BACKTRACK: A feasibility study of technology enabled care pathways for low back pain in Uganda

The objective of the study was to test the feasibility of using a digital clinical decision support tool called BACKTRACK, that was co-developed with frontline health workers in Uganda to assist them in the stratification process of LBP patients  into appropriate pathways of care.  We trained clinicians and deployed the app in 10 rural health centres for 12 weeks. During deployment, semi-structured interviews were conducted with participating clinicians (n=19) and a sample of patients to understand the feasibility, acceptability and impact of BACKTRACK on low back pain management.  Qualitative data were transcribed verbatim and thematic analysis was undertaken. Training and app usage helped clinicians to stratify patients into LBP care pathways. Clinicians engaged well with the app which was perceived as easy to use and it integrated well into their clinical practice. They reported reducing drug prescriptions and spending more time educating and referring patients. Clinicians cited the reduction of health expenditures and unnecessary investigations as beneficial to patients. However, referral issues (transport, costs, navigating the health system) remain major barriers to optimum care. Training was deemed mandatory and the continuous real-time support offered by the research team was highly valued.  Education and training of frontline clinicians is crucial to underpin technology enabled care pathways. There is a need for expansion and strengthening of physiotherapy and rehabilitation services at primary care level in Uganda BACKTRACK was deemed useful to clinicians in terms of enhancing low back pain management for patients at low risk of developing persistent pain and disability and facilitated adoption of evidence based care for LBP in primary care settings. However significant referral barriers to secondary care, such as physiotherapy or imaging, negatively impact implementation of care pathways for patients with severe presentations.