{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T05:17:25Z","timestamp":1788412645388,"version":"build-2803163510"},"reference-count":72,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JMIR Mhealth Uhealth"],"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n As the world\u2019s population ages, the prevalence of chronic low back pain (CLBP) is increasing, placing a substantial burden on individuals and health care systems. Mobile health (mHealth) apps offer a potentially scalable solution to support self-management, but little is known about how, why, for whom, and under what circumstances such tools work in real-world settings.<\/jats:p>\n <\/jats:sec>\n \n Objectives<\/jats:title>\n This study aimed to test and refine 3 program theories\u2014developed through a previous realist review\u2014on how mobile apps support CLBP self-management. The goal was to understand the key contextual factors and mechanisms that influence when and why a digital self-management intervention may succeed or fail.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n A realist evaluation was conducted using one-on-one telephone interviews with 9 participants who had used the Curable app for 3 months to self-manage their CLBP. Realist interviews followed a teacher-learner cycle to explore, test, and refine the program theories. Abductive and retroductive analysis was used to develop context-mechanism-outcome configurations (CMOCs), which were synthesized into refined theories of digital self-management in chronic pain.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n A total of 20 CMOCs were constructed, supporting 3 overarching program theories centered on empowerment, self-management burden, and timing. First, the app was empowering when it offered credible and accessible knowledge that helped participants understand their pain, build confidence, and reduce reliance on health care providers. However, engagement depended on individual beliefs and expectations: those with strong biomedical views struggled to connect with the app\u2019s psychosocial framing. Second, while the app could ease the burden of self-management by offering support between appointments, it could also increase burden during flare-ups, when users lacked the capacity to engage. Features such as proactive content delivery and low-demand interfaces were viewed as essential for continued use. Third, timing emerged as a key factor. Early introduction was beneficial for some, but others needed to first accept the chronicity of their condition before they were ready to engage with self-management tools. Trust in the source recommending the app also influenced engagement. While clinician endorsement was often valued\u2014especially early in the self-management journey\u2014participants who had experienced unmet needs or disillusionment in clinical encounters reported that peer recommendations or nonclinical sources held greater weight. This highlights the importance of aligning recommendations with individuals\u2019 evolving relationships with authority and trust.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Mobile apps like Curable (Curable Inc) can support empowerment and continuity of care in CLBP, but their success depends on personalization, timing, and relational dynamics. To prevent feelings of abandonment, such tools should be introduced as an adjunct to\u2014rather than a replacement for\u2014ongoing clinical support.<\/jats:p>\n <\/jats:sec>","DOI":"10.2196\/66435","type":"journal-article","created":{"date-parts":[[2025,10,14]],"date-time":"2025-10-14T23:10:08Z","timestamp":1760483408000},"page":"e66435-e66435","source":"Crossref","is-referenced-by-count":2,"title":["Mobile App\u2013Supported Self-Management for Chronic Low Back Pain: Realist Evaluation"],"prefix":"10.2196","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7837-7260","authenticated-orcid":false,"given":"Rebecca","family":"Hunter","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7367-0679","authenticated-orcid":false,"given":"Trish","family":"Gorely","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2396-9992","authenticated-orcid":false,"given":"Michelle","family":"Beattie","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2026,2,17]]},"reference":[{"issue":"6","key":"R1","doi-asserted-by":"publisher","first-page":"e316","DOI":"10.1016\/S2665-9913(23)00098-X","article-title":"Global, regional, and national burden of low back pain, 1990\u20132020, its attributable risk factors, and projections to 2050: a systematic analysis of the Global Burden of Disease Study 2021","volume":"5","author":"Ferreira","journal-title":"The Lancet Rheumatology"},{"key":"R2","doi-asserted-by":"publisher","DOI":"10.1590\/S0034-8910.2015049005874","article-title":"Prevalence of chronic low back pain: systematic review","volume":"49","author":"Meucci","journal-title":"Rev Saude Publica"},{"issue":"11","key":"R3","doi-asserted-by":"publisher","first-page":"E668","DOI":"10.1097\/BRS.0b013e318241e5de","article-title":"The burden of chronic low back pain: clinical comorbidities, treatment patterns, and health care costs in usual care settings","volume":"37","author":"Gore","journal-title":"Spine (Phila Pa 1976)"},{"issue":"3","key":"R4","doi-asserted-by":"publisher","first-page":"124","DOI":"10.1177\/2049463713484907","article-title":"Can a pain management programme approach reduce healthcare use? 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