Telerehabilitation Cuts Musculoskeletal Pain, Improves Function

A digital acute musculoskeletal program may help improve pain and function in the short term among people with acute and subacute needs, according to a recent study published in JMIR Rehabilitation and Assistive Technologies.

Participants in the program, which was offered by an employer and consisted of video visits with physical therapists and educational material sent via an app, experienced more significant reductions in pain and improvements in function compared with nonparticipants.

“Telerehabilitation for [musculoskeletal] MSK conditions may produce similar or even better pain-, functional-, and health-related quality of life outcomes than usual care, but most telerehabilitation studies address only chronic or postsurgical pain,” wrote the authors. “Therefore, we aimed to determine whether telerehabilitation was associated with improved clinical outcomes in acute and subacute MSK conditions.”

To assess these outcomes, the researchers conducted an observational, prospective cohort study comparing the digitalprogram participants with nonparticipants at 3, 6, and 12 weeks.The acute program included digital physical therapy, consultation, exercise therapy, and education for the intervention group.

The study is believed to be the first to evaluate a digital program for acute and subacute musculoskeletal painagainst a comparison group of nonparticipants.

Pain and function outcomes were collected through surveys delivered at the 3-, 6-, and 12-week follow-ups. Data was collected from 675 nonparticipants and 262 intervention participants.

The analysis showed the intervention group experienced significantly more pain improvement at all 3 follow-ups compared with the nonparticipant group.

Compared with the baseline, the intervention group experienced a decrease in pain scores of 55.8% at 3 weeks, 69.1% at 6 weeks, and 73% at 12 weeks.

The nonparticipants’ pain scores decreased by only 30.8% at 3 weeks versus baseline, 45.8% at 6 weeks, and 46.7% at 12 weeks.

Adjusted pain scores followed a similar pattern.

For the intervention group, adjusted pain scores decreased from 43.7 (95% CI, 41.1-46.2) at baseline to 19.3 (95% CI, 16.8-21.8) at 3 weeks to 13.5 (95% CI, 10.8-16.2) at 6 weeks to 11.8 (95% CI,. 9-14.6) at 12 weeks.

Nonparticipants’ adjusted pain scores were found to have decreased from 43.8 (95% CI, 42-45.5) at baseline to 30.3 (95% CI, 27.1-33.5) at 3 weeks to 23.7 (95% CI, 20-27.5) at 6 weeks to 23.3 (95% CI, 19.6-27) at 12 weeks.

The proportion of patients in the intervention group that reported that pain was better or much better at follow-up was greater than the proportion of nonparticipants for all 3 follow-ups.

The percentage of patients reporting that pain was better or much better was 40.6% higher for the intervention group at 3 weeks, 31.4% higher at 6 weeks, and 31.2% higher at 12 weeks.

Additionally, more patients in the intervention group reported meaningful functional improvement at weeks 3 and 12. The percentage of participants reporting meaningful functional improvement was higher for the intervention group by 15.2% at 3 weeks and 24.6% at 12 weeks.

Nonparticipants experienced a plateau in functional improvement between 6 and 12 weeks, while the intervention group continued to progress.

These findings indicate significant associations between the intervention and pain improvement and patient’s global impression of change at all 3 follow-ups.

A secondary aim of the study was to measure engagement for the intervention group. The intervention group participated in an average of 1.8 video visits and 17.7 exercise therapy sessions by the week 12 follow-up.

This engagement data shows the feasibility of using app-based data to monitor adherence to recommended exercises, which can supplement self-reports about efficacy and confidence in completing exercises to support better outcomes, according to the authors.

They suggested that the findings of the study are generalizable to the population of people with acute and subacute musculoskeletal pain with expressed interest in a digital acute musculoskeletal program, though not necessarily generalizable to later adopters of technology or all people with musculoskeletal pain.

The authors encourage further studies to evaluate the extent to which digital health effectively manages a range of musculoskeletal needs, recommending more granular follow-up timepoints.

The study had some limitations:causality of the intervention’s effects on outcomes could not be established due to the observational design; important confounding variables may have been omitted; and medications for pain and function taken by participants were not documented.

While outcomes were not assessed separately by region, region was controlled for in the models used.

Reference

Wang G, Yang M, Hong M, Krauss J, Bailey JF. Clinical outcomes after a digital musculoskeletal program for acute and subacute pain: observational, longitudinal study with comparison group. JMIR Rehabil Assist Technol. Published online June 27, 2022. doi:10.2196/38214