Digital Care for Chronic Musculoskeletal Pain: 10,000 Participant Longitudinal Cohort Study.
exercise therapy
low back pain
mobile phone
musculoskeletal pain
patient engagement
telemedicine
telerehabilitation
Journal
Journal of medical Internet research
ISSN: 1438-8871
Titre abrégé: J Med Internet Res
Pays: Canada
ID NLM: 100959882
Informations de publication
Date de publication:
11 05 2020
11 05 2020
Historique:
received:
19
02
2020
accepted:
21
03
2020
revised:
21
03
2020
pubmed:
26
3
2020
medline:
11
11
2020
entrez:
26
3
2020
Statut:
epublish
Résumé
Chronic musculoskeletal pain has a vast global prevalence and economic burden. Conservative therapies are universally recommended but require patient engagement and self-management to be effective. This study aimed to evaluate the efficacy of a 12-week digital care program (DCP) in a large population of patients with chronic knee and back pain. A longitudinal observational study was conducted using a remote DCP available through a mobile app. Subjects participated in a 12-week multimodal DCP incorporating education, sensor-guided exercise therapy (ET), and behavioral health support with 1-on-1 remote health coaching. The primary outcome was pain measured by the visual analog scale (VAS). Secondary measures included engagement levels, program completion, program satisfaction, condition-specific pain measures, depression, anxiety, and work productivity. A total of 10,264 adults with either knee (n=3796) or low back (n=6468) pain for at least three months were included in the study. Participants experienced a 68.45% average improvement in VAS pain between baseline intake and 12 weeks. In all, 73.04% (7497/10,264) participants completed the DCP into the final month. In total, 78.60% (5893/7497) of program completers (7144/10,264, 69.60% of all participants) achieved minimally important change in pain. Furthermore, the number of ET sessions and coaching interactions were both positively associated with improvement in pain, suggesting that the amount of engagement influenced outcomes. Secondary outcomes included a 57.9% and 58.3% decrease in depression and anxiety scores, respectively, and 61.5% improvement in work productivity. Finally, 3 distinct clusters of pain response trajectories were identified, which could be predicted with a mean 76% accuracy using baseline measures. These results support the efficacy and scalability of a DCP for chronic low back and knee pain in a large, diverse, real-world population. Participants demonstrated high completion and engagement rates and a significant positive relationship between engagement and pain reduction was identified, a finding that has not been previously demonstrated in a DCP. Furthermore, the large sample size allowed for the identification of distinct pain response subgroups, which may prove beneficial in predicting recovery and tailoring future interventions. This is the first longitudinal digital health study to analyze pain outcomes in a sample of this magnitude, and it supports the prospect for DCPs to serve the overwhelming number of musculoskeletal pain sufferers worldwide.
Sections du résumé
BACKGROUND
Chronic musculoskeletal pain has a vast global prevalence and economic burden. Conservative therapies are universally recommended but require patient engagement and self-management to be effective.
OBJECTIVE
This study aimed to evaluate the efficacy of a 12-week digital care program (DCP) in a large population of patients with chronic knee and back pain.
METHODS
A longitudinal observational study was conducted using a remote DCP available through a mobile app. Subjects participated in a 12-week multimodal DCP incorporating education, sensor-guided exercise therapy (ET), and behavioral health support with 1-on-1 remote health coaching. The primary outcome was pain measured by the visual analog scale (VAS). Secondary measures included engagement levels, program completion, program satisfaction, condition-specific pain measures, depression, anxiety, and work productivity.
RESULTS
A total of 10,264 adults with either knee (n=3796) or low back (n=6468) pain for at least three months were included in the study. Participants experienced a 68.45% average improvement in VAS pain between baseline intake and 12 weeks. In all, 73.04% (7497/10,264) participants completed the DCP into the final month. In total, 78.60% (5893/7497) of program completers (7144/10,264, 69.60% of all participants) achieved minimally important change in pain. Furthermore, the number of ET sessions and coaching interactions were both positively associated with improvement in pain, suggesting that the amount of engagement influenced outcomes. Secondary outcomes included a 57.9% and 58.3% decrease in depression and anxiety scores, respectively, and 61.5% improvement in work productivity. Finally, 3 distinct clusters of pain response trajectories were identified, which could be predicted with a mean 76% accuracy using baseline measures.
CONCLUSIONS
These results support the efficacy and scalability of a DCP for chronic low back and knee pain in a large, diverse, real-world population. Participants demonstrated high completion and engagement rates and a significant positive relationship between engagement and pain reduction was identified, a finding that has not been previously demonstrated in a DCP. Furthermore, the large sample size allowed for the identification of distinct pain response subgroups, which may prove beneficial in predicting recovery and tailoring future interventions. This is the first longitudinal digital health study to analyze pain outcomes in a sample of this magnitude, and it supports the prospect for DCPs to serve the overwhelming number of musculoskeletal pain sufferers worldwide.
Identifiants
pubmed: 32208358
pii: v22i5e18250
doi: 10.2196/18250
pmc: PMC7248800
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
e18250Informations de copyright
©Jeannie F Bailey, Vibhu Agarwal, Patricia Zheng, Matthew Smuck, Michael Fredericson, David J Kennedy, Jeffrey Krauss. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 11.05.2020.
Références
Am J Med. 2017 Jan;130(1):14-20
pubmed: 27591179
J Med Internet Res. 2018 Apr 25;20(4):e156
pubmed: 29695370
Ann Intern Med. 2015 Apr 7;162(7):465-73
pubmed: 25844995
JMIR Diabetes. 2018 Feb 14;3(1):e4
pubmed: 30291074
Br J Sports Med. 2015 Dec;49(24):1554-7
pubmed: 26405113
Spine J. 2015 Apr 1;15(4):577-86
pubmed: 25452012
J Rehabil Med. 2014 Feb;46(2):153-8
pubmed: 24322559
Spine (Phila Pa 1976). 1999 Jun 1;24(11):1104-12
pubmed: 10361660
Ann Intern Med. 2017 Jul 18;167(2):85-94
pubmed: 28631003
Ann Intern Med. 2017 Apr 4;166(7):514-530
pubmed: 28192789
J Med Internet Res. 2005 Mar 31;7(1):e11
pubmed: 15829473
Osteoarthritis Cartilage. 2019 Jul;27(7):1026-1032
pubmed: 31002940
Pain Res Manag. 2014 Jul-Aug;19(4):179-85
pubmed: 24809067
Am J Phys Med Rehabil. 2008 Apr;87(4):258-69
pubmed: 18356618
BMC Musculoskelet Disord. 2009 Dec 09;10:155
pubmed: 19995464
J Med Internet Res. 2004 Sep 08;6(3):e28
pubmed: 15471754
Clin Rheumatol. 2008 Jul;27(7):873-81
pubmed: 18188660
J Psychosom Res. 2018 Feb;105:92-98
pubmed: 29332639
Phys Ther. 1996 Oct;76(10):1082-8
pubmed: 8863761
Spine (Phila Pa 1976). 2004 Jan 1;29(1):9-16; discussion 16
pubmed: 14699269
J Rehabil Med. 2008 Feb;40(2):137-44
pubmed: 18509579
J Med Internet Res. 2017 May 21;19(5):e179
pubmed: 28550009
Ann Rheum Dis. 2005 Jun;64(6):906-12
pubmed: 15897310
Rheumatology (Oxford). 2010 Dec;49(12):2346-56
pubmed: 20713495
N Engl J Med. 2019 Jun 20;380(25):2440-2448
pubmed: 31216399
Lancet. 2012 Dec 15;380(9859):2197-223
pubmed: 23245608
Br J Sports Med. 2020 Apr;54(8):438-439
pubmed: 31604698
J Med Internet Res. 2019 Jul 17;21(7):e11086
pubmed: 31317869
Sleep Health. 2018 Jun;4(3):307-312
pubmed: 29776626
Spine (Phila Pa 1976). 2006 May 1;31(10):1083-93
pubmed: 16648741
Arch Intern Med. 2003 Nov 10;163(20):2433-45
pubmed: 14609780
NPJ Digit Med. 2019 May 3;2:34
pubmed: 31304380
JAMA Intern Med. 2018 Apr 1;178(4):556-557
pubmed: 29507946
Arthritis Rheum. 2009 Dec;60(12):3546-53
pubmed: 19950287
Transl Behav Med. 2013 Mar;3(1):39-46
pubmed: 24073159
N Engl J Med. 2002 Jul 11;347(2):81-8
pubmed: 12110735
Pain. 2005 May;115(1-2):107-17
pubmed: 15836974
Reg Anesth Pain Med. 2017 Jul/Aug;42(4):488-498
pubmed: 28570436
JAMA Intern Med. 2019 Jun 1;179(6):840-841
pubmed: 30801610
Ann Intern Med. 2015 Feb 17;162(4):295-300
pubmed: 25581341
Sports Med Open. 2018 Sep 3;4(1):42
pubmed: 30178072
NPJ Digit Med. 2019 Jan 7;2:1
pubmed: 31304351
Pain. 1992 Aug;50(2):133-49
pubmed: 1408309
Spine (Phila Pa 1976). 2007 Jun 15;32(14):1474-81
pubmed: 17572614