Intervention and Control Conditions
low back pain
Participants in all 3 groups were instructed to follow any diagnostic- or treatment-related pathways as indicated by health care practitioners they may have consulted during the study period. At the first consultation at the clinic (approximately 6-8 weeks after referral), all patients received usual care, which comprised a clinical examination and the offer of suitable treatment in accordance with current evidence-based guidelines. Treatment options included no further treatment, adjusted recommendations for primary care treatment, outpatient multimodal rehabilitation (individual and/or group sessions), or referral for surgical treatment.Participants randomized to the app group were instructed to install the app via a link provided in the text message containing the information about group allocation. Correspondingly, participants randomized to the e-Help group received a link to the website and login instructions (ie, the website was accessible only for participants randomized to receive the e-Help intervention). Participants randomized to the intervention groups had unrestricted access to the app or e-Help website throughout the study period.The app provides participants with weekly and individually tailored self-management recommendations for physical activity, strength and flexibility exercises, and daily educational messages as well as access to different tools and resources (goal setting, mindfulness audio files, pain-relieving exercises, and sleep reminders) that participants could use at their convenience (eFigure in Case-based reasoning is a knowledge-based AI methodThe e-Help website offered evidence-based support and advice on self-management of neck and low back pain. Participants could access the website via their own device (eg, personal computer, smartphone, or tablet) at any time throughout the study period. The website has 4 main sections: (1) a home page, which describes the purpose of the e-Help intervention and how to use the e-Help resources; (2) educational messages; (3) videos and descriptions of strength and flexibility exercises; and (4) additional resources and educational tools, including instructions on goal setting, pacing techniques, sleep hygiene, and mindfulness along with practice audio files and links to relevant external websites. The content in sections 2 to 4 imitates the content in the app (ie, the same assortment of exercises); however, individual tailoring is not provided on the e-Help website. Clinicians at the outpatient clinic (including N.Ø.B., G.F.B., G.H.M. and S.G.) and a patient representative were involved in the development of the website to ensure it aligned with treatment principles at the clinic.