Development and validation of a pain monitoring app for patients with musculoskeletal conditions (The Keele pain recorder feasibility study)

Abstract

Background: Assessing daily change in pain and related symptoms help in diagnosis, prognosis, and monitoring response to treatment. However, such changes are infrequently assessed, and usually reviewed weeks or months after the start of treatment. We therefore developed a smartphone application (Keele Pain Recorder) to record information on the severity and impact of pain on daily life. Specifically, the study goal was to assess face, content and construct validity of data collection using the Pain Recorder in primary care patients receiving new analgesic prescriptions for musculoskeletal pain, as well as to assess its acceptability and clinical utility.

Methods: The app was developed with Keele's Research User Group (RUG), a clinical advisory group (CAG) and software developer for use on Android devices. The app recorded pain levels, interference, sleep disturbance, analgesic use, mood and side effects. In a feasibility study, patients aged > 18 attending their general practitioner (GP) with a painful musculoskeletal condition were recruited to use the app twice per day for 28 days. Face and construct validity were assessed through baseline and post-study questionnaires (Spearman's rank correlation coefficient). Usability and acceptability were determined through post-study questionnaires, and patient, GP, RUG and CAG interviews.

Results: An app was developed which was liked by both patients and GPs. It was felt that it offered the opportunity for GPs to discuss pain control with their patients in a new way. All participants found the app easy to use (it did not interfere with their activities) and results easy to interpret. Strong associations existed between the first 3 days (Spearman r = 0.79) and last 3 days (r = 0.60) of pain levels and intensity scores on the app with the validated questionnaires.

Conclusions: Collaborating with patient representatives and clinical stakeholders, we developed an app which can be used to help clinicians and patients monitor painful musculoskeletal conditions in response to analgesic prescribing. Recordings were accurate and valid, especially, for pain intensity ratings, and it was easy to use. Future work needs to examine how pain trajectories can help manage changes in a patient's condition, ultimately assisting in self-management.

Keywords: App; Application; Assessment; Musculoskeletal; Pain; Primary care; Smartphone; Telehealth; eHealth.

Fig. 1

Real life examples of different pain 4-week trajectories pain recorded by the app: (a): recovering; (b) fluctuating low to moderate pain; (c) deteriorating; (d) unable to classify

Fig. 2

Real life changes in pain score recorded by the app (a) (1 = no pain, 10 = worst pain), mood (b) (1 = cheerful all the time 5 = none of the time) and interference (c) (1 = not at all, 5 = all the time) over a 28 day period following initiation of a new prescription analgesic