Patient and Clinician Perspectives on Micro-Interventions and Design Features for a Just-in-Time Adaptive Intervention in Chronic Back Pain: Descriptive Interview Study (Preprint)

BACKGROUND Chronic back pain (CBP) is a prevalent condition with substantial individual and socioeconomic impact. Pain catastrophizing is a key psychological factor associated with pain persistence and poor outcomes. Just-in-time adaptive interventions (JITAIs) represent a promising digital approach by delivering context-sensitive, personalized support in daily life. To inform early intervention design, it is important to understand how patients and clinicians prioritize candidate intervention components and delivery features. OBJECTIVE This study aimed to identify areas of alignment and divergence between patients with chronic back pain and clinicians regarding the prioritization of candidate micro-interventions and key JITAI design features to inform the development of a stakeholder-informed digital intervention targeting pain catastrophizing. METHODS Candidate micro-interventions were identified through a targeted, non-systematic literature review. Fifteen patients with chronic back pain and fifteen clinicians with experience in pain treatment participated in structured in-person interviews. Participants prioritized and rated micro-interventions from three domains (psychotherapy-based strategies, relaxation techniques, and physiotherapy exercises) with respect to anticipated usefulness and feasibility. They also evaluated key JITAI design parameters, including symptom-trigger thresholds, assessment frequency, and motivational features. Data were summarized descriptively to compare response patterns between stakeholder groups. RESULTS Patients and clinicians showed distinct prioritization patterns. Patients favored practical, low-threshold micro-interventions such as walking and abdominal breathing, whereas clinicians more often prioritized structured techniques such as progressive muscle relaxation. Both groups consistently rated physiotherapy interventions, particularly yoga, as highly relevant. Differences were also observed for preferred symptom-trigger thresholds and assessment frequency, with patients favoring earlier intervention triggers and fewer daily surveys. Motivational features such as gamification, real-time feedback, and clear interface design were identified as important by both groups CONCLUSIONS This descriptive study highlights areas of alignment and divergence between patient and clinician priorities relevant to the design of a JITAI for CBP. The findings provide structured, stakeholder-informed design inputs to guide subsequent optimization and experimental evaluation of JITAI components in future trials.