Telerehabilitation of acute musculoskeletal multi-disorders: prospective, single-arm, interventional study

Abstract

Background: Acute 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.

Objective: Present the feasibility and results of a fully remote digital care program (DCP) for acute MSK conditions affecting several body areas.

Methods: Interventional 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.

Results: Three 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 limitations: This 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.

Conclusions: We 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 registration: NCT, NCT04092946 . Registered 17/09/2019.

Keywords: Digital therapy; Home-based digital rehabilitation; Musculoskeletal pain; Physical therapy; Rehabilitation; eHealth.

Fig. 1

Flow Diagram of the study

Fig. 2

Longitudinal changes across time for all filtered variables: A: Pain; B: Medication consumption; C: Surgery Intent; D: Fear-avoidance beliefs; E: Mental health (GAD-7 and PHQ-9); F: Work productivity (WPAI overall, WPAI work, WPAI activity). Cases filtered according to the following baseline thresholds - medication usage per week > 0 days; surgery intent scores > 0 points; GAD-7 scores ≥ 5 points; PHQ-9 scores ≥ 5 points; all WPAI > 0 points