Abstract
BackgroundAcute musculoskeletal (MSK) pain is very common and associated with impaired productivity and high economic burden. Access to timely and personalized, evidence-based care is key to improve outcomes while reducing healthcare expenditure. Digital interventions can facilitate access and ensure care scalability.ObjectivePresent the feasibility and results of a fully remote digital care program (DCP) for acute MSK conditions affecting several body areas.MethodsInterventional single-arm study of individuals applying for digital care programs for acute MSK pain. Primary outcome was the mean change between baseline and end-of-program in self-reported Numerical Pain Rating Scale (NPRS) score and secondary outcomes were change in analgesic consumption, intention to undergo surgery, anxiety (GAD-7), depression (PHQ-9), fear-avoidance beliefs (FABQ-PA), work productivity (WPAI-GH) and engagement.ResultsThree hundred forty-three patients started the program, of which 300 (87.5%) completed the program. Latent growth curve analysis (LGCA) revealed that changes in NPRS between baseline and end-of-program were both statistically (p < 0.001) and clinically significant: 64.3% reduction (mean − 2.9 points). Marked improvements were also noted in all secondary outcomes: 82% reduction in medication intake, 63% reduction in surgery intent, 40% in fear-avoidance beliefs, 54% in anxiety, 58% in depression and 79% recovery in overall productivity. All outcomes had steeper improvements in the first 4 weeks, which paralleled higher engagement in this period (3.6 vs 3.2 overall weekly sessions, p < 0.001). Mean patient satisfaction score was 8.7/10 (SD 1.26).Strengths and limitationsThis is the first longitudinal study demonstrating the feasibility of a DCP for patients with acute MSK conditions involving several body areas. Major strengths of this study are the large sample size, the wide range of MSK conditions studied, the breadth of outcomes measured, and the very high retention rate and adherence level. The major limitation regards to the absence of a control group.ConclusionsWe observed very high completion and engagement rates, as well as clinically relevant changes in all health-related outcomes and productivity recovery. We believe this DCP holds great potential in the delivery of effective and scalable MSK care.Trial registrationNCT, NCT04092946. Registered 17/09/2019;
Highlights
Acute MSK injuries are very common, among working-age adults, with 2.9 million injuries in the workplace reported in 2016 [1, 2], as well as in sports, with ~ 4.2 million emergency room visits between 2014 and 2016 in the United States (US) [2]
Primary outcome was the mean change between baseline and end-of-program in self-reported Numerical Pain Rating Scale (NPRS) score and secondary outcomes were change in analgesic consumption, intention to undergo surgery, anxiety (GAD-7), depression (PHQ-9), fear-avoidance beliefs (FABQ-PA), work productivity (WPAI-GH) and engagement
Marked improvements were noted in all secondary outcomes: 82% reduction in medication intake, 63% reduction in surgery intent, 40% in fear-avoidance beliefs, 54% in anxiety, 58% in depression and 79% recovery in overall productivity
Summary
Acute MSK injuries are very common, among working-age adults, with 2.9 million injuries in the workplace reported in 2016 [1, 2], as well as in sports, with ~ 4.2 million emergency room visits between 2014 and 2016 in the United States (US) [2]. The onset of MSK pain can result in a downward spiral of negative physical, social, and psychological consequences, which can lead to chronic MSK pain [4,5,6,7,8,9]. It has been reported, for example, that about 31% of patients do not fully recover from low back pain within 6 months [10] and that 45 to 55% of acute knee injuries develop into a long-term medical condition [11].
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