Introduction: The effects of aquatic exercise on psychological function associated with chronic LBP remains poorly understood and adherence to exercise-based interventions in CLBP is low. A promising solution to improve adherence is through the integration of mobile health application Play the Pain, which allows for continuous self-tracking of pain. 

Objectives: The primary objective of my thesis was to compare the effects of aquatic therapy to standard care on CLBP in terms of pain, disability, and psychological factors. The secondary objective was to determine the feasibility of using Play the Pain in a CLBP clinical intervention in terms of adherence and satisfaction. 

Methods: 34 participants with CLBP were randomized to the aquatic therapy (AT) group or the standard care (SC) group (AT, n=18; SC, n=16), while 12 participants tested Play the Pain. Outcome measures were pain (NPRS), disability (ODI), quality of life (SF-12), depression and anxiety (HADS), pain catastrophizing (PCS), kinesiophobia (TSK-11), insomnia (ISI) and adherence and satisfaction with the app. 

Results: Both groups significantly improved pain, disability, pain catastrophizing and quality of life with no differences between groups. Twelve participants used Play the Pain and 6 completed the exit survey. The adherence to the app was at 41.6% and the user satisfaction was low.  

Conclusions: Our results provide preliminary evidence on the efficacy of aquatic therapy to improve pain, disability and psychological outcomes associated with CLBP. We encountered many technical difficulties during the study that prevented our ability to adequately determine the feasibility of Play the Pain.