Development and feasibility testing of an animated cartoon-based self-care application for low-back pain – a pilot study

Abstract

Objectives: The use of animated cartoons for pain management is an emerging area, however, in no study has it been explored as a digital platform for the rehabilitation of low-back pain (LBP). This study was aimed to develop and evaluate the feasibility of an animated cartoon-based self-care (ACBSC) app for LBP, and to examine the correlation between the app rating parameters and patients’ pain. Methods: This 2-phase study comprised development and feasibility testing components. Development of the ACBSC app was based on Mckenzie’s Mechanical Diagnosis and Therapy (MDT) extension protocol plus back hygiene following standard it-eration and prototyping process. Twenty-eight consecutive patients with chronic non-specific LBP with ‘direction Preference’ for extension based on the MDT screening algorithm participated in the feasibility phase. The participants utilised the car-toon-based app thrice weekly for 2 weeks. Outcomes were assessed in terms of usability, satisfaction and user experience ap-plying the system usability and mobile application rating scales. The Quadruple Visual Analogue Scale (QVAS) was used to assess the participants’ pain intensity. Results: On a unified scale up to 20, functionality (15.4 ± 2.41) and aesthetics 14 ± 2.00 had highest and least objective quality rating on the app parameters. Total objective and subjective quality rating of the app was 16.9 ± 1.97 and 15.6 ± 2.42, respectively. The total impact and usability scores were 24.1 ± 3.39 (out of 30) and 27.8 ± 3.09 (out of 50). Participants re-ported that the cartoon app for back care mostly affected mindfulness/meditation/relaxation (42.9%), increasing happiness/ well-being (46.4%), leading to behavioural changes (60.7%), while targeting physical health (100%). There was no significant correlation between participants’ pain characteristics and app rating parameters (p>0.05). Conclusion: The animated cartoon-based self-care LBP app has moderate to high usability, functionality, aesthetics and quality rating, and may serve as an effective mobile-app for self-management of long-term LBP.