Frame: change from baseline to 6 weeks ]
  The EuroQoL 5-dimension (EQ-5D) questionnaire is used to asses quality of life within each of the five dimension (i.e., mobility, self-care, activities, pain/discomfort and anxiety/depression).
• Brief Illness Perception Questionnaire[ Time Frame: change from baseline to 6 weeks ]
  the questionnaire evaluates the participants' illness perception in an 8-item questionnaire. Items are scored on an ordinal scale ranging from zero [no problems] to 10 [worst severity].
• Patient Health Questionnaire-8[ Time Frame: change from baseline to 6 weeks ]
  the questionnaire is an 8-item questionnaire used to evaluate the participants' depressive symptoms. Items are scored on a 4-point Likert scale scoring frequency of experiencing symptoms of depression.
• Patients Global Perceived effect[ Time Frame: 6 weeks ]
  a single item question for Patient's Global Perceived Effect will be asked at follow-up, where participants are asked to rate improvement or deterioration of their LBP compared to before the intervention
• Patient Acceptable Symptom State[ Time Frame: 6 weeks. ]
  a single item question on whether or not the patient considers their current symptom state as acceptable or not
• Virtual Care Climate Questionnaire[ Time Frame: 6 weeks ]
  The Virtual Care Climate Questionnaire concerns patients' perceived support for autonomy in a virtual care setting.
• User ratings[ Time Frame: 6 weeks ]
  Three rating questions on overall rating, ease of use and recommendation to others scored on a 5-point system

The pilot study precedes a larger randomized controlled trial, to be starting in February 2019. In this pilot study all participants are allocated to the intervention group. The intervention consists of a digital decision support system delivering a weekly plan of suggested activities that the participant can use to self-manage their low back pain. The plan is presented to the participant in the selfBACK app.

• Other: Usual care + selfBACK
  The selfBACK intervention is a digital Decision Support System (DSS) for self-management of LBP provided to the participant via a smartphone app (selfBACK app). In addition, the participant is provided with a step-detecting wristband (Xiaomi Mi Band 2) that interacts with the selfBACK app. The DSS provides individually tailored self-management plans including content from three categories; 1) information/education, 2) physical activity monitoring through wearing the step-detecting wristband, and 3) strength and flexibility exercises. The weekly plans are individually tailored to the specific patient, using the data available from the patient, and each week the patients report back their progress on physical activity (step count) and exercise (volume completed). These data are matched with the patients follow-up data to create a self-management plan that is up to date and adaptable to variation in health-status of the individual patient.

• Experimental: Usual care + selfBACK
  Participants will use the selfBACK system and app