Towards a million better backs: Wallscope and Active X Backs

With 50,000 people a day suffering lower back pain in Edinburgh alone, finding a solution is something close to all osteopaths’ hearts – no more so than Gavin Routledge of Active X Backs. His campaign to create ‘a million better backs’ might seem ambitious, but with the help of Wallscope it’s something he’s confident he can achieve.

One thing's for certain - pills don't cure and neither does surgery (though admittedly it often helps in the short-term). The only known, proven "solutions" to lower back pain are education and exercise,’ he says. But once patients have a programme of exercises, it’s often a struggle to keep them engaged – and so the problem persists.

Wallscope have been working with Gavin to build a digital platform that supports real behaviour change amongst back pain sufferers, offering a tailored programme of exercises accessible across web and mobile devices. At a time when healthcare costs are mounting, there’s a big focus on preventative approaches. Technology that can help people change their habits is key.

And the key to making that technology effective in the long term is an understanding of the user – who are they, what do they want, and how will they interact with the platform? As Gavin says: ‘They’re not just people with sore backs, they’re doctors, people like me, employers – so a big research piece around what users want was crucial before we started building anything.’

To take forward this research Gavin and Wallscope are now embarking on a series of workshops with the University of Edinburgh’s Design Informatics Department. ‘What we’re particularly interested in is using their ethnographic insights – so looking at the user population and finding out how they are most likely to engage with this application to inform the development of the mobile app,’ he says. ‘Once this design work is completed we’ll be clearer on how to present the information in order to make it as easy as possible for the user to do what they need to do.’

And it’s not just about the individual user – creating a fully integrated health care platform could bring significant efficiencies and cost benefits for the NHS. Back pain sufferers can be guided to the app by their GP or a pharmacist for example, quickly identifying whether they need to see a doctor, go to the hospital, or can just self-care through the digital platform. ‘Largely the point is that people self-manage with the help of the app, and also that it will integrate with their existing medical records, so we can send reports out to physios, osteopaths, GPs, occupational health people – anyone they choose to share that information with,’ Gavin adds.

Wallscope’s role here is vital as they can ensure that the platform is safe and secure – users won’t engage with a platform they don’t trust. Their expertise in semantic technologies, particularly Natural Language Processing, will also provide the insights needed to guide users intelligently through the app. As Gavin explains: ‘Looking at the way people describe their pain will help to profile the types of people using the application. So for instance, if people use what we call catastrophizing language, they tend to have a poor outcome. If somebody types in “it feels like somebody’s stabbing me in the back”, we ought to be able to work out with semantic technology that this person is going to need more support than someone who says “my back’s quite sore today”.’

Wallscope’s experience working with the NHS, as part of the Scottish Government’s CivTech programme, also brings some valuable insight to the world of back pain. Founder and Product Director Ian Allaway explains: ‘We are currently building a metadata level which dynamically connects different NHS data depositories to each other. This includes data from the British National formulary – a pharmaceutical reference book used by all doctors that contains a wide spectrum of information on prescribed drugs. This has the potential to be of immense value to the NHS – for example in linking information relating to areas where drugs are prescribed or where particular infections are prevalent, using geodata.’ There are concerns in the UK and more widely about the over-prescription of opiates in particular for lower back pain, so identifying areas where patients can be guided towards self-care is crucial.

Gavin adds: ‘It will free up resources for those who need more help by ensuring that those who can be managed perfectly well in the digital health space are catered for in a really effective way. It’s companies like Wallscope who I think can bring that to the table and make huge savings for Scotland.’

So what’s next? Lothian Health Board have already shown an interest in the application and as the NHS moves towards more innovative approaches Gavin hopes to secure a clinical trial. The app is already in a beta version and after further development by Wallscope and Design Informatics he will have a significantly improved version by August 2017. With Gavin’s understanding of psychology and behaviour change, combined with Wallscope’s technological insights, it seems ‘a million better backs’ could be within our reach.