Telerehabilitation Reduces Pain, Improves Function for People With Musculoskeletal Needs

A digital acute musculoskeletal (MSK) program may help improve pain and function in the short term among people with acute and subacute MSK needs, according to a recent study published in JMIR Rehabilitation and Assistive Technologies. Participants in a digital acute MSK program experienced greater reductions in pain and improvements in function compared with nonparticipants.

“Telerehabilitation for 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, an observational, prospective cohort study comparing digital MSK acute program participants to nonparticipants at 3, 6, and 12 weeks was conducted. The acute program included digital physical therapy, consultation, exercise therapy, and education for the intervention group. Educational content was delivered through an app. The study is believed to be the first to evaluate a digital MSK program for acute and subacute needs against nonparticipants.

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

The analysis showed the intervention group experienced significantly more pain improvement at all 3 follow-ups vs the nonparticipant group. Compared with the baseline, the intervention group experienced a 55.8% decrease in pain scores 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 vs 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), 13.5 (95% CI, 10.8-16.2), and 11.8 (95% CI, 9.0-14.6) at 3, 6, and 12 weeks, respectively. Nonparticipants’ adjusted pain scores decreased from 43.8 (95% CI, 42.0-45.5) at baseline to 30.3 (95% CI, 27.1-33.5), 23.7 (95% CI, 20.0-27.5), and 23.3 (95% CI, 19.6-27.0).

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, 15.2% and 24.6% more patients in the intervention group reported meaningful functional improvement at weeks 3 and 12, respectively. 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. These engagement data show 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 suggest that the findings of the study are generalizable to the population of people with acute and subacute MSK pain with expressed interest in a digital acute MSK program, but not necessarily generalizable to later adopters of technology or all people with MSK pain.

The study faced 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.

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

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