Lower back pain is one of the most common medical complaints and unfortunately it’s also one of the hardest to treat. Often the pain is chronic, and thus ongoing management and physiotherapy is required to reduce symptoms and improve mobility. In an effort to increase awareness of the leading treatment for lower back pain – spinal manipulation – Clinically Relevant Technologies has developed a new iPhone app called Lumbar Manipulation.
Lumbar Manipulation is principally a tool for the clinician, but also has utility in patient self-education. Lumbar Manipulation features a clinical prediction rule (CPR), which uses a number of evidence-based medical signs, symptoms and examination findings to predict the incidence of a favorable outcome for the spinal manipulation treatment. The clinical prediction rule in this app has both a 2-factor rule and a 5-factor rule, although the 5-factor rule encompasses the two elements in the other rule. The 5 factor rule has 5 variables, including:
- Duration of current back pain episode
- Symptoms distal to the knee
- A fear-avoidance questionnaire
- Hypomobile lumbar segments
- Hip joint range of motion (ROM)
By altering these variables (yes or no questions), the user can use the app to calculate the post-treatment chance of success (i.e reduction in lower back pain). Without an attempt at prediction, the procedure’s chance of success is 45%, and this will increase depending on how many of the variables are altered. It’s a solid clinical decision making tool – as every procedure has risks, and it is always best-practice to have an idea of the chance of success before carrying out a treatment.
That being said, spinal manipulation is a reasonably low-risk and non-invasive treatment option – but is not suitable for every patient. The procedure itself is explained in the app, along with a video showing how the procedure is performed. There are also instructions and videos demonstrating how to measure two of the variables from the clinical prediction rule – hip joint range of motion and lumbar segment mobility.
Lumbar Manipulation also features links to the scientific literature upon which the clinical prediction rule and the treatment modality is based, however an active internet connection is required to view (PubMed).
This app is obviously limited in scope to lower back pain and necessarily limited in its audience to physicians, clinicians and associated allied health workers, but is still an invaluable tool given the importance of lower back pain as a health concern (and cost). Lumbar Manipulation is based upon 7 recommendations from the American College of Physicians and American Pain Society regarding lower back pain and makes use of these national guidelines to improve delivery of proper spinal manipulation techniques, which will translate into better quality of life outcomes for patients.
Lumbar Manipulation requires iPhone OS 3.0 or later and is compatible with both iPhone and iPod Touch.