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Annika G, Rica H, Florian A, Christoff Z, Kerstin L. Effects of an artificial intelligence-based exercise program on pain intensity and disability in patients with neck pain compared with group exercise therapy: A cohort study. J Bodyw Mov Ther 2025; 42:1031-1038. [PMID: 40325632 DOI: 10.1016/j.jbmt.2025.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2024] [Revised: 02/18/2025] [Accepted: 02/21/2025] [Indexed: 05/07/2025]
Abstract
OBJECTIVES This study compares the effects of an artificial intelligence app-based exercise program with group exercise therapy on pain intensity and neck-related disability in patients with neck pain. PARTICIPANTS 84 patients with neck pain. 70 fulfilled the study requirements. 52 were in the intervention and 18 in the comparison group. INTERVENTION The intervention group utilized an AI-based exercise program accessible via digital devices. The AI provided 3-5 daily exercises tailored to individual feedback, pain intensity, and well-being. The exercise duration was up to 15 min per day. The comparison group attended up to two 45-min group exercise sessions weekly. METHODS Pain intensity and neck-related disability were assessed using an 11-point numerical rating scale and the Neck Disability Index via online questionnaires at baseline, 4 weeks, and 8 weeks. The non-parametric Mann-Whitney U test was used to test for between group differences. RESULTS After 8 weeks, the intervention group showed a significantly lower pain intensity than the comparison group (U = 287, Z = -2.447, p = 0.042, r = 0.3). Compared to baseline, the intervention group showed a significant reduction in neck pain (Chi2 (2) = 15.775, p < 0.001, W = 0.15) and an improvement in neck-related disability (Chi2 (2) = 25.094, p < 0.001, W = 0.24). The comparison group showed no significant change over time. CONCLUSION The app-based exercise program demonstrated promising results for the reduction of pain intensity and neck-related disability, offering a personalized and mobile alternative to group exercise therapy for patients with neck pain.
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Affiliation(s)
- Griefahn Annika
- Universität zu Lübeck, Institute of Health Sciences, Department of Physiotherapy, Ratzeburger Allee 160, 23562 Lübeck, Germany; University of Applied Science, Faculty Business Management and Social Sciences, Albrechtstraße 30, 49076 Osnabrück, Germany; medicalmotion GmbH, Blütenstraße 15, 80799 München, Germany
| | - Hartmann Rica
- University of Applied Science, Faculty Business Management and Social Sciences, Albrechtstraße 30, 49076 Osnabrück, Germany
| | | | - Zalpour Christoff
- University of Applied Science, Faculty Business Management and Social Sciences, Albrechtstraße 30, 49076 Osnabrück, Germany
| | - Luedtke Kerstin
- Universität zu Lübeck, Institute of Health Sciences, Department of Physiotherapy, Ratzeburger Allee 160, 23562 Lübeck, Germany
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Hu R, Wang J, Zhu S, Wang Z, Hu Z. Impact of Monthly Community Follow-Ups in Knee Osteoarthritis Management for Elderly Patients. Med Sci Monit 2025; 31:e947224. [PMID: 40356209 PMCID: PMC12085101 DOI: 10.12659/msm.947224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2024] [Accepted: 03/14/2025] [Indexed: 05/15/2025] Open
Abstract
BACKGROUND Chronic knee osteoarthritis (KOA) severely affects elderly populations, yet optimal pain management remains elusive. While community interventions show rehabilitation potential, evidence comparing structured follow-up frequencies is limited. This randomized trial compared intensified monthly community follow-ups vs semi-annual monitoring for improving pain control, functional capacity, and quality of life in elderly patients with KOA. MATERIAL AND METHODS A total of 112 elderly patients with KOA were enrolled and randomly assigned to either a control group (semi-annual follow-ups) or a follow-up group (monthly community interventions including pain management education and exercise adherence supervision) during the 14-month study. Outcomes were assessed using the visual analog scale (VAS), Knee Injury and Osteoarthritis Outcome Score (KOOS), and Short Form Health Survey (SF-36). Statistical analyses performed with SPSS 27.0 included paired-sample t tests for intra-group changes and independent-sample t tests for inter-group comparisons. RESULTS The control group showed a significant reduction in VAS scores at the final assessment (P<0.05). The follow-up group showed significant improvements across VAS, KOOS, and SF-36 scores (P<0.05). Improvements in VAS, KOOS, and SF-36 scores were significantly greater in the follow-up group than in the control group (P<0.05). Furthermore, changes in VAS scores were correlated with changes in KOOS and SF-36 scores (P<0.05). CONCLUSIONS Regular community follow-ups significantly enhanced pain management, functional outcomes, and quality of life among elderly patients with KOA. By fostering adherence to exercise regimens, this approach proved to be a viable strategy for enhancing rehabilitation outcomes, meriting its broader adoption in clinical practice.
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Affiliation(s)
- Ruhai Hu
- The Second Rehabilitation Hospital of Shanghai, Clinical Research Center, Shanghai, PR China
- Department of Rehabilitation Medicine, Shanghai Jiading District Anting Town Community Health Service Centre, Shanghai, PR China
| | - Jinyan Wang
- The Second Rehabilitation Hospital of Shanghai, Clinical Research Center, Shanghai, PR China
| | - Shengjie Zhu
- Department of Rehabilitation Medicine, Shanghai Jiading District Anting Town Community Health Service Centre, Shanghai, PR China
| | - Zhilin Wang
- Department of Rehabilitation Medicine, Shanghai Jiading District Anting Town Community Health Service Centre, Shanghai, PR China
| | - Zekai Hu
- The Second Rehabilitation Hospital of Shanghai, Clinical Research Center, Shanghai, PR China
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Mayer TA, Koska D, Harsch AK, Maiwald C. Effectiveness of Self-Training With a Web-Based Digital Health Application Versus Physiotherapy in the Treatment of Disorders of the Patella: Randomized Controlled Trial. J Med Internet Res 2025; 27:e66463. [PMID: 40323642 PMCID: PMC12089869 DOI: 10.2196/66463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2024] [Revised: 02/14/2025] [Accepted: 04/03/2025] [Indexed: 05/07/2025] Open
Abstract
BACKGROUND Disorders of the patella are among the most prevalent knee injuries. While exercise therapy is widely accepted as an effective treatment strategy, the positive effects of conventional exercise therapy under the guidance of a physiotherapist may be offset by inherent limitations, such as difficulties in scheduling appointments or statutory policies restricting the number of training sessions. Home-based exercise interventions using digital health applications (DHAs) may help address some of these limitations. OBJECTIVE This study aimed to assess the efficacy of a 12-week exercise intervention using a web-based DHA for improving knee function and reducing pain in patients with disorders of the patella (International Classification of Diseases code M22). METHODS The outcomes of the DHA intervention group (IG) were compared to a control group (CG) that received conventional physiotherapy covered by statutory health insurance in Germany (SHI-PT). A total of 259 patients with diagnosed disorders of the patella were included in the trial and randomly allocated to IG DHA (n=136, 52.5%) and CG SHI-PT (n=123, 47.5%). Two primary end points were examined: "knee function" (Knee Injury and Osteoarthritis Outcome Score-Activities of Daily Living [KOOSADL] subscale, range 0-100 points) and "knee pain" (visual analog scale [VAS], range 0-100 points). Participants were asked to complete 2 surveys: one before the first therapy session (PRE) and one after completing the treatment period of 12 weeks (POST). RESULTS Training with the DHA resulted in a 4.5-fold greater improvement in "knee function" (PRE-POST differences in KOOSADL score; IG DHA: 15.7 points, 95% CI 13.7-17.6 vs CG SHI-PT: 3.5 points, 95% CI 1.5-5.5) and a 3.5-fold greater reduction in "knee pain" (PRE-POST differences in VAS pain score; IG DHA: -22.5 points, 95% CI -25.2 to -19.9 vs CG SHI-PT: -6.5 points, 95% CI -8.7 to -4.4) compared to SHI-PT. The improvements in IG DHA exceeded the limits of clinical relevance. The differences between the treatment groups (KOOSADL score -10.1 points, 95% CI -infinity to -8.0; VAS pain score 14.3 points 95% CI 11.7-infinity) were statistically significant (P<.001) for both end points in favor of IG DHA. No effect was found for age or sex. The reported use of pain medication decreased substantially in IG DHA, and showed almost no change in CG SHI-PT. CONCLUSIONS Our findings indicated that the investigated DHA is superior to SHI-PT for treating disorders of the patella. Therefore, DHA has been approved by the German Federal Institute for Drugs and Medical Devices for treating disorders of the patella in persons of all sexes aged ≥12 years. TRIAL REGISTRATION German Clinical Trials Register (DRKS) DRKS00023454; https://drks.de/search/en/trial/DRKS00023454.
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Affiliation(s)
- Tobias A Mayer
- Department of Research Methodology and Data Analysis in Biomechanics, Institute of Human Movement Science and Health, Chemnitz University of Technology, Chemnitz, Germany
| | - Daniel Koska
- Department of Research Methodology and Data Analysis in Biomechanics, Institute of Human Movement Science and Health, Chemnitz University of Technology, Chemnitz, Germany
| | - Ann-Kathrin Harsch
- Department of Research Methodology and Data Analysis in Biomechanics, Institute of Human Movement Science and Health, Chemnitz University of Technology, Chemnitz, Germany
| | - Christian Maiwald
- Department of Research Methodology and Data Analysis in Biomechanics, Institute of Human Movement Science and Health, Chemnitz University of Technology, Chemnitz, Germany
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Brown MC, Lin CQ, Jin C, Rohde M, Rocos B, Belding J, Woods BI, Ackerman SJ. Effect of a Digital Health Exercise Program on the Intention for Spinal Surgery in Adult Spinal Deformity: Exploratory Cross-Sectional Survey. JMIR Form Res 2025; 9:e66889. [PMID: 40300159 PMCID: PMC12054968 DOI: 10.2196/66889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2024] [Revised: 04/08/2025] [Accepted: 04/10/2025] [Indexed: 05/01/2025] Open
Abstract
Background Adult spinal deformity (ASD) is a prevalent condition estimated at 38%. Symptomatic ASD is associated with substantial health care costs. The role of nonoperative interventions in the management of ASD remains elusive. The National Scoliosis Clinic's (NSC) scoliosis realignment therapy (SRT) is a personalized digital health exercise program for the nonoperative management of ASD. Objective This exploratory study had two objectives: (1) to evaluate the effect of the SRT program on users' intention of having spinal fusion; and (2) from a US payer perspective, to estimate the annual cost savings per 100,000 beneficiaries by averting spinal surgery. Methods Individuals were enrolled in the SRT study from October 1, 2023 to September 1, 2024. Participants completed a web-based, cross-sectional survey about their history of prior scoliosis surgery and intent of having surgery before and after use of SRT (on a 4-point Likert scale, where 1 = "No Intent for Surgery" and 4 = "High Intent for Surgery"). Intent for surgery before and after participation in SRT was compared using a nonparametric Wilcoxon signed-rank test for paired data. Annual cost savings per 100,000 beneficiaries by averting spinal fusions were estimated separately for commercial payers and Medicare using published literature and public data sources. Payer expenditures were inflation-adjusted to 2024 US dollars using the Hospital Services component of the Consumer Price Index. Results A total of 62 NSC members (38.8%) responded to the survey and were enrolled in the SRT program for an average (SD) of 17 (12) weeks. The mean (SD) age was 65.3 (13.5) years, and the majority were female (47/48, 98%) and White (45/46, 98%). Among the SRT users who did not have prior scoliosis surgery (n=56), 14% (8/56) reported a decrease in intent for surgery (that is, a lower Likert score) with the use of SRT. The mean (SD) intent for surgery scores before compared to after SRT were 1.29 (0.53) and 1.14 (0.35), respectively (mean difference 0.15 [P=.006]). Participants with "No Intent for Surgery" pre- versus postuse of SRT (42/56 versus 48/56, respectively) corresponded to an absolute risk reduction of 11% and a number needed to treat of 9 to avert one spinal fusion. Among the 6 participants who transitioned to "No Intent" for spinal surgery with the use of SRT, 3 were aged <65 years and 3 were ≥65 years of age. The annual cost savings from averted spinal surgeries were estimated at US $415,000 per 100,000 commercially-insured beneficiaries and US $617,000 per 100,000 Medicare beneficiaries. Conclusions SRT is a personalized, scoliosis-specific digital health exercise program with the potential for averting 1 spinal surgery for every 9 participants, resulting in a substantial reduction in payer expenditures while improving the quality of care for commercial payers and Medicare beneficiaries.
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Affiliation(s)
- Marsalis Christian Brown
- Department of Orthopaedic Surgery, MetroHealth Medical Center, 2500 MetroHealth Dr, Cleveland, OH, 44109, United States, 1 614-441-3703
| | - Christopher Quincy Lin
- Department of Medicine, The Larner College of Medicine, The University of Vermont, Burlington, VT, United States
| | - Christopher Jin
- Department of Medical, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Matthew Rohde
- The Department of Orthopaedics, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
| | - Brett Rocos
- Duke Spine Center, Duke University Health System, Durham, NC, United States
| | - Jonathan Belding
- Department of Orthopaedic Surgery, MetroHealth Medical Center, 2500 MetroHealth Dr, Cleveland, OH, 44109, United States, 1 614-441-3703
| | - Barrett I Woods
- Department of Spine Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University Rothman Institute, Philadelphia, PA, United States
| | - Stacey J Ackerman
- Department of Biomedical Engineering, Johns Hopkins University, San Diego, CA, United States
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Zhu B, Zhu D, Xue X, Yang H, Zhang S. Behavioral Therapy-Based Digital Interventions for Treating Osteoarthritis: Systematic Review and Meta-Analysis. J Med Internet Res 2025; 27:e56227. [PMID: 40106814 PMCID: PMC11966084 DOI: 10.2196/56227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 07/09/2024] [Accepted: 10/17/2024] [Indexed: 03/22/2025] Open
Abstract
BACKGROUND Osteoarthritis (OA) is characterized by pain, functional impairments, muscle weakness, and joint stiffness. Since OA heightens reliance on heath care resources and exacerbates socioeconomic burden, remote OA rehabilitation using digital technologies is rapidly evolving. OBJECTIVE The aim of this study was to analyze the efficacy of behavioral therapy-based digital interventions for patients with OA. METHODS This study is a systematic review of randomized controlled trials (RCTs) that assessed the effects of behavioral therapy-based digital intervention tools for OA. These RCTs were searched from inception to June 2023 in the Web of Science, Embase, Cochrane Library, Ovid, and PubMed databases. RESULTS Ten eligible RCTs comprising 1895 patients with OA were included. Digital tools based on either cognitive behavioral therapy (CBT) or behavior change technique (BCT) were investigated. All studies demonstrated low-to-moderate effects on pain reduction in the short term (standardized mean difference [SMD] -0.20, 95% CI -0.35 to -0.05). Six studies reported improvement in physical function (SMD -0.20, 95% CI -0.41 to 0.00), and 5 confirmed increased pain self-efficacy (SMD 0.22, 95% CI 0.02-0.42). In subgroup analysis, compared with CBT, BCT-based digital interventions demonstrated their effects on pain reduction (SMD -0.25, 95% CI -0.49 to 0.00) and physical function (SMD -0.26, 95% CI -0.54 to -0.01) in the short term. In addition, physiotherapist involvement in treatment had a positive effect on pain control (SMD -0.14, 95% CI -0.27 to -0.02). Furthermore, web-based digital tools improved physical function in the short term (SMD -0.28, 95% CI -0.54 to -0.01). CONCLUSIONS Moderate- and low-quality evidence supported that behavioral therapy-based digital tools improved pain intensity, physical function, and self-efficacy in the short term. However, affective interactions between patients and professionals may affect the clinical outcomes. TRIAL REGISTRATION PROSPERO CRD42023430716; https://tinyurl.com/yc49vzyy.
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Affiliation(s)
- Beiyao Zhu
- Shanghai Jiao Tong University, The Ninth People's Hospital, Shanghai, China
| | - Dian Zhu
- School of Design, Shanghai Jiao Tong University, Shanghai, China
| | - Xiao'ao Xue
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Hongyi Yang
- School of Design, Shanghai Jiao Tong University, Shanghai, China
| | - Shurong Zhang
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
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Mapinduzi J, Ndacayisaba G, Verbrugghe J, Timmermans A, Kossi O, Bonnechère B. Effectiveness of mHealth Interventions to Improve Pain Intensity and Functional Disability in Individuals With Hip or Knee Osteoarthritis: A Systematic Review and Meta-analysis. Arch Phys Med Rehabil 2025; 106:280-291. [PMID: 38945508 DOI: 10.1016/j.apmr.2024.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 06/06/2024] [Accepted: 06/16/2024] [Indexed: 07/02/2024]
Abstract
OBJECTIVE This review aimed to investigate the effectiveness of mHealth-supported active exercise interventions to reduce pain intensity and disability level in persons with hip or knee osteoarthritis (OA). DATA SOURCES Three databases (PubMed, Cochrane Library, and Web of Science) were systematically searched for randomized controlled trials (RCTs) published between January 1, 2012 and July 31, 2023. PROSPERO registration number of this review was CRD42023394119. STUDY SELECTION We included only RCTs that were identified and screened by 2 independent reviewers (J.M. and G.N.). In addition, the reference lists of the identified studies were manually checked for further inclusion. Included studies had to provide mHealth-supported active exercises for persons with hip or knee OA, and evaluate pain intensity and disability using both questionnaires and performance tests. DATA EXTRACTION From the included studies, the 2 independent authors extracted data using a predetermined Excel form. Characteristics of the interventions were described and a meta-analysis was performed. DATA SYNTHESIS Twelve RCTs were included, representing 1541 patients with a mean age of 58.7±5 years, and a body mass index of 28.8±3.1 kg/m2; women being more predominant than men with a total female to male ratio of 2.2. The methodological quality of the included studies was moderate in 75% of the studies. There was no statistically significant difference between mHealth-supported active exercises compared with the interventions without mHealth in terms of pain reduction (standard mean differences [SMD]=-0.42; 95% CI, -0.91 to 0.07; P=.08) and disability mitigation (SMD=-0.36; 95% CI, -0.81 to 0.09; P=.10). However, a statistically significant difference was found between patient education combined with mHealth-supported active exercises compared with patient education alone in terms of pain (SMD= -0.42; 95% CI, -0.61 to -0.22; P<.01) and disability (SMD=-0.27; 95% CI, -0.46 to -0.08; P<.01) reduction. CONCLUSIONS mHealth-supported exercises were found to be effective, especially when combined with patient education, in reducing pain and mitigating disability in patients with hip or knee OA.
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Affiliation(s)
- Jean Mapinduzi
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, BE 3590, Belgium; TechnoRehab Lab, Physiotherapy and Rehabilitation School, Department of Clinical Sciences, National Institute of Public Health (INSP), Bujumbura, PB 6807, Burundi.
| | - Gérard Ndacayisaba
- TechnoRehab Lab, Physiotherapy and Rehabilitation School, Department of Clinical Sciences, National Institute of Public Health (INSP), Bujumbura, PB 6807, Burundi; CNRKR- National Reference Center for Physiotherapy and Medical Rehabilitation, Bujumbura, PB 3792, Burundi
| | - Jonas Verbrugghe
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, BE 3590, Belgium
| | - Annick Timmermans
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, BE 3590, Belgium
| | - Oyéné Kossi
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, BE 3590, Belgium; ENATSE - National School of Public Health and Epidemiology, Department of Health Sciences, University of Parakou, Parakou, 03 PB 10, Benin
| | - Bruno Bonnechère
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, BE 3590, Belgium; Technology-Supported and Data-Driven Rehabilitation, Data Sciences Institute, Hasselt University, Diepenbeek, Belgium; Data Sciences Institute, Hasselt University, Diepenbeek, Belgium; Department of PXL - Healthcare, PXL University of Applied Sciences and Arts, Hasselt, Belgium
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Van Oirschot G, Pomphrey A, Dunne C, Murphy K, Blood K, Doherty C. An Evaluation of the Design of Multimedia Patient Education Materials in Musculoskeletal Health Care: Systematic Review. JMIR Rehabil Assist Technol 2024; 11:e48154. [PMID: 39162239 PMCID: PMC11522670 DOI: 10.2196/48154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 09/27/2023] [Accepted: 08/20/2024] [Indexed: 08/21/2024] Open
Abstract
BACKGROUND Educational multimedia is a cost-effective and straightforward way to administer large-scale information interventions to patient populations in musculoskeletal health care. While an abundance of health research informs the content of these interventions, less guidance exists about optimizing their design. OBJECTIVE This study aims to identify randomized controlled trials of patient populations with musculoskeletal conditions that used multimedia-based patient educational materials (PEMs) and examine how design was reported and impacted patients' knowledge and rehabilitation outcomes. Design was evaluated using principles from the cognitive theory of multimedia learning (CTML). METHODS PubMed, CINAHL, PsycINFO, and Embase were searched from inception to September 2023 for studies examining adult patients with musculoskeletal conditions receiving multimedia PEMs compared to any other interventions. The primary outcome was knowledge retention measured via test scores. Secondary outcomes were any patient-reported measures. Retrievability was noted, and PEMs were sourced through search, purchase, and author communication. RESULTS A total of 160 randomized controlled trials were eligible for inclusion: 13 (8.1%) included their educational materials and 31 (19.4%) required a web search, purchase, or direct requests for educational materials. Of these 44 (27.5%) studies, none fully optimized the design of their educational materials, particularly lacking in the CTML principles of coherence, redundancy, modality, and generative activities for the learner. Of the 160 studies, the remaining 116 (72.5%) contained interventions that could not be retrieved or appraised. Learning was evaluated in 5 (3.1%) studies. CONCLUSIONS Musculoskeletal studies should use open science principles and provide their PEMs wherever possible. The link between providing multimedia PEMs and patient learning is largely unexamined, but engagement potential may be maximized when considering design principles such as the CTML.
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Affiliation(s)
- Garett Van Oirschot
- School of Public Health, Physiotherapy & Sport Science, University College Dublin, Dublin, Ireland
- Insight SFI Research Centre for Data Analytics, Dublin, Ireland
| | - Amanda Pomphrey
- School of Public Health, Physiotherapy & Sport Science, University College Dublin, Dublin, Ireland
| | - Caoimhe Dunne
- School of Public Health, Physiotherapy & Sport Science, University College Dublin, Dublin, Ireland
| | - Kate Murphy
- School of Public Health, Physiotherapy & Sport Science, University College Dublin, Dublin, Ireland
| | - Karina Blood
- School of Public Health, Physiotherapy & Sport Science, University College Dublin, Dublin, Ireland
| | - Cailbhe Doherty
- School of Public Health, Physiotherapy & Sport Science, University College Dublin, Dublin, Ireland
- Insight SFI Research Centre for Data Analytics, Dublin, Ireland
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Whittaker SL, Brusco NK, Hill KD, Taylor NF. Self-management Programs Within Rehabilitation Yield Positive Health Outcomes at a Small Increased Cost Compared With Usual Care: A Systematic Review and Meta-analysis. Arch Phys Med Rehabil 2024; 105:1946-1960. [PMID: 38729404 DOI: 10.1016/j.apmr.2024.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 04/09/2024] [Accepted: 05/02/2024] [Indexed: 05/12/2024]
Abstract
OBJECTIVE To determine if self-management programs, supported by a health professional, in rehabilitation are cost effective. DATA SOURCES Six databases were searched until December 2023. STUDY SELECTION Randomized controlled trials with adults completing a supported self-management program while participating in rehabilitation or receiving health professional input in the hospital or community settings were included. Self-management programs were completed outside the structured, supervised therapy and health professional sessions. Included trials had a cost measure and an effectiveness outcome reported, such as health-related quality of life or function. Grading of Recommendations, Assessment, Development, and Evaluations was used to determine the certainty of evidence across trials included in each meta-analysis. Incremental cost-effectiveness ratios were calculated based on the mean difference from the meta-analyses of contributing health care costs and quality of life. DATA EXTRACTION After application of the search strategy, two independent reviewers determined eligibility of identified literature, initially by reviewing the title and/or abstract before full-text review. Using a customized form, data were extracted by one reviewer and checked by a second reviewer. DATA SYNTHESIS Forty-three trials were included, and 27 had data included in meta-analyses. Where self-management was a primary intervention, there was moderate certainty of a meaningful positive difference in quality-of-life utility index of 0.03 units (95% confidence interval, 0.01-0.06). The cost difference between self-management as the primary intervention and usual care (comprising usual intervention/therapy, minimal intervention [including education only], or no intervention) potentially favored the comparison group (mean difference=Australian dollar [AUD]90; 95% confidence interval, -AUD130 to AUD310). The cost per quality-adjusted life year (QALY) gained for self-management programs as a stand-alone intervention was AUD3000, which was below the acceptable willingness-to-pay threshold in Australia per QALY gained (AUD50,000/QALY gained). CONCLUSIONS Self-management as an intervention is low cost and could improve health-related quality of life.
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Affiliation(s)
- Sara L Whittaker
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, Melbourne, Victoria.
| | - Natasha K Brusco
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, Melbourne, Victoria
| | - Keith D Hill
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, Melbourne, Victoria
| | - Nicholas F Taylor
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria; Eastern Health, Allied Health Clinical Research Office, Box Hill, Victoria, Australia
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Weatherly S, McKenna T, Wahba S, Friedman A, Goltry W, Wahid T, Abourahma H, Lee K, Rehman A, Odeh A, Costin J. Effectiveness of Digital Health Interventions (DHI) in Chronic Pain Management: A Scoping Review of Current Evidence and Emerging Trends. Cureus 2024; 16:e72562. [PMID: 39610577 PMCID: PMC11602419 DOI: 10.7759/cureus.72562] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2024] [Accepted: 10/28/2024] [Indexed: 11/30/2024] Open
Abstract
This review aims to address the impact of digital health interventions (DHIs) on chronic pain management, specifically, mHealth, eHealth, wearable devices, virtual reality (VR), and artificial intelligence. The following study identifies and assesses DHIs' efficacy in specific chronic pain conditions and then extrapolates improved outcomes and patient groups that benefit from their use. Using a systematic methodology, this review synthesizes findings that could improve knowledge for patients and practitioners in chronic pain management while also addressing gaps in understanding the impact of DHIs. Sub-questions guide the identification of gaps and recommendations assessing DHIs' effectiveness for pain reduction and improved quality of life. A systematic search across databases (EMBASE, Ovid MEDLINE, CINAHL, Web of Sciences, Cochrane Central) targets original, English-language, peer-reviewed studies (2013-2023). The inclusion criteria cover DHIs in chronic pain management for adults age 18+, excluding non-full texts, reviews, opinion pieces, or unrelated articles. Search terms include "chronic pain management" OR "long-term pain relief strategies" OR "sustained pain alleviation" OR "pain control for chronic conditions" OR "chronic pain" AND "ehealth interventions" OR "mobile health interventions" OR "digital therapy" OR "health informatic solutions" OR "digital health intervention." After applying inclusion criteria, 34 articles from 11 countries are included, with studies conducted primarily in the United States (n = 17), United Kingdom (n = 4), and Australia (n = 3). DHIs are emerging as effective tools in pain management, as they can emphasize patient autonomy and communication with clinicians while enabling medical self-management in diverse populations. These various digital interventions show promise in reducing pharmaceutical usage and deferring surgical procedures, with most studies reporting positive outcomes in pain reduction. DHIs were also associated with positive mental health outcomes; however, some studies found no significant improvement. Additionally, interventions targeting pain catastrophizing showed varied results, with some app-based approaches demonstrating promise. Overall, the review underscores the potential of DHIs in improving chronic pain management outcomes.
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Affiliation(s)
- Shannon Weatherly
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, USA
| | - Tara McKenna
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, USA
| | - Simon Wahba
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, USA
| | - Arielle Friedman
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, USA
| | - Wesley Goltry
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, USA
| | - Talha Wahid
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, USA
| | - Hussein Abourahma
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, USA
| | - Kenneth Lee
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, USA
| | - Ahmed Rehman
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, USA
| | - Ali Odeh
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, USA
| | - Joshua Costin
- Department of Medical Education, Dr. Kiran C. Patel College of Allopathic Medicine, Nova Southeastern University, Fort Lauderdale, USA
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Dieter V, Janssen P, Krauss I. Efficacy of the mHealth-Based Exercise Intervention re.flex for Patients With Knee Osteoarthritis: Pilot Randomized Controlled Trial. JMIR Mhealth Uhealth 2024; 12:e54356. [PMID: 39250181 PMCID: PMC11420596 DOI: 10.2196/54356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 05/16/2024] [Accepted: 06/12/2024] [Indexed: 09/10/2024] Open
Abstract
BACKGROUND Exercise therapy is recommended by international guidelines as a core treatment for patients with knee osteoarthritis. However, there is a significant gap between recommendations and practice in health care. Digital exercise apps are promising to help solve this undersupply. OBJECTIVE This study aims to evaluate the efficacy of a 12-week fully automated app-based exercise intervention with and without a supporting knee brace on health-related outcomes, performance measures, and adherence in patients with knee osteoarthritis. METHODS This closed user group trial included participants with moderate to severe unicondylar painful knee osteoarthritis. Randomization was 1:1:2 into an intervention group (IG) with 2 subgroups (app-based training [IG A] and app-based training and a supportive knee brace [IG AB]) and a control group (CG). The intervention included a 12-week home exercise program with 3 sessions per week. Instructions for the exercises were given via the app and monitored using 2 accelerometers placed below and above the affected knee joint. Participants in the CG did not receive any study intervention but were allowed to make use of usual care. Osteoarthritis-specific pain (Knee Injury and Osteoarthritis Outcome Score) was defined as the primary outcome, and secondary outcomes included all other Knee Injury and Osteoarthritis Outcome Score subscales, general health-related quality of life (Veterans RAND 12-item Health Survey), psychological measures (eg, exercise self-efficacy), performance measures (strength and postural control), and the monitoring of adherence and safety. Outcomes were assessed at baseline and after 12 weeks. Intervention effects were calculated using baseline-adjusted analysis of covariance for the joint comparison of IG A and IG AB versus the CG using a per-protocol approach. Subgroup analyses were conducted for each IG separately. RESULTS A total of 61 participants were included (IG: n=30, 49%; CG: n=31, 51%; male: n=31, 51%; female: n=30, 49%; mean age 62.9, SD 8.5 years; mean BMI 27.7, SD 4.5 kg/m2). Analysis revealed statistically significant effects in favor of the IG for pain reduction (P<.001; effect size [ES]=0.76), improvements in physical function (P<.001; ES=0.64), improvements in symptoms (P=.01; ES=0.53), improvements in sport and recreation activities (P=.02; ES=0.47), improvements in knee-related quality of life (P<.001; ES=0.76), and improvements in the physical component of general health-related quality of life (P<.001; ES=0.74). Mean differences ranged from 6.0 to 13.2 points (scale range 0-100). ESs indicated small to medium effects. No effects were found for psychological and performance measures. Participants adhered to 92.5% (899/972) of all scheduled exercise sessions. CONCLUSIONS Individuals with knee osteoarthritis undergoing a 12-week sensor-assisted app-based exercise intervention with or without an additional knee brace experienced clinically meaningful treatment effects regarding pain relief and improvements in physical function as well as other osteoarthritis-specific concerns compared to controls. TRIAL REGISTRATION German Clinical Trials Register (DRKS) DRKS00023269; https://drks.de/search/de/trial/DRKS00023269.
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Affiliation(s)
- Valerie Dieter
- Department of Sports Medicine, Medical Clinic, University Hospital Tübingen, Tübingen, Germany
- Interfaculty Research Institute for Sports and Physical Activity, Tübingen, Germany
| | - Pia Janssen
- Department of Sports Medicine, Medical Clinic, University Hospital Tübingen, Tübingen, Germany
- Interfaculty Research Institute for Sports and Physical Activity, Tübingen, Germany
| | - Inga Krauss
- Department of Sports Medicine, Medical Clinic, University Hospital Tübingen, Tübingen, Germany
- Interfaculty Research Institute for Sports and Physical Activity, Tübingen, Germany
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11
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Kamdar M, Jethwani K, Centi AJ, Agboola S, Fischer N, Traeger L, Rinaldi S, Strand J, Ritchie C, Temel JS, Greer JA, Kvedar J, El-Jawarhi A, Jackson V. A Digital Therapeutic Application (ePAL) to Manage Pain in Patients With Advanced Cancer: A Randomized Controlled Trial. J Pain Symptom Manage 2024; 68:261-271. [PMID: 38866116 DOI: 10.1016/j.jpainsymman.2024.05.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 05/25/2024] [Accepted: 05/30/2024] [Indexed: 06/14/2024]
Abstract
BACKGROUND Patients with advanced cancer often experience immense cancer pain that negatively impacts their quality of life. Interventions to address cancer-related pain are limited. METHODS We conducted a randomized trial of a digital therapeutic app (ePAL) for patients with advanced cancer receiving care in a specialty palliative care clinic at a tertiary care hospital. Patients were randomized to ePAL or usual care. ePAL included 1) active pain monitoring; 2) artificial intelligence algorithm to triage patient symptoms; and 3) patient education to address barriers to pain management. Participants were instructed to use ePAL over eight weeks. Patient-reported pain symptoms were assessed at baseline, Week-4, and Week-8 (primary endpoint) using the Brief Pain Inventory. Secondary outcomes include pain-related hospitalizations by Week-8. RESULTS We enrolled 112 patients who were randomly assigned to ePAL (N = 56) or usual care (N = 56). Patients utilized ePAL on average 2.1 times per week to report pain symptoms, and 47.6% reported their pain at least once per week over eight weeks. Patients randomized to ePAL reported lower pain scores at Week-4 (mean: 3.16 vs. 4.28, P = 0.010) and week-8 (mean:2.99 vs. 4.05, P = 0.017), compared to those receiving usual care. Participants randomized to ePAL were less likely to experience a pain-related hospitalization compared to those in the usual care group (7.1% vs. 23.2% P = 0.018) CONCLUSIONS: ePAL was associated with lower patient-reported pain and fewer pain-related hospitalizations compared to usual care in patients with advanced cancer. This study demonstrates the promise of digital therapeutics for improving patients' symptoms while reducing burdensome hospitalizations.
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Affiliation(s)
- Mihir Kamdar
- Massachusetts General Hospital (M.K., L.T., S.R., C.R., J.S.T., J.A.G., J.K., A.E.J., V.J.), Boston, Massachusetts, USA; Harvard Medical School (M.K., L.T., C.R., J.S.T., J.A.G., J.K., A.E.J., V.J.), Boston, Massachusetts, USA.
| | | | | | | | | | - Lara Traeger
- Massachusetts General Hospital (M.K., L.T., S.R., C.R., J.S.T., J.A.G., J.K., A.E.J., V.J.), Boston, Massachusetts, USA; Harvard Medical School (M.K., L.T., C.R., J.S.T., J.A.G., J.K., A.E.J., V.J.), Boston, Massachusetts, USA
| | - Simone Rinaldi
- Massachusetts General Hospital (M.K., L.T., S.R., C.R., J.S.T., J.A.G., J.K., A.E.J., V.J.), Boston, Massachusetts, USA
| | - Jacob Strand
- Medicine, Mayo Clinic (J.S.), Rochester, Minnesota, USA
| | - Christine Ritchie
- Massachusetts General Hospital (M.K., L.T., S.R., C.R., J.S.T., J.A.G., J.K., A.E.J., V.J.), Boston, Massachusetts, USA; Harvard Medical School (M.K., L.T., C.R., J.S.T., J.A.G., J.K., A.E.J., V.J.), Boston, Massachusetts, USA
| | - Jennifer S Temel
- Massachusetts General Hospital (M.K., L.T., S.R., C.R., J.S.T., J.A.G., J.K., A.E.J., V.J.), Boston, Massachusetts, USA; Harvard Medical School (M.K., L.T., C.R., J.S.T., J.A.G., J.K., A.E.J., V.J.), Boston, Massachusetts, USA
| | - Joseph A Greer
- Massachusetts General Hospital (M.K., L.T., S.R., C.R., J.S.T., J.A.G., J.K., A.E.J., V.J.), Boston, Massachusetts, USA; Harvard Medical School (M.K., L.T., C.R., J.S.T., J.A.G., J.K., A.E.J., V.J.), Boston, Massachusetts, USA
| | - Joseph Kvedar
- Massachusetts General Hospital (M.K., L.T., S.R., C.R., J.S.T., J.A.G., J.K., A.E.J., V.J.), Boston, Massachusetts, USA; Harvard Medical School (M.K., L.T., C.R., J.S.T., J.A.G., J.K., A.E.J., V.J.), Boston, Massachusetts, USA
| | - Areej El-Jawarhi
- Massachusetts General Hospital (M.K., L.T., S.R., C.R., J.S.T., J.A.G., J.K., A.E.J., V.J.), Boston, Massachusetts, USA; Harvard Medical School (M.K., L.T., C.R., J.S.T., J.A.G., J.K., A.E.J., V.J.), Boston, Massachusetts, USA
| | - Vicki Jackson
- Massachusetts General Hospital (M.K., L.T., S.R., C.R., J.S.T., J.A.G., J.K., A.E.J., V.J.), Boston, Massachusetts, USA; Harvard Medical School (M.K., L.T., C.R., J.S.T., J.A.G., J.K., A.E.J., V.J.), Boston, Massachusetts, USA
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12
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Armfield N, Elphinston R, Liimatainen J, Scotti Requena S, Eather CE, Edirippulige S, Ritchie C, Robins S, Sterling M. Development and Use of Mobile Messaging for Individuals With Musculoskeletal Pain Conditions: Scoping Review. JMIR Mhealth Uhealth 2024; 12:e55625. [PMID: 39141913 PMCID: PMC11358670 DOI: 10.2196/55625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 04/29/2024] [Accepted: 06/12/2024] [Indexed: 08/16/2024] Open
Abstract
BACKGROUND Population studies show that musculoskeletal conditions are a leading contributor to the total burden of healthy life lost, second only to cancer and with a similar burden to cardiovascular disease. Prioritizing the delivery of effective treatments is necessary, and with the ubiquity of consumer smart devices, the use of digital health interventions is increasing. Messaging is popular and easy to use and has been studied for a range of health-related uses, including health promotion, encouragement of behavior change, and monitoring of disease progression. It may have a useful role to play in the management and self-management of musculoskeletal conditions. OBJECTIVE Previous reviews on the use of messaging for people with musculoskeletal conditions have focused on synthesizing evidence of effectiveness from randomized controlled trials. In this review, our objective was to map the musculoskeletal messaging literature more broadly to identify information that may inform the design of future messaging interventions and summarize the current evidence of efficacy, effectiveness, and economics. METHODS Following a prepublished protocol developed using the Joanna Briggs Institute Manual for Evidence Synthesis, we conducted a comprehensive scoping review of the literature (2010-2022; sources: PubMed, CINAHL, Embase, and PsycINFO) related to SMS text messaging and app-based messaging for people with musculoskeletal conditions. We described our findings using tables, plots, and a narrative summary. RESULTS We identified a total of 8328 papers for screening, of which 50 (0.6%) were included in this review (3/50, 6% previous reviews and 47/50, 94% papers describing 40 primary studies). Rheumatic diseases accounted for the largest proportion of the included primary studies (19/40, 48%), followed by studies on multiple musculoskeletal conditions or pain sites (10/40, 25%), back pain (9/40, 23%), neck pain (1/40, 3%), and "other" (1/40, 3%). Most studies (33/40, 83%) described interventions intended to promote positive behavior change, typically by encouraging increased physical activity and exercise. The studies evaluated a range of outcomes, including pain, function, quality of life, and medication adherence. Overall, the results either favored messaging interventions or had equivocal outcomes. While the theoretical underpinnings of the interventions were generally well described, only 4% (2/47) of the papers provided comprehensive descriptions of the messaging intervention design and development process. We found no relevant economic evaluations. CONCLUSIONS Messaging has been used for the care and self-management of a range of musculoskeletal conditions with generally favorable outcomes reported. However, with few exceptions, design considerations are poorly described in the literature. Further work is needed to understand and disseminate information about messaging content and message delivery characteristics, such as timing and frequency specifically for people with musculoskeletal conditions. Similarly, further work is needed to understand the economic effects of messaging and practical considerations related to implementation and sustainability. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1136/bmjopen-2021-048964.
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Affiliation(s)
- Nigel Armfield
- RECOVER Injury Research Centre, The University of Queensland, Brisbane, Australia
- National Health and Medical Research Council (NHMRC) Centre for Research Excellence in Better Outcomes for Compensable Injury, Brisbane, Australia
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- STARS Education and Research Alliance, Surgical Treatment and Rehabilitation Service, The University of Queensland and Metro North Health, Brisbane, Australia
| | - Rachel Elphinston
- RECOVER Injury Research Centre, The University of Queensland, Brisbane, Australia
- National Health and Medical Research Council (NHMRC) Centre for Research Excellence in Better Outcomes for Compensable Injury, Brisbane, Australia
- STARS Education and Research Alliance, Surgical Treatment and Rehabilitation Service, The University of Queensland and Metro North Health, Brisbane, Australia
- School of Psychology, The University of Queensland, St Lucia, Australia
| | - Jenna Liimatainen
- RECOVER Injury Research Centre, The University of Queensland, Brisbane, Australia
- National Health and Medical Research Council (NHMRC) Centre for Research Excellence in Better Outcomes for Compensable Injury, Brisbane, Australia
- STARS Education and Research Alliance, Surgical Treatment and Rehabilitation Service, The University of Queensland and Metro North Health, Brisbane, Australia
| | - Simone Scotti Requena
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Chloe-Emily Eather
- RECOVER Injury Research Centre, The University of Queensland, Brisbane, Australia
- National Health and Medical Research Council (NHMRC) Centre for Research Excellence in Better Outcomes for Compensable Injury, Brisbane, Australia
- STARS Education and Research Alliance, Surgical Treatment and Rehabilitation Service, The University of Queensland and Metro North Health, Brisbane, Australia
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Australia
| | - Sisira Edirippulige
- Centre for Online Health, Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Carrie Ritchie
- RECOVER Injury Research Centre, The University of Queensland, Brisbane, Australia
| | - Sarah Robins
- RECOVER Injury Research Centre, The University of Queensland, Brisbane, Australia
| | - Michele Sterling
- RECOVER Injury Research Centre, The University of Queensland, Brisbane, Australia
- National Health and Medical Research Council (NHMRC) Centre for Research Excellence in Better Outcomes for Compensable Injury, Brisbane, Australia
- STARS Education and Research Alliance, Surgical Treatment and Rehabilitation Service, The University of Queensland and Metro North Health, Brisbane, Australia
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13
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Xiang XN, Wang ZZ, Hu J, Zhang JY, Li K, Chen QX, Xu FS, Zhang YW, He HC, He CQ, Zhu SY. Telehealth-Supported Exercise or Physical Activity Programs for Knee Osteoarthritis: Systematic Review and Meta-Analysis. J Med Internet Res 2024; 26:e54876. [PMID: 39094114 PMCID: PMC11329855 DOI: 10.2196/54876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 05/08/2024] [Accepted: 07/03/2024] [Indexed: 08/04/2024] Open
Abstract
BACKGROUND The integration of telehealth-supported programs in chronic disease management has become increasingly common. However, its effectiveness for individuals with knee osteoarthritis (KOA) remains unclear. OBJECTIVE This study aimed to assess the effectiveness of telehealth-supported exercise or physical activity programs for individuals with KOA. METHODS A comprehensive literature search encompassing Embase, MEDLINE, CENTRAL, Web of Science, PubMed, Scopus, PEDro, GreyNet, and medRxiv from inception to September 2023 was conducted to identify randomized controlled trials comparing telehealth-supported exercise or physical activity programs to a control condition for KOA. Data were extracted and qualitatively synthesized across eligible studies, and a meta-analysis was performed to evaluate the effects. The study was reported according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020. RESULTS In total, 23 studies met eligibility criteria, with 20 included in the meta-analysis. Results showed that telehealth-supported exercise or physical activity programs reduced pain (g=-0.39; 95% CI -0.67 to -0.11; P<.001), improved physical activity (g=0.13; 95% CI 0.03-0.23; P=.01), and enhanced physical function (g=-0.51; 95% CI -0.98 to -0.05; P=.03). Moreover, significant improvements in quality of life (g=0.25; 95% CI 0.14-0.36; P<.001), self-efficacy for pain (g=0.72; 95% CI 0.53-0.91; P<.001), and global improvement (odds ratio 2.69, 95% CI 1.41-5.15; P<.001) were observed. However, self-efficacy for physical function (g=0.14; 95% CI -0.26 to 0.53; P=.50) showed insignificant improvements. Subgroup analyses based on the World Health Organization classification of digital health (pain: χ22=6.5; P=.04 and physical function: χ22=6.4; P=.04), the type of teletechnology in the intervention group (pain: χ24=4.8; P=.31 and function: χ24=13.0; P=.01), and active or inactive controls (pain: χ21=5.3; P=.02 and physical function: χ21=3.4; P=.07) showed significant subgroup differences. CONCLUSIONS Telehealth-supported exercise or physical activity programs might reduce knee pain and improve physical activity, physical function, quality of life, self-efficacy, and global improvement in individuals with KOA. Future research should consider longer implementation durations and assess the feasibility of incorporating wearables and standardized components into large-scale interventions to evaluate the effects. TRIAL REGISTRATION PROSPERO CRD42022359658; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=359658.
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Affiliation(s)
- Xiao-Na Xiang
- Rehabilitation Medicine Center and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, China
- School of Rehabilitation Sciences, West China School of Medicine, Sichuan University, Chengdu, China
| | - Ze-Zhang Wang
- Rehabilitation Medicine Center and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, China
- School of Rehabilitation Sciences, West China School of Medicine, Sichuan University, Chengdu, China
| | - Jing Hu
- Rehabilitation Medicine Center and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, China
- School of Rehabilitation Sciences, West China School of Medicine, Sichuan University, Chengdu, China
| | - Jiang-Yin Zhang
- Rehabilitation Medicine Center and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, China
- School of Rehabilitation Sciences, West China School of Medicine, Sichuan University, Chengdu, China
| | - Ke Li
- Center of Statistical Research, School of Statistics, Southwestern University of Finance and Economics, Chengdu, China
- Joint Lab of Data Science and Business Intelligence, School of Statistics, Southwestern University of Finance and Economics, Chengdu, China
| | - Qi-Xu Chen
- Center of Statistical Research, School of Statistics, Southwestern University of Finance and Economics, Chengdu, China
- Joint Lab of Data Science and Business Intelligence, School of Statistics, Southwestern University of Finance and Economics, Chengdu, China
| | - Fa-Shu Xu
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China
| | - Yue-Wen Zhang
- Center of Statistical Research, School of Statistics, Southwestern University of Finance and Economics, Chengdu, China
- Joint Lab of Data Science and Business Intelligence, School of Statistics, Southwestern University of Finance and Economics, Chengdu, China
| | - Hong-Chen He
- Rehabilitation Medicine Center and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, China
- School of Rehabilitation Sciences, West China School of Medicine, Sichuan University, Chengdu, China
| | - Cheng-Qi He
- Rehabilitation Medicine Center and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, China
- School of Rehabilitation Sciences, West China School of Medicine, Sichuan University, Chengdu, China
| | - Si-Yi Zhu
- Rehabilitation Medicine Center and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, China
- School of Rehabilitation Sciences, West China School of Medicine, Sichuan University, Chengdu, China
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14
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Yadav S, Gold LS, Zaidi QH, Hwang R, Lu L, Wang G. Spinal fusion surgery use among adults with low back pain enrolled in a digital musculoskeletal program: an observational study. BMC Musculoskelet Disord 2024; 25:520. [PMID: 38970032 PMCID: PMC11225358 DOI: 10.1186/s12891-024-07573-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 06/06/2024] [Indexed: 07/07/2024] Open
Abstract
OBJECTIVES To compare 12-month spinal fusion surgery rates in the setting of low back pain among digital musculoskeletal (MSK) program participants versus a comparison cohort who only received usual care. STUDY DESIGN Retrospective cohort study with propensity score matched comparison cohort using commercial medical claims data representing over 100 million commercially insured lives. METHODS All study subjects experienced low back pain between January 2020 and December 2021. Digital MSK participants enrolled in the digital MSK low back program between January 2020 and December 2021. Non-participants had low back pain related physical therapy (PT) between January 2020 and December 2021. Digital MSK participants were matched to non-participants with similar demographics, comorbidities and baseline MSK-related medical care use. Spinal fusion surgery rates at 12 months post participation were compared. RESULTS Compared to non-participants, digital MSK participants had lower rates of spinal fusion surgery in the post-period (0.7% versus 1.6%; p < 0.001). Additionally, in the augmented inverse probability weighting (AIPW) model, digital MSK participants were found to have decreased odds of undergoing spinal fusion surgery (adjusted odds ratio: 0.64, 95% CI: 0.51-0.81). CONCLUSIONS This study provides evidence that participation in a digital MSK program is associated with a lower rate of spinal fusion surgery.
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Affiliation(s)
- Sandhya Yadav
- Clinical Research, Hinge Health, Inc., 455 Market Street, San Francisco, CA, 94105, USA.
| | - Laura S Gold
- Clinical Learning, Evidence and Research Center, University of Washington, Seattle, WA, USA
| | | | - Raymond Hwang
- Clinical Research, Hinge Health, Inc., 455 Market Street, San Francisco, CA, 94105, USA
| | - Louie Lu
- Clinical Research, Hinge Health, Inc., 455 Market Street, San Francisco, CA, 94105, USA
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15
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Han SH, Kong SH. A Pilot Study on the Efficacy of an App-Based Rehabilitation Counselling Program after Total Knee Arthroplasty. Healthcare (Basel) 2024; 12:1329. [PMID: 38998864 PMCID: PMC11241247 DOI: 10.3390/healthcare12131329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Revised: 06/26/2024] [Accepted: 07/01/2024] [Indexed: 07/14/2024] Open
Abstract
The aim of this study was to determine the effects of a novel app-based rehabilitation counselling program in patients recovering from total knee arthroplasty. In the app-based rehabilitation counselling program, a counselor provides one-on-one rehabilitation exercises and management-focused psychological counselling after total knee arthroplasty (TKA). This study included 42 patients, who were divided into three groups of 14 patients each: Group A, whose rehabilitation training was based on a guideline leaflet; Group B, whose rehabilitation was based on the app-based rehabilitation counselling program; and Group C, whose rehabilitation training was based on continuous passive motion combined with the app-based rehabilitation counselling program. To determine the effects of rehabilitation, the isokinetic knee muscle strength and knee joint range of motion were measured in addition to knee function tests such as the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and the visual analogue scale (VAS) for pain at two and three months after rehabilitation. The comparison of the means of the three groups was analyzed using one-way analysis of variance (ANOVA), with Group C showing significant variance in isokinetic knee muscle strength (p < 0.05), passive ROM (p < 0.01), and WOMAC (p < 0.05) after three months. As a result, this study confirmed the positive potential of the app-based rehabilitation counselling program.
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Affiliation(s)
- Sang-Ho Han
- Department of Orthopedic Surgery, Daechan Hospital, 590 Inju-Daero, Namdong-Gu, Incheon Metropolitan City 21570, Republic of Korea
| | - Se-Hee Kong
- Hospital Daechan Sports Medical Research Center, 590 Inju-Daero, Namdong-Gu, Incheon Metropolitan City 21570, Republic of Korea
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16
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Zhu D, Zhao J, Wang M, Cao B, Zhang W, Li Y, Zhang C, Han T. Rehabilitation Applications Based on Behavioral Therapy for People With Knee Osteoarthritis: Systematic Review. JMIR Mhealth Uhealth 2024; 12:e53798. [PMID: 38696250 PMCID: PMC11099817 DOI: 10.2196/53798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 02/07/2024] [Accepted: 03/14/2024] [Indexed: 05/04/2024] Open
Abstract
BACKGROUND The development of digital applications based on behavioral therapies to support patients with knee osteoarthritis (KOA) has attracted increasing attention in the field of rehabilitation. This paper presents a systematic review of research on digital applications based on behavioral therapies for people with KOA. OBJECTIVE This review aims to describe the characteristics of relevant digital applications, with a special focus on the current state of behavioral therapies, digital interaction technologies, and user participation in design. The secondary aim is to summarize intervention outcomes and user evaluations of digital applications. METHODS A systematic literature search was conducted using the keywords "Knee Osteoarthritis," "Behavior Therapy," and "Digitization" in the following databases (from January 2013 to July 2023): Web of Science, Embase, Science Direct, Ovid, and PubMed. The Mixed Methods Assessment Tool (MMAT) was used to assess the quality of evidence. Two researchers independently screened and extracted the data. RESULTS A total of 36 studies met the inclusion criteria and were further analyzed. Behavioral change techniques (BCTs) and cognitive behavioral therapy (CBT) were frequently combined when developing digital applications. The most prevalent areas were goals and planning (n=31) and repetition and substitution (n=27), which were frequently used to develop physical activity (PA) goals and adherence. The most prevalent combination strategy was app/website plus SMS text message/telephone/email (n=12), which has tremendous potential. This area of application design offers notable advantages, primarily manifesting in pain mitigation (n=24), reduction of physical dysfunction (n=21), and augmentation of PA levels (n=12). Additionally, when formulating design strategies, it is imperative to consider the perspectives of stakeholders, especially in response to the identified shortcomings in application design elucidated within the study. CONCLUSIONS The results demonstrate that "goals and planning" and "repetition and substitution" are frequently used to develop PA goals and PA behavior adherence. The most prevalent combination strategy was app/website plus SMS text message/telephone/email, which has tremendous potential. Moreover, incorporating several stakeholders in the design and development stages might enhance user experience, considering the distinct variations in their requirements. To improve the efficacy and availability of digital applications, we have several proposals. First, comprehensive care for patients should be ensured by integrating multiple behavioral therapies that encompass various aspects of the rehabilitation process, such as rehabilitation exercises and status monitoring. Second, therapists could benefit from more precise recommendations by incorporating additional intelligent algorithms to analyze patient data. Third, the implementation scope should be expanded from the home environment to a broader social community rehabilitation setting.
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Affiliation(s)
- Dian Zhu
- School of Design, Shanghai Jiao Tong University, Shanghai, China
| | - Jianan Zhao
- School of Design, Shanghai Jiao Tong University, Shanghai, China
| | - Mingxuan Wang
- School of Design, Shanghai Jiao Tong University, Shanghai, China
| | - Bochen Cao
- School of Design, Shanghai Jiao Tong University, Shanghai, China
| | - Wenhui Zhang
- School of Design, Shanghai Jiao Tong University, Shanghai, China
| | - Yunlong Li
- Department of Design, Jiangxi Science and Technology Normal University, Shanghai, China
| | - Chenqi Zhang
- School of Design, Shanghai Jiao Tong University, Shanghai, China
| | - Ting Han
- School of Design, Shanghai Jiao Tong University, Shanghai, China
- Institute of Medical Robotics, Shanghai Jiao Tong University, Shanghai, China
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Barnet-Hepples T, Dario A, Oliveira J, Maher C, Tiedemann A, Amorim A. Health coaching improves physical activity, disability and pain in adults with chronic non-cancer pain: a systematic review. J Physiother 2024; 70:115-123. [PMID: 38494402 DOI: 10.1016/j.jphys.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 12/18/2023] [Accepted: 01/29/2024] [Indexed: 03/19/2024] Open
Abstract
QUESTION What is the effect of health coaching on physical activity, disability, pain and quality of life compared with a non-active control in adults with chronic non-cancer pain? DESIGN Systematic review and meta-analysis of randomised controlled trials. Evidence was synthesised as standardised mean differences with 95% confidence intervals using random-effects models. Risk of bias was assessed using the revised Cochrane risk of bias tool. Grading of Recommendations Assessment, Development, and Evaluation (GRADE) was used to determine evidence certainty. DATA SOURCES MEDLINE, Embase, CENTRAL, CINAHL, Scopus and PEDro were searched from inception to November 2023. PARTICIPANTS Adults with chronic non-cancer pain. INTERVENTION Health coaching to increase physical activity. OUTCOME MEASURES Measures of physical activity, disability, pain and quality of life. RESULTS Twenty-six randomised trials (n = 4,403) were included. Trials had moderate to high risk of bias. Health coaching had a trivial to small effect on improving physical activity compared with control (15 trials; SMD 0.21, 95% CI 0.07 to 0.35; low certainty evidence). Health coaching had a small effect on improving disability (19 trials; SMD 0.25, 95% CI 0.17 to 0.32; moderate certainty evidence) and pain (19 trials; SMD 0.31, 95% CI 0.18 to 0.43; very low certainty evidence) compared with control. The effect of health coaching on quality of life was unclear due to significant imprecision in the effect estimate (five trials; SMD 0.19, 95% CI -0.14 to 0.53; moderate certainty evidence). CONCLUSION Health coaching promotes a trivial to small improvement in physical activity and small improvements in disability and pain in adults with chronic non-cancer pain. The effect of health coaching on quality of life remains unclear. REGISTRATION PROSPERO CRD42020182740.
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Affiliation(s)
- Talia Barnet-Hepples
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
| | - Amabile Dario
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Juliana Oliveira
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Institute for Musculoskeletal Health, Sydney Local Health District, Sydney, Australia
| | - Christopher Maher
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Institute for Musculoskeletal Health, Sydney Local Health District, Sydney, Australia
| | - Anne Tiedemann
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Institute for Musculoskeletal Health, Sydney Local Health District, Sydney, Australia
| | - Anita Amorim
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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Gitajn IL, Werth PM, Carlini AR, Bosse MJ, Gary JL, Firoozabadi R, Obremskey W, McKinley TO, Castillo RC, O’Toole RV, and METRC. Deep Surgical Site Infection after Fracture Has a Profound Effect on Functional Outcomes. JB JS Open Access 2024; 9:e23.00042. [PMID: 38196850 PMCID: PMC10773708 DOI: 10.2106/jbjs.oa.23.00042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2024] Open
Abstract
Background Fracture-related infection is one of the most challenging complications in orthopaedic trauma surgery. However, the effect of infection on functional and pain-related outcomes has not been well established. The aims of this study were to evaluate functional recovery for patients with fracture and a deep surgical site infection compared with patients with fracture without infection and to evaluate whether pain severity, social support, and preinjury mental health have a moderating effect on the magnitude and direction of the relationship between deep surgical site infection and functional recovery. Methods This is a secondary retrospective cohort study using prospectively collected data from the VANCO trial (Local Antibiotic Therapy to Reduce Infection After Operative Treatment of Fractures at High Risk of Infection) and the OXYGEN (Supplemental Perioperative Oxygen to Reduce Surgical Site Infection After High Energy Fracture Surgery) trial. In this study, 2,116 patients with tibial plateau, pilon, or calcaneal fractures at high risk for infection were included. Patients were divided into cohorts of patients who experienced a deep surgical site infection and those who did not. The primary outcome measure was the functional outcome using the Veterans RAND 12-Item Health Survey (VR-12). Results After controlling for covariates, deep surgical site infection was independently associated with functional outcome, with a 3.3-point reduction in the VR-12 Physical Component Score, and pain severity was independently associated with functional outcome, with a 2.5-point reduction in the VR-12 Physical Component Score. Furthermore, the Brief Pain Inventory pain severity demonstrated an important moderating effect on the relationship between infection and functional outcome. In patients with lower pain scores, infection had a large negative impact on functional outcome, whereas, in patients with higher pain scores, infection had no significant impact on functional outcome. Furthermore, the functional outcome in the entire cohort remains at only 61% of baseline. Conclusions This study documents the negative impact of postoperative infection on functional recovery after injury, as well as the novel finding of pain severity as an important moderating factor. This study emphasizes not only the importance of developing effective interventions designed to reduce postoperative infection, but also the role that factors that moderate pain severity plays in limiting recovery of physical function. Level of evidence Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
| | - Paul M. Werth
- Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | | | - Michael J. Bosse
- Atrium Health Musculoskeletal Institute, Charlotte, North Carolina
| | - Joshua L. Gary
- Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Reza Firoozabadi
- University of Washington Harborview Medical Center, Seattle, Washington
| | | | - Todd O. McKinley
- Indiana University School of Medicine, Indianapolis, Indiana and
| | - Renan C. Castillo
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Feng Y, Wu Y, Liu H, Bao T, Wang C, Wang Z, Huang J, Jiang Y, He C, Zhu S. Effect of the telemedicine-supported multicomponent exercise therapy in patients with knee osteoarthritis: study protocol for a randomized controlled trial. Trials 2023; 24:729. [PMID: 37964273 PMCID: PMC10647045 DOI: 10.1186/s13063-023-07749-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 10/25/2023] [Indexed: 11/16/2023] Open
Abstract
INTRODUCTION The rising prevalence of knee osteoarthritis is placing a considerable strain on the global healthcare system. To address this issue, telemedicine-supported multicomponent exercise therapy has emerged as a promising approach. This therapy combines exercise, patient education, and health coaching to empower knee osteoarthritis patients to manage their condition from the comfort of their homes. Nevertheless, there are some existing limitations in the current research on this approach, including challenges related to patient compliance and the absence of objective evaluation methods. METHODS AND ANALYSIS Patients diagnosed with knee osteoarthritis, who have not undergone knee surgery in the past year, will be recruited for a randomized controlled trial. The trial will include an intervention group and a control group. The intervention group will receive an mHealth app-based multicomponent exercise therapy, consisting of exercise therapy, patient education, and health coaching. Meanwhile, the control group will receive usual care, involving drug therapy and patient education. The primary outcome of the trial will be the measurement of pain intensity, assessed using a visual analog scale at baseline and at 4, 8, and 12 weeks of the post-intervention. To analyze the data, a two-factor, four-level repeated measures ANOVA will be used if the assumptions of homogeneity of variance and sphericity are met. If not, a mixed effects model will be employed. DISCUSSION The aim of the study is to evaluate the effectiveness of multicomponent exercise therapy aimed at enhancing pain self-management for knee osteoarthritis patients in the comfort of their own homes. The intervention incorporate wearable devices equipped with advanced deep learning systems to monitor patients' adherence to the prescribed at-home exercise regimen, as well as to track changes in outcomes before and after the exercise sessions. The findings from this trial have the potential to enhance both the accessibility and quality of care provided to knee osteoarthritis patients, offering valuable insights for future improvements in their treatment and management. TRIAL REGISTRATION Chinese Clinical Trials Registry, ChiCTR2300073688. Registered on 19 July 2023, https://www.chictr.org.cn/bin/project/edit?pid=199707 . World Health Organization International Clinical Trials Registry Platform, https://trialsearch.who.int/Trial2.aspx?TrialID=ChiCTR2300073688 .
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Affiliation(s)
- Yuan Feng
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China
- Department of Rehabilitation Medicine, West China Clinical Medical College, Sichuan University, Chengdu, China
| | - Yan Wu
- Department of Postgraduate Students, West China School of Medicine/West China Hospital, Sichuan University, Chengdu, China
- College of Marxism, Sichuan University, Chengdu, China
| | - Huizhen Liu
- Centre for Biostatistics, Design, Measurement and Evaluation (CBDME), West China Hospital, Sichuan University, Chengdu, China
| | - Tianjie Bao
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China
- Department of Rehabilitation Medicine, West China Clinical Medical College, Sichuan University, Chengdu, China
- Rehabilitation Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, China
| | - Chongyang Wang
- Department of Computer Science and Technology, Tsinghua University, No. 30, Shuangqing Road, Beijing, Haidian District, China
| | - Zezhang Wang
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China
- Department of Rehabilitation Medicine, West China Clinical Medical College, Sichuan University, Chengdu, China
| | - Jielei Huang
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China
- Department of Rehabilitation Medicine, West China Clinical Medical College, Sichuan University, Chengdu, China
| | - Yiwei Jiang
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China
- Department of Rehabilitation Medicine, West China Clinical Medical College, Sichuan University, Chengdu, China
| | - Chengqi He
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China.
- Department of Rehabilitation Medicine, West China Clinical Medical College, Sichuan University, Chengdu, China.
- Rehabilitation Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, China.
| | - Siyi Zhu
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China.
- Department of Rehabilitation Medicine, West China Clinical Medical College, Sichuan University, Chengdu, China.
- Rehabilitation Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, China.
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20
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Wang G, Lu L, Gold LS, Bailey JF. Opioid Initiation Within One Year After Starting a Digital Musculoskeletal (MSK) Program: An Observational, Longitudinal Study with Comparison Group. J Pain Res 2023; 16:2609-2618. [PMID: 37533561 PMCID: PMC10390711 DOI: 10.2147/jpr.s412081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 07/24/2023] [Indexed: 08/04/2023] Open
Abstract
Background In-person, conservative care may decrease opioid use for chronic musculoskeletal (MSK) pain, but the impact of digitally delivered conservative care on opioid use is unknown. This study examines associations between a digital MSK program and opioid initiation and prescriptions among opioid naive adults with chronic MSK pain. Methods This observational study used commercial medical and pharmacy claims data to compare digital MSK program members to matched physical therapy (PT) patients. Outcomes were any opioid prescriptions and opioid prescriptions per 100 participants within the 12-months after starting a digital MSK program. After propensity-score matching, we conducted multivariate regression models that controlled for demographic, comorbidity, and baseline MSK healthcare use. Results The study included 4195 members and 4195 matched PT patients. For opioid initiation, 7.89% (95% Confidence Interval [CI]: 7.07%, 8.71%) of members had opioid prescriptions within 12 months after starting the digital MSK program versus 13.64% (95% CI: 12.60%, 14.67%) of matched PT patients (p < 0.001). Members had significantly fewer opioid prescriptions (16.73 per 100 participants; 95% CI: 14.11, 19.36) versus PT patients (22.36 per 100 participants; 95% CI: 19.99, 24.73). Members had lower odds (OR: 0.52, 95% CI: 0.45, 0.60) of initiating opioids and significantly fewer prescriptions per 100 participants (beta: -6.40, 95% CI: -9.88, -2.93) versus PT patients after controlling for available confounding factors. Conclusion An MSK program that delivers conservative care digitally may be a promising approach for decreasing opioid initiation among individuals with chronic MSK pain given the limitations of the observational design and matching on only available covariates.
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Affiliation(s)
- Grace Wang
- Clinical Research, Hinge Health, Inc, San Francisco, CA, USA
| | - Louie Lu
- Clinical Research, Hinge Health, Inc, San Francisco, CA, USA
| | - Laura S Gold
- Clinical Learning, Evidence and Research Center, University of Washington, Seattle, WA, USA
| | - Jeannie F Bailey
- Orthopaedic Surgery, University of California, San Francisco, CA, USA
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21
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Davergne T, Meidinger P, Dechartres A, Gossec L. The Effectiveness of Digital Apps Providing Personalized Exercise Videos: Systematic Review With Meta-Analysis. J Med Internet Res 2023; 25:e45207. [PMID: 37440300 PMCID: PMC10375281 DOI: 10.2196/45207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 05/03/2023] [Accepted: 05/10/2023] [Indexed: 07/14/2023] Open
Abstract
BACKGROUND Among available digital apps, those providing personalized video exercises may be helpful for individuals undergoing functional rehabilitation. OBJECTIVE We aimed to assess the effectiveness of apps providing personalized video exercises to support rehabilitation for people with short- and long-term disabling conditions, on functional capacity, confidence in exercise performance, health care consumption, health-related quality of life, adherence, and adverse events. METHODS In this systematic review, we searched MEDLINE, CENTRAL, and Embase databases up to March 2022. All randomized controlled trials evaluating the effect of apps providing personalized video exercises to support rehabilitation for any condition requiring physical rehabilitation were included. Selection, extraction, and risk of bias assessment were performed by 2 independent reviewers. The primary outcome was functional capacity at the end of the intervention. The secondary outcomes included confidence in exercise performance, care consumption, health-related quality of life, adherence, and adverse events. A meta-analysis was performed where possible; the magnitude of the effect was assessed with the standardized mean difference (SMD). RESULTS From 1641 identified references, 10 papers (n=1050 participants, 93% adults) were included: 7 papers (n=906 participants) concerned musculoskeletal disorders and 3 (n=144 participants) concerned neurological disorders. Two (n=332 participants) were employee based. The apps were mostly commercial (7/10); the videos were mostly elaborated on by a physiotherapist (8/10). The duration of app use was 3-48 weeks. All included studies had a high overall risk of bias. Low-quality evidence suggested that the use of apps providing personalized video exercises led to a significant small to moderate improvement in physical function (SMD 0.35, 95% CI 0.19-0.51; Phet=.86; I2=0%) and confidence in exercise performance (SMD 0.67; 95% CI 0.37-0.96; Phet=.22; I2=33%). Because of the very low quality of the evidence, the effects on quality of life and exercise adherence were uncertain. Apps did not influence the rate of adverse events. CONCLUSIONS Apps providing personalized video exercises to support exercise performance significantly improved physical function and confidence in exercise performance. However, the level of evidence was low; more robust studies are needed to confirm these results. TRIAL REGISTRATION PROSPERO CRD42022323670; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=323670.
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Affiliation(s)
- Thomas Davergne
- Physical Medicine and Rehabilitation Department, Assistance Publique - Hôpitaux de Paris Lariboisière-Fernand-Widal, Université Paris Cité, Institut national de la santé et de la recherche médicale, Biologie de l'os et du cartilage, Paris, France
| | - Philippe Meidinger
- Université Grenoble Alpes, Centre national de la recherche scientifique, VetAgro Sup, Grenoble Institut polytechnique de Grenoble, Grenoble, France
| | - Agnès Dechartres
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Hôpital Pitié-Salpêtrière, Département de Santé
Publique, 75013, Paris, France
| | - Laure Gossec
- Rheumatology Department, Pitié-Salpêtrière Hospital, Assistance Publique - Hôpitaux de Paris, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Institut national de la santé et de la recherche médicale, Sorbonne Université, Paris, France
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Hasan F, Mudey A, Joshi A. Role of Internet of Things (IoT), Artificial Intelligence and Machine Learning in Musculoskeletal Pain: A Scoping Review. Cureus 2023; 15:e37352. [PMID: 37182066 PMCID: PMC10170184 DOI: 10.7759/cureus.37352] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 04/09/2023] [Indexed: 05/16/2023] Open
Abstract
Artificial intelligence (AI), Internet of Things (IoT), and machine learning (ML) have considerably increased in numerous critical medical sectors and significantly impacted our daily lives. Digital health interventions support cost-effective, accessible, and preferred interventions that meet time and resource constraints for large patient populations. Musculoskeletal conditions significantly impact society, the economy, and people's life. Adults with chronic neck and back pain are frequently the victims, rendering them physically unable to move. They often experience discomfort, necessitating them to take over-the-counter medications or painkilling gels. Technologies driven by AI have been suggested as an alternative approach to improve adherence to exercise therapy, which in turn helps patients undertake exercises every day to relieve pain associated with the musculoskeletal system. Even though there are many computer-aided evaluations available for physiotherapy rehabilitation, current approaches to computer-aided performance and monitoring lack flexibility and robustness. A thorough literature search was conducted using key databases like PubMed and Google Scholar, as well as Medical Subject Headings (MeSH) terms and related keywords. This research aimed to determine if AI-operated digital health therapies that use cutting-edge IoT, brain imaging, and ML technologies are beneficial in lowering pain and enhancing functional impairment in patients with musculoskeletal diseases. The secondary goal was to ascertain whether solutions driven by machine learning or artificial intelligence can improve exercise compliance and be viewed as a lifestyle choice.
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Affiliation(s)
- Fatima Hasan
- Community Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Wardha, IND
| | - Abhay Mudey
- Community Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Wardha, IND
| | - Abhishek Joshi
- Community Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Wardha, IND
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Scheer J, Areias AC, Molinos M, Janela D, Moulder R, Lains J, Bento V, Yanamadala V, Dias Correia F, Costa F. Engagement and Utilization of a Complete Remote Digital Care Program for Musculoskeletal Pain Management in Urban and Rural Areas Across the United States: Longitudinal Cohort Study. JMIR Mhealth Uhealth 2023; 11:e44316. [PMID: 36735933 PMCID: PMC10132051 DOI: 10.2196/44316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 01/12/2023] [Accepted: 02/02/2023] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Musculoskeletal (MSK) conditions are the number one cause of disability worldwide. Digital care programs (DCPs) for MSK pain management have arisen as alternative care delivery models to circumvent challenges in accessibility of conventional therapy. Despite the potential of DCPs to reduce inequities in accessing care, the outcomes of such interventions in rural and urban populations have yet to be studied. OBJECTIVE The aim of this study was to assess the impact of urban or rural residency on engagement and clinical outcomes after a multimodal DCP for MSK pain. METHODS This study consists of an ad hoc analysis of a decentralized single-arm investigation into engagement and clinical-related outcomes after a multimodal DCP in patients with MSK conditions. Patients were coded according to their zip codes to a specific rural-urban commuting area code and grouped into rural and urban cohorts. Changes in their engagement and clinical outcomes from baseline to program end were assessed. Latent growth curve analysis was performed to estimate change trajectories adjusting for the following covariates: age, gender, BMI, employment status, and pain acuity. Outcomes included engagement, self-reported pain, and the results of the Generalized Anxiety Disorder 7-item, Patient Health Questionnaire 9-item, and Work Productivity and Activity Impairment scales. A minimum clinically important difference (MCID) of 30% was considered for pain. RESULTS Patients with urban and rural residency across the United States participated in the program (n=9992). A 73.8% (7378/9992) completion rate was observed. Both groups reported high satisfaction scores and similar engagement with exercise sessions, with rural residents showing higher engagement with educational content (P<.001) and higher program completion rates (P=.02). All groups showed a significant improvement in all clinical outcomes, including pain, mental health, and work productivity, without statistically significant intergroup differences. The percentage of patients meeting the MCID was similar in both groups (urban: 67.1%, rural: 68.3%; P=.30). CONCLUSIONS This study advocates for the utility of a DCP in improving access to MSK care in urban and rural areas alike, showcasing its potential to promote health equity. High engagement, satisfaction, and completion rates were noted in both groups, as well as significant improvements in clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov NCT04092946; https://clinicaltrials.gov/ct2/show/NCT04092946.
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Affiliation(s)
- Justin Scheer
- Department of Neurological Surgery, University of California, San Francisco, CA, United States
| | | | | | | | - Robert Moulder
- Institute for Cognitive Science, University of Colorado Boulder, Boulder, CO, United States
| | - Jorge Lains
- Rovisco Pais Medical and Rehabilitation Centre, Coimbra, Portugal
- Faculty of Medicine, Coimbra University, Coimbra, Portugal
| | | | - Vijay Yanamadala
- Sword Health Inc, Draper, UT, United States
- Department of Neurosurgery, Hartford Healthcare Medical Group, Westport, CT, United States
- Department of Surgery, Frank H Netter School of Medicine, Quinnipiac University, Hamden, CT, United States
| | - Fernando Dias Correia
- Sword Health Inc, Draper, UT, United States
- Neurology Department, Centro Hospitalar e Universitário do Porto, Porto, Portugal
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Godziuk K, Prado CM, Quintanilha M, Forhan M. Acceptability and preliminary effectiveness of a single-arm 12-week digital behavioral health intervention in patients with knee osteoarthritis. BMC Musculoskelet Disord 2023; 24:129. [PMID: 36797720 PMCID: PMC9936108 DOI: 10.1186/s12891-023-06238-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 02/09/2023] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND Digital health interventions may improve osteoarthritis (OA) management. This study evaluated the acceptability and preliminary effectiveness of a multimodal digital nutrition, exercise, and mindfulness intervention in adults with knee OA. METHODS Adults with advanced knee OA and an orthopaedic referral were invited to self-enroll in a pragmatic 12-week single-arm intervention. OA-focused nutrition and exercise resources were delivered weekly by email, and secondary components accessed on-demand (web-platform, webinars, and nutrition consultation). Acceptability was assessed by qualitative interview data and completion rates. Preliminary effectiveness on clinical outcomes was assessed by change in health-related quality of life, well-being, mindfulness, self-efficacy, and interest in total knee arthroplasty (TKA) between baseline and 12-weeks. RESULTS N = 102 patients self-enrolled (73.5% female, age 64 ± 7 years, body mass index 32.9 ± 7.3 kg/m2); n = 53 completed the 12-week intervention (71.7% female, age 65 ± 7 years, body mass index 33.4 ± 6.3 kg/m2). Acceptability was demonstrated by positive perceptions of tailored intervention resources. In study completers, health-related quality of life components of pain and physical functioning domains improved at 12-weeks [change in SF36 4.4 (95%CI 0.2-8.6), p = 0.016, and 6.7 (95%CI 2.7-10.7), p < 0.001, respectively]. Self-efficacy for managing daily activities improved [change in PROMIS T-score 4.4 (95%CI 2.8-6.0), p < 0.001]. CONCLUSION A 12-week digital multimodal intervention for knee OA was acceptable to patients and shows preliminary effectiveness in improving self-efficacy, aspects of quality of life, and decreasing interest in TKA. Digital behavioral interventions for knee OA may be an acceptable approach to improve patient outcomes and OA self-management while potentially reducing utilization of costly health system resources.
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Affiliation(s)
- Kristine Godziuk
- Department of Agricultural, Food and Nutritional Science, Faculty of Agricultural, Life and Environmental Sciences, University of Alberta, 2-004 Li Ka Shing Centre, Edmonton, AB T6G 2P5 Canada
| | - Carla M. Prado
- Department of Agricultural, Food and Nutritional Science, Faculty of Agricultural, Life and Environmental Sciences, University of Alberta, 2-004 Li Ka Shing Centre, Edmonton, AB T6G 2P5 Canada
| | - Maira Quintanilha
- Department of Agricultural, Food and Nutritional Science, Faculty of Agricultural, Life and Environmental Sciences, University of Alberta, 2-004 Li Ka Shing Centre, Edmonton, AB T6G 2P5 Canada
| | - Mary Forhan
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON Canada
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Kamilu Sulaiman S, Wong AYL, Liangchi Li L, Fordjour Antwi-Afari M, Ou H, Wh Tsang H. The use of mobile health technology in the management of osteoarthritis: A scoping review with scientometric analyses. Int J Med Inform 2023; 170:104937. [PMID: 36493537 DOI: 10.1016/j.ijmedinf.2022.104937] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 11/18/2022] [Accepted: 11/23/2022] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Although mHealth technology is an emerging approach for enabling self-management/education of hip/knee osteoarthritis (OA) that may reduce burdens in primary and secondary care, no scoping review has been conducted to comprehensively review the scope of mHealth technology in managing hip/knee OA. This scoping review and scientometric analyses aimed to summarize the current state of research on the use of mHealth technology (mobile applications/web-based interventions) for self-management/education of adults with hip/knee OA, identify key research activities, and provide future directions on the development/usage of mHealth technology. METHODS The Arksey and O'Malley methodological framework was employed, augmented with scientometric analyses. Six databases were searched from inception to 31 May 2021. Findings were reported according to the PRISMA extension for scoping review. Co-word, co-author, and co-citation scientometric analyses were conducted to examine the social and intellectual connections of the research field (e.g., research hotspots and researcher collaborations). RESULTS Twenty mHealth programs for promoting self-management of hip/knee OA were identified. The programs mainly included exercises or directives on performance of exercises. Compared to no interventions, mHealth technology was usable and might be more effective in improving pain, physical function, and quality of life in individuals with OA. The scientometric analyses identified multiple co-occurring keywords that reflected conceptual properties of this research domain. Although some intellectual connections among authors, research articles, and journals were noted, there were insufficient international collaborations in this field. DISCUSSION While individual small-scale studies highlighted promising short-term effects of mHealth technology in self-managing hip/knee OA, many mHealth technologies were developed without clinicians' and/or patients' contributions. Future mHealth programs should be developed based on a strong theoretical background and professional inputs. The long-term benefits and cost-effectiveness of mHealth technologies, user experience, as well as cross-cultural adaptation of these technologies should be evaluated.
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Affiliation(s)
- Surajo Kamilu Sulaiman
- Bayero University Kano, Nigeria; Guangzhou Medical University, China; The Hong Kong Polytechnic University, Hong Kong.
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Scheer JK, Costa F, Janela D, Molinos M, Areias AC, Moulder RG, Lains J, Bento V, Yanamadala V, Correia FD. Sleep Disturbance in Musculoskeletal Conditions: Impact of a Digital Care Program. J Pain Res 2023; 16:33-46. [PMID: 36636267 PMCID: PMC9830709 DOI: 10.2147/jpr.s394421] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 12/16/2022] [Indexed: 01/06/2023] Open
Abstract
Background Musculoskeletal (MSK) pain is highly prevalent worldwide, resulting in significant disability, and comorbid sleep disturbances. Digital therapy for MSK pain can provide significant improvements in care access, alongside pain and disability reductions. However, studies on the effect of such programs on sleep are lacking. Purpose To evaluate the impact on pain-related sleep impairment after a 12-week remote multimodal digital care program (DCP) for MSK conditions. Patients and Methods This is an ad-hoc analysis of a decentralized single-arm study into engagement and clinical outcomes after a DCP for MSK rehabilitation. Patients were stratified by baseline sleep disturbance, based on sleep questions in the questionnaires: Oswestry Disability Index, Neck Disability Index, and the Quick Disabilities of the Arm, Shoulder and Hand questionnaire. Additional outcomes were pain, Generalized Anxiety Disorder 7-item scale, Patient Health 9-item questionnaire, Work Productivity, and Activity Impairment, and program engagement. Results At baseline, 5749 patients reported sleep disturbance (78.0% of eligible patients). These reported significantly worse clinical outcomes at baseline than patients without sleep disturbance (all p<0.001). Patients with comorbid sleep disturbance showed improvements in sleep, with a significant proportion reporting full recovery at program completion: 56% of patients with upper limb conditions (including 10% of patients with severe sleep disturbance at baseline), and 24% with spine conditions. These patients also reported significant improvements in all clinical outcomes at program completion. Engagement and satisfaction were high, and also higher than in patients without sleep impairment. Conclusion This is the first study of its kind investigating the effect of a completely remote DCP for MSK pain on sleep. Patients reporting comorbid sleep disturbance had significant improvement in sleep, alongside pain, mental health and work productivity at program completion. The results suggest that a DCP for MSK pain can improve sleep disturbances in patients with upper limb and spine conditions.
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Affiliation(s)
- Justin K Scheer
- Department of Neurological Surgery, University of California, San Francisco, CA, USA
| | | | | | | | | | - Robert G Moulder
- Institute for Cognitive Science, University of Colorado Boulder, Boulder, CO, USA
| | - Jorge Lains
- Rovisco Pais Medical and Rehabilitation Centre, Tocha, Portugal,Faculty of Medicine, Coimbra University, Coimbra, Portugal
| | | | - Vijay Yanamadala
- Sword Health, Inc, Draper, UT, USA,Department of Surgery, Quinnipiac University Frank H. Netter School of Medicine, Hamden, CT, USA,Department of Neurosurgery, Hartford Healthcare Medical Group, Westport, CT, USA
| | - Fernando Dias Correia
- Sword Health, Inc, Draper, UT, USA,Neurology Department, Centro Hospitalar e Universitário do Porto, Porto, Portugal,Correspondence: Fernando Dias Correia, Sword Health Inc, 13937 Sprague Lane Ste 100, Draper, UT, 84020, USA, Tel +1 385-308-8034, Fax +1 801-206-3433, Email
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Janela D, Costa F, Weiss B, Areias AC, Molinos M, Scheer JK, Lains J, Bento V, Cohen SP, Correia FD, Yanamadala V. Effectiveness of biofeedback-assisted asynchronous telerehabilitation in musculoskeletal care: A systematic review. Digit Health 2023; 9:20552076231176696. [PMID: 37325077 PMCID: PMC10262679 DOI: 10.1177/20552076231176696] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 05/02/2023] [Indexed: 06/17/2023] Open
Abstract
Background Musculoskeletal conditions are the leading cause of disability worldwide. Telerehabilitation may be a viable option in the management of these conditions, facilitating access and patient adherence. Nevertheless, the impact of biofeedback-assisted asynchronous telerehabilitation remains unknown. Objective To systematically review and assess the effectiveness of exercise-based asynchronous biofeedback-assisted telerehabilitation on pain and function in individuals with musculoskeletal conditions. Methods This systematic review followed Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. The search was conducted using three databases: PubMed, Scopus, and PEDro. Study criteria included articles written in English and published from January 2017 to August 2022, reporting interventional trials evaluating exercise-based asynchronous telerehabilitation using biofeedback in adults with musculoskeletal disorders. The risks of bias and certainty of evidence were appraised using the Cochrane tool and Grading of Recommendations, Assessment, Development, and Evaluation (GRADE), respectively. The results are narratively summarized, and the effect sizes of the main outcomes were calculated. Results Fourteen trials were included: 10 using motion tracker technology (N = 1284) and four with camera-based biofeedback (N = 467). Telerehabilitation with motion trackers yields at least similar improvements in pain and function in people with musculoskeletal conditions (effect sizes: 0.19-1.45; low certainty of evidence). Uncertain evidence exists for the effectiveness of camera-based telerehabilitation (effect sizes: 0.11-0.13; very low evidence). No study found superior results in a control group. Conclusions Asynchronous telerehabilitation may be an option in the management of musculoskeletal conditions. Considering its potential for scalability and access democratization, additional high-quality research is needed to address long-term outcomes, comparativeness, and cost-effectiveness and identify treatment responders.
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Affiliation(s)
| | | | - Brandon Weiss
- Lake Erie College of Osteopathic Medicine, Erie, PA, USA
| | | | | | - Justin K. Scheer
- Department of Neurological Surgery, University of California, San Francisco, CA, USA
| | - Jorge Lains
- Rovisco Pais Medical and Rehabilitation Centre, Tocha, Portugal
- Faculty of Medicine, Coimbra University, Coimbra, Portugal
| | | | - Steven P. Cohen
- Departments of Anesthesiology & Critical Care Medicine, Physical Medicine and Rehabilitation, Neurology, and Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Departments of Anesthesiology and Physical Medicine and Rehabilitation and Anesthesiology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Fernando Dias Correia
- Sword Health, Inc, Draper, UT, USA
- Neurology Department, Centro Hospitalar e Universitário do Porto, Porto, Portugal
| | - Vijay Yanamadala
- Sword Health, Inc, Draper, UT, USA
- Department of Surgery, Quinnipiac University Frank H. Netter School of Medicine, Hamden, CT, USA
- Department of Neurosurgery, Hartford Healthcare Medical Group, Westport, CT, USA
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Hadjiat Y, Arendt-Nielsen L. Digital health in pain assessment, diagnosis, and management: Overview and perspectives. FRONTIERS IN PAIN RESEARCH 2023; 4:1097379. [PMID: 37139342 PMCID: PMC10149799 DOI: 10.3389/fpain.2023.1097379] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 03/27/2023] [Indexed: 05/05/2023] Open
Abstract
Managing pain is essential for social, psychological, physical, and economic reasons. It is also a human right with a growing incidence of untreated and under-treated pain globally. Barriers to diagnosing, assessing, treating, and managing pain are complicated, subjective, and driven by patient, healthcare provider, payer, policy, and regulatory challenges. In addition, conventional treatment methods pose their own challenges including the subjectivity of assessment, lack of therapeutic innovation over the last decade, opioid use disorder and financial access to treatment. Digital health innovations hold much promise in providing complementary solutions to traditional medical interventions and may reduce cost and speed up recovery or adaptation. There is a growing evidence base for the use of digital health in pain assessment, diagnosis, and management. The challenge is not only to develop new technologies and solutions, but to do this within a framework that supports health equity, scalability, socio-cultural consideration, and evidence-based science. The extensive limits to physical personal interaction during the Covid-19 pandemic 2020/21 has proven the possible role of digital health in the field of pain medicine. This paper provides an overview of the use of digital health in pain management and argues for the use of a systemic framework in evaluating the efficacy of digital health solutions.
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Affiliation(s)
- Yacine Hadjiat
- Paris Saclay University, National Institute of Health and Medical Research, U987, Inserm, Paris, France
- Correspondence: Yacine Hadjiat
| | - Lars Arendt-Nielsen
- Center for Neuroplasticity and Pain (CNAP), Department of Health Science and Technology, School of Medicine, Aalborg University, Aalborg E, Denmark
- Department of Gastroenterology and Hepatology, Mech-Sense, Aalborg University Hospital, Aalborg C, Denmark
- Steno Diabetes Center North Denmark, Clinical Institute, Aalborg University Hospital, Aalborg, Denmark
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Chen T, Or CK. Perceptions of a machine learning-based lower-limb exercise training system among older adults with knee pain. Digit Health 2023; 9:20552076231186069. [PMID: 37426581 PMCID: PMC10328003 DOI: 10.1177/20552076231186069] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 06/16/2023] [Indexed: 07/11/2023] Open
Abstract
Objective To facilitate the older adults with knee pain to perform exercises and improve knee health, we proposed the design of a machine learning-based system for lower-limb exercise training that features three main components: video demonstration of exercises, real-time movement feedback, and tracking of exercise progress. At this early stage of design, we aimed to examine the perceptions of a paper-based prototype among older adults with knee pain and investigate the factors that may influence their perceptions of the system. Methods A cross-sectional survey of the participants' (N = 94) perceptions of the system was conducted using a questionnaire, which assessed their perceived effects of the system, perceived ease of use of the system, attitude toward the system, and intention to use the system. Ordinal logistic regression was conducted to examine whether the participants' perceptions of the system were influenced by their demographic and clinical characteristics, physical activity level, and exercise experience. Results The participants' responses to the perception statements exhibited consensus agreement (≥ 75%). Age, gender, duration of knee pain, knee pain intensity, experience with exercise therapy, and experience with technology-supported exercise programs were significantly associated with the participants' perceptions of the system. Conclusions Our results demonstrate that the system appears promising for use by older adults to manage their knee pain. Therefore, it is needed to develop a computer-based system and further investigate its usability, acceptance, and clinical effectiveness.
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Affiliation(s)
- Tianrong Chen
- Department of Industrial and Manufacturing Systems Engineering, The University of Hong Kong, Hong Kong, China
| | - Calvin Kalun Or
- Department of Industrial and Manufacturing Systems Engineering, The University of Hong Kong, Hong Kong, China
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Miró J, Lleixà-Daga M, de la Vega R, Llorens-Vernet P, Jensen MP. A Mobile Application to Help Self-Manage Pain Severity, Anxiety, and Depressive Symptoms in Patients with Fibromyalgia Syndrome: A Pilot Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12026. [PMID: 36231327 PMCID: PMC9566351 DOI: 10.3390/ijerph191912026] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 09/16/2022] [Accepted: 09/21/2022] [Indexed: 06/16/2023]
Abstract
Treatment for individuals with fibromyalgia syndrome (FMS) is complex and is not always accessible to those who could benefit. The aim of this study was to conduct a preliminary evaluation of a mobile-app-delivered, cognitive behavioral treatment (CBT)-based intervention in helping adults self-manage fibromyalgia symptoms. A total of 100 adults with FMS (M [SD] age = 49.81, [9.99] years; 94% women) were given access to the digital treatment program and downloaded the app. Pain severity, anxiety symptoms, depression symptoms, fatigue, and sleep quality were assessed at pre-treatment, post-treatment, and 3-month follow-up. Fifty-three of the potential participants completed the 47-day treatment. Data showed significant improvements in pain severity (p = 0.007, d = 0.43), anxiety (p = 0.011, d = 0.40) and depressive symptoms (p = 0.001, d = 0.50) from pre-treatment to post-treatment. The effect sizes associated with app use are consistent with improvements seen in previously published clinical trials of CBT for FMS. Improvements were generally maintained, although there was some decrease in the outcomes from post-treatment to the 3-month follow-up. Most participants reported that they were very satisfied with the app. The use of the app was associated with similar levels of improvements found with in-person CBT treatment for FMS. Research to evaluate the effectiveness of the app in a controlled trial is warranted.
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Affiliation(s)
- Jordi Miró
- Universitat Rovira i Virgili, Carretera de Valls, 43007 Tarragona, Spain
- Unit for the Study and Treatment of Pain—ALGOS, Research Center for Behavior Assessment (CRAMC), Department of Psychology, Institut d’Investigació Sanitària Pere Virgili, 43007 Tarragona, Spain
| | - Meritxell Lleixà-Daga
- Universitat Rovira i Virgili, Carretera de Valls, 43007 Tarragona, Spain
- Unit for the Study and Treatment of Pain—ALGOS, Research Center for Behavior Assessment (CRAMC), Department of Psychology, Institut d’Investigació Sanitària Pere Virgili, 43007 Tarragona, Spain
| | - Rocío de la Vega
- Faculty of Psychology, Andalucía Tech. Campus de Teatinos, Universidad de Málaga, 29071 Málaga, Spain
- Biomedical Research Institute of Málaga (IBIMA), Avda. Jorge Luis Borges n°15, Bl.3 Pl.3, 29010 Málaga, Spain
| | - Pere Llorens-Vernet
- Universitat Rovira i Virgili, Carretera de Valls, 43007 Tarragona, Spain
- Unit for the Study and Treatment of Pain—ALGOS, Research Center for Behavior Assessment (CRAMC), Department of Psychology, Institut d’Investigació Sanitària Pere Virgili, 43007 Tarragona, Spain
| | - Mark P. Jensen
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA 98195, USA
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Valentijn PP, Tymchenko L, Jacobson T, Kromann J, Biermann CW, AlMoslemany MA, Arends RY. Digital Health Interventions for Musculoskeletal Pain Conditions: Systematic Review and Meta-analysis of Randomized Controlled Trials. J Med Internet Res 2022; 24:e37869. [PMID: 36066943 PMCID: PMC9490534 DOI: 10.2196/37869] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 05/17/2022] [Accepted: 07/25/2022] [Indexed: 11/24/2022] Open
Abstract
Background Digital health solutions can provide populations with musculoskeletal pain with high-reach, low-cost, easily accessible, and scalable patient education and self-management interventions that meet the time and resource restrictions. Objective The main objective of this study was to determine the effectiveness of digital health interventions for people with musculoskeletal pain conditions (ie, low back pain, neck pain, shoulder pain, knee pain, elbow pain, ankle pain, and whiplash). Methods A systematic review and meta-analysis was conducted. We searched PubMed and Cochrane Central Register of Controlled Trials (from 1974 to August 2021) and selected randomized controlled trials of digital health interventions in the target population of patients with musculoskeletal pain with a minimum follow-up of 1 month. A total of 2 researchers independently screened and extracted the data. Results A total of 56 eligible studies were included covering 9359 participants, with a mean follow-up of 25 (SD 15.48) weeks. In moderate-quality evidence, digital health interventions had a small effect on pain (standardized mean difference [SMD] 0.19, 95% CI 0.06-0.32), disability (SMD 0.14, 95% CI 0.03-0.25), quality of life (SMD 0.22, 95% CI 0.07-0.36), emotional functioning (SMD 0.24, 95% CI 0.12-0.35), and self-management (SMD 0.14, 95% CI 0.05-0.24). Conclusions Moderate-quality evidence supports the conclusion that digital health interventions are effective in reducing pain and improving functioning and self-management of musculoskeletal pain conditions. Low-quality evidence indicates that digital health interventions can improve the quality of life and global treatment. Little research has been conducted on the influence of digital health on expenses, knowledge, overall improvement, range of motion, muscle strength, and implementation fidelity. Trial Registration PROSPERO CRD42022307504; https://tinyurl.com/2cd25hus
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Affiliation(s)
- Pim Peter Valentijn
- Essenburgh Research & Consultancy, Essenburgh Group, Harderwijk, Netherlands.,Department of Health Services Research, School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
| | - Liza Tymchenko
- Essenburgh Research & Consultancy, Essenburgh Group, Harderwijk, Netherlands
| | | | | | | | | | - Rosa Ymkje Arends
- Essenburgh Research & Consultancy, Essenburgh Group, Harderwijk, Netherlands.,University of Applied Sciences Utrecht, Utrecht, Netherlands
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Kaul U, Scher C, Henderson CR, Kim P, Dyhrberg M, Rudin V, Lytle M, Bundy N, Reid MC. A mobile health + health coaching application for the management of chronic non-cancer pain in older adults: Results from a pilot randomized controlled study. FRONTIERS IN PAIN RESEARCH 2022; 3:921428. [PMID: 35959237 PMCID: PMC9362151 DOI: 10.3389/fpain.2022.921428] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 07/07/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction The rapid growth of mobile health (mHealth) devices holds substantial potential for improving care and care outcomes in aging adults with chronic non-cancer pain (CNCP), however, research evaluating these devices in older adults remains limited. Objective To ascertain the feasibility and preliminary efficacy of an mHealth intervention (Mymee) that combines symptom, diet, and behavior tracking via a smartphone application with data analytics to detect associations between symptoms and lifestyle factors along with weekly health coaching sessions to mitigate CNCP in adults 55 years of age and older. Methods Participants (N = 31) in this pilot study were recruited from one primary care practice in New York City and randomized to an intervention [app + up to 12 health coaching sessions (scheduled approximately once weekly) + usual care] or a control (app + usual care) arm. Feasibility measures included recruitment (proportion of eligible persons who enrolled) and retention rates (proportion of subjects completing a follow-up assessment) as well as adherence with the weekly coaching sessions and logging daily data on the app. Efficacy outcomes (e.g., pain intensity, self-efficacy, disability, anxiety) were assessed at baseline and follow-up (~16 weeks after baseline). Descriptive statistics were obtained and general linear mixed models used for primary analyses. Results Participants had a mean (standard deviation) age of 67.32 (9.17) and were mostly female (61%). Feasibility outcomes were mixed as evidenced by recruitment and retention rates of 74% and 65%, respectively. The mean number of weekly coaching sessions attended by intervention participants was 6.05 (SD = 5.35), while the average number of days logging data on the app was 44.82 (34.02). We found a consistent trend in favor of the intervention, where pain intensity, affect, and quality of life measures improved considerably more among intervention (vs. control) participants. Finally, the proportion of participants with GAD-7 scores at follow up decreased by 0.35 to 0, whereas controls did not change, a significant effect in favor of the intervention (p = 0.02). Conclusions This study supports the need for future research that seeks to enhance feasibility outcomes and confirm the efficacy of the Mymee intervention among aging adults with CNCP.
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Affiliation(s)
- Usha Kaul
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medical Center, New York, NY, United States
| | - Clara Scher
- Rutgers School of Social Work, New Brunswick, NJ, United States
| | | | - Patricia Kim
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medical Center, New York, NY, United States
| | | | | | | | | | - M. Carrington Reid
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medical Center, New York, NY, United States
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Aglio LS, Mezzalira E, Mendez-Pino L, Corey SM, Fields KG, Abbakar R, Baez LA, Kelly-Aglio NJ, Vetter T, Jamison RN, Edwards RR. Surgical Prehabilitation: Strategies and Psychological Intervention to Reduce Postoperative Pain and Opioid Use. Anesth Analg 2022; 134:1106-1111. [PMID: 35427271 DOI: 10.1213/ane.0000000000005963] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Linda S Aglio
- From the Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.,Computational Neurosurgical Outcome Center, Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Elisabetta Mezzalira
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Laura Mendez-Pino
- From the Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Sarah M Corey
- From the Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Kara G Fields
- From the Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Reem Abbakar
- From the Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Leah A Baez
- From the Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Nicole J Kelly-Aglio
- Computational Neurosurgical Outcome Center, Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Thomas Vetter
- Department of Surgery and Perioperative Care, Dell Medical School at the University of Texas at Austin, Austin, Texas
| | - Robert N Jamison
- From the Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Robert R Edwards
- From the Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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McHugh C, Kostic A, Katz J, Losina E. Effectiveness of remote exercise programs in reducing pain for patients with knee osteoarthritis: A systematic review of randomized trials. OSTEOARTHRITIS AND CARTILAGE OPEN 2022; 4:100264. [DOI: 10.1016/j.ocarto.2022.100264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 03/30/2022] [Accepted: 04/28/2022] [Indexed: 12/26/2022] Open
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Agnew JMR, Hanratty CE, McVeigh JG, Nugent C, Kerr DP. An Investigation Into the Use of mHealth in Musculoskeletal Physiotherapy: Scoping Review. JMIR Rehabil Assist Technol 2022; 9:e33609. [PMID: 35275089 PMCID: PMC8956993 DOI: 10.2196/33609] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 12/14/2021] [Accepted: 01/24/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Musculoskeletal physiotherapy provides conservative management for a range of conditions. Currently, there is a lack of engagement with exercise programs because of the lack of supervision and low self-efficacy. The use of mobile health (mHealth) interventions could be a possible solution to this problem, helping promote self-management at home. However, there is little evidence for musculoskeletal physiotherapy on the most effective forms of mHealth. OBJECTIVE The aim of this review is to investigate the literature focusing on the use of mHealth in musculoskeletal physiotherapy and summarize the evidence. METHODS A scoping review of 6 peer-reviewed databases was conducted in March 2021. No date limits were applied, and only articles written in the English language were selected. A reviewer screened all the articles, followed by 2 additional researchers screening a random sample before data extraction. RESULTS Of the 1393 studies, 28 (2.01%) were identified. Intervention characteristics comprised stretching and strengthening exercises, primarily for degenerative joint pain and spinal conditions (5/28, 18%). The most reported use of mHealth included telephone and videoconferencing calls to provide a home exercise program or being used as an adjunct to physiotherapy musculoskeletal assessment (14/28, 50%). Although patient satisfaction with mHealth was reported to be high, reasons for disengagement included a lack of high-quality information and poor internet speeds. Barriers to clinical uptake included insufficient training with the intervention and a lack of time to become familiar. CONCLUSIONS mHealth has some benefits regarding treatment adherence and can potentially be as effective as normal physiotherapy care while being more cost-effective. The current use of mHealth is most effective when ongoing feedback from a health care professional is available.
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Affiliation(s)
- Jonathon M R Agnew
- Discipline in Physiotherapy, School of Life and Health Sciences, University of Ulster, Newtownabbey, United Kingdom
| | - Catherine E Hanratty
- Discipline in Physiotherapy, School of Life and Health Sciences, University of Ulster, Newtownabbey, United Kingdom
| | - Joseph G McVeigh
- Discipline of Physiotherapy, School of Clinical Therapies, College of Medicine and Health, University College Cork, Cork, Ireland
| | - Chris Nugent
- Discipline in Computing, School of Computing, University of Ulster, Newtownabbey, United Kingdom
| | - Daniel P Kerr
- Discipline in Physiotherapy, School of Life and Health Sciences, University of Ulster, Newtownabbey, United Kingdom
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Gruner MP, Hogaboom N, Hasley I, Hoffman J, Gonzalez-Carta K, Cheville AL, Li Z, Sellon JL. Prospective, Single-blind, Randomized Controlled Trial to Evaluate the Effectiveness of a Digital Exercise Therapy Application Compared With Conventional Physical Therapy for the Treatment of Nonoperative Knee Conditions. Arch Rehabil Res Clin Transl 2022; 3:100151. [PMID: 34977534 PMCID: PMC8683841 DOI: 10.1016/j.arrct.2021.100151] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Objective To evaluate the effectiveness and adherence of a home exercise therapy program using a digital exercise therapy application (DETA) compared with conventional physical therapy (PT). Design Parallel group, randomized controlled trial. Setting Two clinics in a tertiary care academic center. Participants Participants (N=60) were enrolled within 1 week after a provider visit for knee pain. Inclusion criteria: age 18-75 years, knee pain diagnosis, and clinician-prescribed PT. Interventions Participants were randomized to complete either an 8-week intervention of conventional PT (enrolled n=29; complete n=26) or the DETA (enrolled n=31; completed n=24). Main Outcome Measures Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Interference (PI) and Physical Function (PF) scores implemented via computer adaptive tests; number of exercise sessions completed per week (adherence). Results Compared with the PT group, the DETA group reported significant decreases in PROMIS-PI scores (−6.1±6.7 vs −1.5±6.6, P<.05, d=0.78) and increases in PROMIS-PF scores (6.0±6.6 vs −0.8±5.8, P<.01, d=0.89) after 8 weeks. No group differences in adherence were observed (P>.05). Conclusions Use of this DETA resulted in greater pain and functional improvements compared with PT, with no differences in adherence. It is possible this application may be a viable alternative to conventional PT in certain cases. A larger sample from various geographic locations is needed to improve generalizability and for subgroup analysis. Further investigation is warranted to determine the factors responsible for the differences observed between the groups.
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Affiliation(s)
- Marc P. Gruner
- Department of Physical Medicine and Rehabilitation, Mayo Clinic College of Medicine and Science, Rochester, MN
- Corresponding author Marc P. Gruner, DO, MBA, 6608 Rivertrail Ct, Bethesda, MD 20817.
| | - Nathan Hogaboom
- Center for Spinal Cord Injury Research, Kessler Foundation, West Orange, NJ
- Center for Outcomes and Assessment Research, Kessler Foundation, West Orange, NJ
| | - Ike Hasley
- Department of Physical Medicine and Rehabilitation, Mayo Clinic College of Medicine and Science, Rochester, MN
| | - Jared Hoffman
- Department of Physical Medicine and Rehabilitation, Mayo Clinic College of Medicine and Science, Rochester, MN
| | - Karina Gonzalez-Carta
- Department of Physical Medicine and Rehabilitation, Mayo Clinic College of Medicine and Science, Rochester, MN
| | - Andrea L. Cheville
- Department of Physical Medicine and Rehabilitation, Mayo Clinic College of Medicine and Science, Rochester, MN
| | - Zhuo Li
- Division of Biomedical Statistics and Informatics, Mayo Clinic College of Medicine and Science, Rochester, MN
| | - Jacob L. Sellon
- Department of Physical Medicine and Rehabilitation, Mayo Clinic College of Medicine and Science, Rochester, MN
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Tan BY, Thach T, Munro YL, Skou ST, Thumboo J, Car J, Car LT. Complex Lifestyle and Psychological Intervention in Knee Osteoarthritis: Scoping Review of Randomized Controlled Trials. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:12757. [PMID: 34886480 PMCID: PMC8657138 DOI: 10.3390/ijerph182312757] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 11/23/2021] [Accepted: 11/30/2021] [Indexed: 01/21/2023]
Abstract
Knee osteoarthritis (OA) causes pain, disability and poor quality of life in the elderly. The primary aim was to identify and map out the current evidence for randomised controlled trials (RCTs) on complex lifestyle and psychosocial interventions for knee OA. The secondary aim was to outline different components of complex lifestyle and psychosocial interventions. Our scoping review searched five databases from 2000 to 2021 where complex lifestyle or psychosocial interventions for patients with knee OA were compared to other interventions. Screening and data extraction were performed by two review authors independently and discrepancies resolved through consensus and in parallel with a third reviewer. A total of 38 articles were selected: 9 studied the effectiveness of psychological interventions; 11 were on self-management and lifestyle interventions; 18 looked at multifaceted interventions. This review highlights the substantial variation in knee OA interventions and the overall lack of quality in the current literature. Potential areas of future research, including identifying prognostic social factors, stratified care models, transdisciplinary care delivery and technology augmented interventions, have been identified. Further high-quality RCTs utilizing process evaluations and economic evaluation in accordance with the MRC guidelines are critical for the development of evidence-based knee OA programs globally.
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Affiliation(s)
- Bryan Yijia Tan
- Department of Orthopaedic Surgery, Woodlands Health Campus, Singapore 768024, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Singapore; (Y.L.M.); (J.C.); (L.T.C.)
| | - Tivona Thach
- Faculty of Medicine, University of New South Wales, Sydney, NSW 2052, Australia;
| | - Yasmin Lynda Munro
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Singapore; (Y.L.M.); (J.C.); (L.T.C.)
| | - Soren Thorgaard Skou
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, 5230 Odense, Denmark;
- Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, 4200 Slagelse, Denmark
| | - Julian Thumboo
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore 169608, Singapore;
| | - Josip Car
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Singapore; (Y.L.M.); (J.C.); (L.T.C.)
| | - Lorainne Tudor Car
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Singapore; (Y.L.M.); (J.C.); (L.T.C.)
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Cudejko T, Button K, Willott J, Al-Amri M. Applications of Wearable Technology in a Real-Life Setting in People with Knee Osteoarthritis: A Systematic Scoping Review. J Clin Med 2021; 10:5645. [PMID: 34884347 PMCID: PMC8658504 DOI: 10.3390/jcm10235645] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 11/25/2021] [Accepted: 11/29/2021] [Indexed: 12/12/2022] Open
Abstract
With the growing number of people affected by osteoarthritis, wearable technology may enable the provision of care outside a traditional clinical setting and thus transform how healthcare is delivered for this patient group. Here, we mapped the available empirical evidence on the utilization of wearable technology in a real-world setting in people with knee osteoarthritis. From an analysis of 68 studies, we found that the use of accelerometers for physical activity assessment is the most prevalent mode of use of wearable technology in this population. We identify low technical complexity and cost, ability to connect with a healthcare professional, and consistency in the analysis of the data as the most critical facilitators for the feasibility of using wearable technology in a real-world setting. To fully realize the clinical potential of wearable technology for people with knee osteoarthritis, this review highlights the need for more research employing wearables for information sharing and treatment, increased inter-study consistency through standardization and improved reporting, and increased representation of vulnerable populations.
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Affiliation(s)
- Tomasz Cudejko
- School of Healthcare Sciences, College of Biomedical and Life Sciences, Cardiff University, College House, King George V Drive East, Heath Park, Cardiff CF14 4EP, UK; (K.B.); (J.W.); (M.A.-A.)
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Bjornaraa J, Bowers A, Mino D, Choice D, Metz D, Wagner K. Effects of a Remotely Delivered Cognitive Behavioral Coaching Program on the Self-Rated Functional Disability of Participants with Low Back Pain. Pain Manag Nurs 2021; 23:397-410. [PMID: 34706832 DOI: 10.1016/j.pmn.2021.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 06/28/2021] [Accepted: 08/10/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE A remotely delivered cognitive behavioral coaching (CBC) program was offered as a service benefit for commercial health plan members with low back pain (LBP). This study describes changes in self-rated functional disability in a sample of plan members participating in the program (N=423). METHODS Independent measures included demographics, length of program enrollment, total CBC sessions, and baseline self-reported patient activation and presenteeism levels. Participants rated their functional disability level due to LBP using the Oswestry Disability Index (ODI). Dependent outcomes quantified change in participant functional disability rating (final ODI score minus baseline ODI score). Nonparametric tests compare differences between groups and within-group ODI score change. Two generalized linear models test for associations between independent variables and the ODI change score. RESULTS A significant difference between baseline and final ODI scores was observed at the overall program level (p<.001) and within all independent variable categories of interest. Over 68% of total participants (n=289) reported improved functional ability from baseline to final (decrease in ODI score). Participants who completed more CBC sessions demonstrated significantly greater improvement in functional ability (p=.038) compared to those who completed fewer sessions. Participants aged 55 and older were significantly more likely to show deterioration in functional ability from baseline to final (p=.021). CONCLUSION Outcomes suggest that program participation can influence self-rated functional disability in the management of LBP.
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Affiliation(s)
- Jaynie Bjornaraa
- American Specialty Health, Carmel, IN; Doctor of Physical Therapy Program, St. Catherine University, St. Paul, MN.
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Noutsios CD, Boisvert-Plante V, Laberge E, Perez J, Ingelmo P. The Telemedicine-Based Pediatric Examination of the Back and Lower Limbs: A Narrative Review. J Pain Res 2021; 14:2959-2979. [PMID: 34584449 PMCID: PMC8464344 DOI: 10.2147/jpr.s329173] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 09/03/2021] [Indexed: 12/20/2022] Open
Abstract
The COVID-19 pandemic has accelerated the transition to virtual healthcare while also prompting an abundance of new literature highlighting telemedicine's capabilities and limitations for various medical applications, notably musculoskeletal examinations. Telemedicine provides an opportunity to deliver timely patient- and family-centred care while maintaining physical distancing and improving access to remote communities. This review aims to narrate the current state of the literature on telemedicine applied in the context of a musculoskeletal examination for children aged 3 to 18 years. The PubMed and ScienceDirect databases were searched for relevant articles from January 2015 to August 2021 using a combination of keywords and nested searches. The general examination components relevant to the back and lumbosacral spine, hip, knee, ankle/foot, and gait are described. These components include inspection, palpation, range of motion, motor, and sensory examination as well as special testing. There is general feasibility, validity, and substantial reliability in performing most examination components, and primary diagnoses established virtually were found to be either the same or similar in the vast majority of cases. Despite the current literature focusing mainly on adult populations, we describe how each aspect of the exam can be reliably incorporated into a virtual appointment specific to the pediatric population. Currently available smartphone-based applications that measure joint range of motion were generally found to have high reliability and validity. Caregivers are needed for most of the consultation, especially in younger children, but select physical exam maneuvers can be self-performed by older children and adolescents alone. By providing an overview of the available smartphone tools as well as the reliability and validity of remote assessments, this review not only establishes a foundation for a structured pediatric musculoskeletal examination, but also aims to increase providers' confidence in incorporating telemedicine into their practice.
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Affiliation(s)
| | | | - Erika Laberge
- Edward’s Family Interdisciplinary Centre for Pediatric Complex Pain, Montreal Children’s Hospital (McGill University Health Centre), Montreal, QC, Canada
| | - Jordi Perez
- Alan Edwards Pain Management Unit, Montreal General Hospital (McGill University Health Centre), Montreal, QC, Canada
- Alan Edwards Centre for Pain Research, McGill University, Montreal, QC, Canada
| | - Pablo Ingelmo
- Edward’s Family Interdisciplinary Centre for Pediatric Complex Pain, Montreal Children’s Hospital (McGill University Health Centre), Montreal, QC, Canada
- Alan Edwards Centre for Pain Research, McGill University, Montreal, QC, Canada
- Research Institute, McGill University Health Centre, Montreal, QC, Canada
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Shah N, Costello K, Mehta A, Kumar D. Applications of Digital Health Technologies in Knee Osteoarthritis: A Narrative Review (Preprint). JMIR Rehabil Assist Technol 2021; 9:e33489. [PMID: 35675102 PMCID: PMC9218886 DOI: 10.2196/33489] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 01/12/2022] [Accepted: 05/06/2022] [Indexed: 12/23/2022] Open
Abstract
Background With the increasing adoption of high-speed internet and mobile technologies by older adults, digital health is a promising modality to enhance clinical care for people with knee osteoarthritis (KOA), including those with knee replacement (KR). Objective This study aimed to summarize the current use, cost-effectiveness, and patient and clinician perspectives of digital health for intervention delivery in KOA and KR. Methods In this narrative review, search terms such as mobile health, smartphone, mobile application, mobile technology, ehealth, text message, internet, knee osteoarthritis, total knee arthroplasty, and knee replacement were used in the PubMed and Embase databases between October 2018 and February 2021. The search was limited to original articles published in the English language within the past 10 years. In total, 91 studies were included. Results Digital health technologies such as websites, mobile apps, telephone calls, SMS text messaging, social media, videoconferencing, and custom multi-technology systems have been used to deliver interventions in KOA and KR populations. Overall, there was significant heterogeneity in the types and applications of digital health used in these populations. Digital patient education improved disease-related knowledge, especially when used as an adjunct to traditional methods of patient education for both KOA and KR. Digital health that incorporated person-specific motivational messages, biofeedback, or patient monitoring was more successful at improving physical activity than self-directed digital interventions for both KOA and KR. Many digital exercise interventions were found to be as effective as in-person physical therapy for people with KOA. Many digital exercise interventions for KR incorporated both in-person and web-based treatments (blended format), communication with clinicians, and multi-technology systems and were successful in improving knee range of motion and self-reported symptoms and reducing the length of hospital stays. All digital interventions that incorporated cognitive behavioral therapy or similar psychological interventions showed significant improvements in knee pain, function, and psychological health when compared with no treatment or traditional treatments for both KOA and KR. Although limited in number, studies have indicated that digital health may be cost-effective for these populations, especially when travel costs are considered. Finally, although patients with KOA and KR and clinicians had positive views on digital health, concerns related to privacy and security and concerns related to logistics and training were raised by patients and clinicians, respectively. Conclusions For people with KOA and KR, many studies found digital health to be as effective as traditional treatments for patient education, physical activity, and exercise interventions. All digital interventions that incorporated cognitive behavioral therapy or similar psychological treatments were reported to result in significant improvements in patients with KOA and KR when compared with no treatment or traditional treatments. Overall, technologies that were blended and incorporated communication with clinicians, as well as biofeedback or patient monitoring, showed favorable outcomes.
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Affiliation(s)
- Nirali Shah
- Department of Physical Therapy and Athletic Training, Boston University, Boston, MA, United States
| | - Kerry Costello
- Department of Physical Therapy and Athletic Training, Boston University, Boston, MA, United States
| | - Akshat Mehta
- Department of Physical Therapy and Athletic Training, Boston University, Boston, MA, United States
| | - Deepak Kumar
- Department of Physical Therapy and Athletic Training, Boston University, Boston, MA, United States
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Biebl JT, Rykala M, Strobel M, Kaur Bollinger P, Ulm B, Kraft E, Huber S, Lorenz A. App-Based Feedback for Rehabilitation Exercise Correction in Patients With Knee or Hip Osteoarthritis: Prospective Cohort Study. J Med Internet Res 2021; 23:e26658. [PMID: 34255677 PMCID: PMC8317029 DOI: 10.2196/26658] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 02/03/2021] [Accepted: 04/19/2021] [Indexed: 02/06/2023] Open
Abstract
Background The use of digital therapeutic solutions for rehabilitation of conditions such as osteoarthritis provides scalable access to rehabilitation. Few validated technological solutions exist to ensure supervision of users while they exercise at home. Motion Coach (Kaia Health GmbH) provides audiovisual feedback on exercise execution in real time on conventional smartphones. Objective We hypothesized that the interrater agreement between physiotherapists and Motion Coach would be noninferior to physiotherapists’ interrater agreement for exercise evaluations in a cohort with osteoarthritis. Methods Patients diagnosed with osteoarthritis of the knee or hip were recruited at a university hospital to perform a set of 6 exercises. Agreement between Motion Coach and 2 physiotherapists’ corrections for segments of the exercises were compared using Cohen κ and percent agreement. Results Participants (n=24) were enrolled and evaluated. There were no significant differences between interrater agreements (Motion Coach app vs physiotherapists: percent agreement 0.828; physiotherapist 1 vs physiotherapist 2: percent agreement 0.833; P<.001). Age (70 years or under, older than 70 years), gender (male, female), or BMI (30 kg/m2 or under, greater than 30 kg/m2) subgroup analysis revealed no detectable difference in interrater agreement. There was no detectable difference in levels of interrater agreement between Motion Coach vs physiotherapists and between physiotherapists in any of the 6 exercises. Conclusions The results demonstrated that Motion Coach is noninferior to physiotherapist evaluations. Interrater agreement did not differ between 2 physiotherapists or between physiotherapists and the Motion Coach app. This finding was valid for all investigated exercises and subgroups. These results confirm the ability of Motion Coach to detect user form during exercise and provide valid feedback to users with musculoskeletal disorders.
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Affiliation(s)
- Johanna Theresia Biebl
- Department of Orthopaedics, Physical Medicine, and Rehabilitation, University Hospital, Ludwig Maximilians University of Munich, Munich, Germany
| | - Marzena Rykala
- Department of Orthopaedics, Physical Medicine, and Rehabilitation, University Hospital, Ludwig Maximilians University of Munich, Munich, Germany
| | | | | | - Bernhard Ulm
- Unabhängige statistische Beratung Bernhard Ulm, Munich, Germany
| | - Eduard Kraft
- Department of Orthopaedics, Physical Medicine, and Rehabilitation, University Hospital, Ludwig Maximilians University of Munich, Munich, Germany
| | | | - Andreas Lorenz
- Department of Orthopaedics, Physical Medicine, and Rehabilitation, University Hospital, Ludwig Maximilians University of Munich, Munich, Germany
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Scotti Requena S, Sterling M, Elphinston RA, Ritchie C, Robins S, R Armfield N. Development and use of mobile messaging for individuals with musculoskeletal pain conditions: a scoping review protocol. BMJ Open 2021; 11:e048964. [PMID: 34253673 PMCID: PMC8276305 DOI: 10.1136/bmjopen-2021-048964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 06/29/2021] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Previous reviews of mobile messaging for individuals with musculoskeletal pain have shown positive effects on pain and disability. However, the configuration of digital content, method of presentation and interaction, dose and frequency needed for optimal results remain unclear. Patient preferences concerning such systems are also unclear. Addressing these knowledge gaps, incorporating evidence from both experimental and observational studies, may be useful to understand the extent of the relevant literature, and to influence the design and outcomes of future messaging systems. We aim to map information that could be influential in the design of future mobile messaging systems for individuals with musculoskeletal pain conditions, and to summarise the findings of efficacy, effectiveness, and economics derived from both experimental and observational studies. METHODS AND ANALYSIS We will include studies describing the development and/or use of mobile messaging to support adults (≥18 years) with acute or chronic musculoskeletal pain. We will exclude digital health studies that lack a mobile messaging component, or those targeted at other health conditions unrelated to the bones, muscles and connective tissues, or involving surgical or patients with cancer, or studies involving solely healthy individuals. Our sources of information will be online databases and reference lists of relevant papers. We will include papers published in English in the last 10 years. Two pairs of independent reviewers will screen, select and extract the data, with any disagreements mediated by a third reviewer. We will report the results according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews checklist. We will synthesise the findings in a tabular format and provide a descriptive summary. ETHICS AND DISSEMINATION Formal ethical approval is not required. We will disseminate the findings through publication in a peer-reviewed journal, relevant conferences, and relevant consumer forums. TRIAL REGISTRATION Open Science Framework https://osf.io/8mzya; DOI: 10.17605/OSF.IO/8MZYA.
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Affiliation(s)
- Simone Scotti Requena
- RECOVER Injury Research Centre, The University of Queensland, Herston, Queensland, Australia
| | - Michele Sterling
- RECOVER Injury Research Centre, The University of Queensland, Herston, Queensland, Australia
- NHMRC Centre for Research Excellence in Road Traffic Injury Recovery, Herston, Queensland, Australia
| | - Rachel A Elphinston
- RECOVER Injury Research Centre, The University of Queensland, Herston, Queensland, Australia
- NHMRC Centre for Research Excellence in Road Traffic Injury Recovery, Herston, Queensland, Australia
- School of Psychology, The University of Queensland, Saint Lucia, Queensland, Australia
| | - Carrie Ritchie
- RECOVER Injury Research Centre, The University of Queensland, Herston, Queensland, Australia
| | - Sarah Robins
- RECOVER Injury Research Centre, The University of Queensland, Herston, Queensland, Australia
| | - Nigel R Armfield
- RECOVER Injury Research Centre, The University of Queensland, Herston, Queensland, Australia
- Centre for Health Services Research, The University of Queensland, Wooloongabba, Queensland, Australia
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Johnson AJ, Palit S, Terry EL, Thompson OJ, Powell-Roach K, Dyal BW, Ansell M, Booker SQ. Managing osteoarthritis pain with smart technology: a narrative review. Rheumatol Adv Pract 2021; 5:rkab021. [PMID: 33928214 PMCID: PMC8068316 DOI: 10.1093/rap/rkab021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 02/26/2021] [Indexed: 12/23/2022] Open
Abstract
Osteoarthritis (OA) is a highly prevalent musculoskeletal condition worldwide. More than 300 million individuals are affected by OA, and pain is the most common and challenging symptom to manage. Although many new advances have led to improved OA-related pain management, smart technology offers additional opportunities to enhance symptom management. This narrative review identifies and describes the current literature focused on smart technology for pain management in individuals with OA. In collaboration with a health sciences librarian, an interdisciplinary team of clinician-scientists searched multiple databases (e.g. PubMed, CINAHL and Embase), which generated 394 citations for review. After inclusion criteria were met, data were extracted from eight studies reporting on varied smart technologies, including mobile health, wearables and eHealth tools to measure or manage pain. Our review highlights the dearth of research in this crucial area, the implications for clinical practice and technology development, and future research needs.
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Affiliation(s)
- Alisa J Johnson
- Pain Research and Intervention Center of Excellence, Department of Community Dentistry and Behavioral Science, College of Dentistry
| | - Shreela Palit
- Pain Research and Intervention Center of Excellence, Department of Community Dentistry and Behavioral Science, College of Dentistry
| | - Ellen L Terry
- Pain Research and Intervention Center of Excellence, Department of Community Dentistry and Behavioral Science, College of Dentistry
| | - Osheeca J Thompson
- Pain Research and Intervention Center of Excellence, Department of Community Dentistry and Behavioral Science, College of Dentistry
| | - Keesha Powell-Roach
- Pain Research and Intervention Center of Excellence, Department of Community Dentistry and Behavioral Science, College of Dentistry
| | - Brenda W Dyal
- Department of Biobehavioral Nursing Science, College of Nursing
| | - Margaret Ansell
- George A. Smathers Libraries, Health Science Center Libraries, University of Florida, Gainesville, FL, USA
| | - Staja Q Booker
- Pain Research and Intervention Center of Excellence, Department of Community Dentistry and Behavioral Science, College of Dentistry
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Chen T, Or CK, Chen J. Effects of technology-supported exercise programs on the knee pain, physical function, and quality of life of individuals with knee osteoarthritis and/or chronic knee pain: A systematic review and meta-analysis of randomized controlled trials. J Am Med Inform Assoc 2021; 28:414-423. [PMID: 33236109 PMCID: PMC7883981 DOI: 10.1093/jamia/ocaa282] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 10/26/2020] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE The study sought to examine the effects of technology-supported exercise programs on the knee pain, physical function, and quality of life of individuals with knee osteoarthritis and/or chronic knee pain by a systematic review and meta-analysis of randomized controlled trials. MATERIALS AND METHODS We searched MEDLINE, EMBASE, CINAHL Plus, and the Cochrane Library from database inception to August 2020. A meta-analysis and subgroup analyses, stratified by technology type and program feature, were conducted. RESULTS Twelve randomized controlled trials were reviewed, all of which implemented the programs for 4 weeks to 6 months. Telephone, Web, mobile app, computer, and virtual reality were used to deliver the programs. The meta-analysis showed that these programs were associated with significant improvements in knee pain (standardized mean difference [SMD] = -0.29; 95% confidence interval [CI], -0.48 to -0.10; P = .003) and quality of life (SMD = 0.25; 95% CI, 0.04 to 0.46; P = .02) but not with significant improvement in physical function (SMD = 0.22; 95% CI, 0 to 0.43; P = .053). Subgroup analyses showed that some technology types and program features were suggestive of potential benefits. CONCLUSIONS Using technology to deliver the exercise programs appears to offer benefits. The technology types and program features that were associated with health values have been identified, based on which suggestions are discussed for the further research and development of such programs.
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Affiliation(s)
- Tianrong Chen
- Department of Industrial and Manufacturing Systems Engineering, The University of Hong Kong, Hong Kong, China
| | - Calvin Kalun Or
- Department of Industrial and Manufacturing Systems Engineering, The University of Hong Kong, Hong Kong, China
| | - Jiayin Chen
- Department of Industrial and Manufacturing Systems Engineering, The University of Hong Kong, Hong Kong, China
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Biebl JT, Huber S, Rykala M, Kraft E, Lorenz A. Attitudes and Expectations of Health Care Professionals Toward App-Based Therapy in Patients with Osteoarthritis of the Hip or Knee: Questionnaire Study. JMIR Mhealth Uhealth 2020; 8:e21704. [PMID: 33112255 PMCID: PMC7657727 DOI: 10.2196/21704] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 08/19/2020] [Accepted: 09/03/2020] [Indexed: 02/06/2023] Open
Abstract
Background The use of mobile health (mHealth) apps is becoming increasingly widespread. However, little is known about the attitudes, expectations, and basic acceptance of health care professionals toward such treatment options. As physical activity and behavior modification are crucial in osteoarthritis management, app-based therapy could be particularly useful for the self-management of this condition. Objective The objective of the study was to determine the expectations and attitudes of medical professionals toward app-based therapy for osteoarthritis of the hip or knee. Methods Health care professionals attending a rehabilitation congress and employees of a university hospital were asked to fill out a questionnaire consisting of 16 items. A total of 240 questionnaires were distributed. Results A total of 127 participants completed the questionnaire. At 95.3% (121/127), the approval rate for app-based therapy for patients with osteoarthritis of the hip or knee was very high. Regarding possible concerns, aspects related to data protection and privacy were primarily mentioned (41/127, 32.3%). Regarding potential content, educational units, physiotherapeutic exercise modules, and practices based on motivation psychology were all met with broad approval. Conclusions The study showed a high acceptance of app-based therapy for osteoarthritis, indicating a huge potential of this form of treatment to be applied, prescribed, and recommended by medical professionals. It was widely accepted that the content should reflect a multimodal therapy approach.
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Affiliation(s)
- Johanna Theresia Biebl
- Department of Orthopaedics, Physical Medicine and Rehabilitation, University Hospital, LMU Munich, Munich, Germany
| | | | - Marzena Rykala
- Department of Orthopaedics, Physical Medicine and Rehabilitation, University Hospital, LMU Munich, Munich, Germany
| | - Eduard Kraft
- Department of Orthopaedics, Physical Medicine and Rehabilitation, University Hospital, LMU Munich, Munich, Germany
| | - Andreas Lorenz
- Department of Orthopaedics, Physical Medicine and Rehabilitation, University Hospital, LMU Munich, Munich, Germany
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Brennan L, Kessie T, Caulfield B. Patient Experiences of Rehabilitation and the Potential for an mHealth System with Biofeedback After Breast Cancer Surgery: Qualitative Study. JMIR Mhealth Uhealth 2020; 8:e19721. [PMID: 32687476 PMCID: PMC7424492 DOI: 10.2196/19721] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 05/26/2020] [Accepted: 06/14/2020] [Indexed: 12/24/2022] Open
Abstract
Background Physiotherapy-led home rehabilitation after breast cancer surgery can protect against the development of upper limb dysfunction and other disabling consequences of surgery. A variety of barriers can limit physical rehabilitation outcomes, and patients may benefit from more support during this time. Mobile health (mHealth) systems can assist patients during rehabilitation by providing exercise support, biofeedback, and information. Before designing mHealth systems for a specific population, developers must first engage with users to understand their experiences and needs. Objective The aims of this study were to explore patients’ rehabilitation experiences and unmet needs during home rehabilitation after breast cancer surgery and to understand their experiences of mHealth technology and the requirements they desire from an mHealth system. Methods This was the first stage of a user-centered design process for an mHealth system. We interviewed 10 breast cancer survivors under the two main topics of “Rehabilitation” and “Technology” and performed a thematic analysis on the interview data. Results Discussions regarding rehabilitation focused on the acute and long-term consequences of surgery; unmet needs and lack of support; self-driven rehabilitation; and visions for high-quality rehabilitation. Regarding technology, participants reported a lack of mHealth options for this clinical context and using non-cancer–specific applications and wearables. Participants requested an mHealth tool from a reliable source that provides exercise support. Conclusions There are unmet needs surrounding access to physiotherapy, information, and support during home rehabilitation after breast cancer surgery that could be addressed with an mHealth system. Breast cancer survivors are open to using an mHealth system and require that it comes from a reliable source and focuses on supporting exercise performance.
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Affiliation(s)
- Louise Brennan
- Physiotherapy Department, Beacon Hospital, Dublin, Ireland.,Insight Centre for Data Analytics, University College Dublin, Dublin, Ireland.,School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Threase Kessie
- Maynooth University Innovation Lab, Maynooth University, Kildare, Ireland
| | - Brian Caulfield
- Insight Centre for Data Analytics, University College Dublin, Dublin, Ireland.,School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
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Safari R, Jackson J, Sheffield D. Digital Self-Management Interventions for People With Osteoarthritis: Systematic Review With Meta-Analysis. J Med Internet Res 2020; 22:e15365. [PMID: 32706657 PMCID: PMC7428148 DOI: 10.2196/15365] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Revised: 11/13/2019] [Accepted: 02/26/2020] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Osteoarthritis (OA) is not curable, but the symptoms can be managed through self-management programs (SMPs). Owing to the growing burden of OA on the health system and the need to ensure high-quality integrated services, delivering SMPs through digital technologies could be an economic and effective community-based approach. OBJECTIVE This study aims to analyze the effectiveness of digital-based structured SMPs on patient outcomes in people with OA. METHODS A total of 7 web-based and 3 gray literature databases were searched for randomized controlled trials assessing digital-based structured SMPs on self-reported outcomes including pain, physical function, disability, and health-related quality of life (QoL) in people with OA. Two reviewers independently screened the search results and reference lists of the identified papers and related reviews. Data on the intervention components and delivery and behavioral change techniques used were extracted. A meta-analysis, risk of bias sensitivity analysis, and subgroup analysis were performed where appropriate. The Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach was used to assess the quality of evidence. RESULTS A total of 8 studies were included in this review involving 2687 patients with knee (n=2); knee, hip, or both (n=5); and unspecified joint (n=1) OA. SMPs were delivered via telephone plus audio and video, internet, or mobile apps. Studies reported that digital-based structured SMPs compared with the treatment as usual control group (n=7) resulted in a significant, homogeneous, medium reduction in pain and improvement in physical function (standardized mean difference [SMD] -0.28, 95% CI -0.38 to -0.18 and SMD -0.26, 95% CI -0.35 to -0.16, respectively) at posttreatment. The digital-based structured SMP effect on pain and function reduced slightly at the 12-month follow-up but remained to be medium and significant. The posttreatment effect of digital-based structured SMPs was small and significant for disability, but nonsignificant for QoL (SMD -0.10, 95% CI -0.17 to 0.03 and SMD -0.17, 95% CI -0.47 to 0.14, respectively; each reported in 1 study only). The 12-month follow-up effect of the intervention was very small for disability and QoL. The quality of evidence was rated as moderate for pain and physical function and low and very low for disability and QoL, respectively, using the GRADE approach. CONCLUSIONS Digital-based structured SMPs may result in improvement in pain and physical function that is largely sustained at the 12-month follow-up in people with knee and hip OA. The effects on disability and QoL are smaller and less clear. The quality of evidence is moderate to low, and further research is required to confirm the findings of the review and assess the effects of digital-based structured SMPs on other health-related outcomes.
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Affiliation(s)
- Reza Safari
- Health and Social Care Research Centre, University of Derby, Derby, United Kingdom
| | - Jessica Jackson
- Health and Social Care Research Centre, University of Derby, Derby, United Kingdom
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Hewitt S, Sephton R, Yeowell G. The Effectiveness of Digital Health Interventions in the Management of Musculoskeletal Conditions: Systematic Literature Review. J Med Internet Res 2020; 22:e15617. [PMID: 32501277 PMCID: PMC7305565 DOI: 10.2196/15617] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 02/02/2020] [Accepted: 03/22/2020] [Indexed: 01/22/2023] Open
Abstract
Background Musculoskeletal conditions are the second greatest contributor to disability worldwide and have significant individual, societal, and economic implications. Due to the growing burden of musculoskeletal disability, an integrated and strategic response is urgently required. Digital health interventions provide high-reach, low-cost, readily accessible, and scalable interventions for large patient populations that address time and resource constraints. Objective This review aimed to investigate if digital health interventions are effective in reducing pain and functional disability in patients with musculoskeletal conditions. Methods A systematic review was undertaken to address the research objective. The review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The review protocol was registered with the International Prospective Register of Systematic Reviews before commencement of the study. The following databases were searched: Medical Literature Analysis and Retrieval System Online (MEDLINE), Excerpta Medica database (EMBASE), Cumulative Index to Nursing and Allied Health Literature, and Scopus from January 1, 2000, to November 15, 2019, using search terms and database specific−medical subject headings terms in various combinations appropriate to the research objective. Results A total of 19 English language studies were eligible for inclusion. Of the 19 studies that assessed musculoskeletal pain, 9 reported statistically significant reductions following digital intervention. In all, 16 studies investigated functional disability; 10 studies showed a statistically significant improvement. Significant improvements were also found in a range of additional outcomes. Due to the heterogeneity of the results, a meta-analysis was not feasible. Conclusions This review has demonstrated that digital health interventions have some clinical benefits in the management of musculoskeletal conditions for pain and functional disability. Digital health interventions have the potential to contribute positively toward reducing the multifaceted burden of musculoskeletal conditions to the individual, economy, and society. Trial Registration PROSPERO CRD42018093343; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=93343
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Affiliation(s)
- Stephanie Hewitt
- St Helens Therapy Department, North West Boroughs Healthcare NHS Foundation Trust, Merseyside, United Kingdom
| | - Ruth Sephton
- St Helens Therapy Department, North West Boroughs Healthcare NHS Foundation Trust, Merseyside, United Kingdom
| | - Gillian Yeowell
- Department of Health Professions, Manchester Metropolitan University, Manchester, United Kingdom
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50
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Bailey JF, Agarwal V, Zheng P, Smuck M, Fredericson M, Kennedy DJ, Krauss J. Digital Care for Chronic Musculoskeletal Pain: 10,000 Participant Longitudinal Cohort Study. J Med Internet Res 2020; 22:e18250. [PMID: 32208358 PMCID: PMC7248800 DOI: 10.2196/18250] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 03/21/2020] [Accepted: 03/21/2020] [Indexed: 12/20/2022] Open
Abstract
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.
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Affiliation(s)
- Jeannie F Bailey
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA, United States
| | | | - Patricia Zheng
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA, United States
| | - Matthew Smuck
- Division of Physical Medicine & Rehabilitation, Stanford University, Palo Alto, CA, United States
| | - Michael Fredericson
- Division of Physical Medicine & Rehabilitation, Stanford University, Palo Alto, CA, United States
| | - David J Kennedy
- Vanderbilt University Medical Center, Nashville, CA, United States
| | - Jeffrey Krauss
- Hinge Health, Inc, San Francisco, CA, United States.,Division of Physical Medicine & Rehabilitation, Stanford University, Palo Alto, CA, United States
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