JMIR Publications

ABSTRACT

Background:

Although many pain-related smartphone applications (apps) exist, little attention has been given to understanding how these apps are used over time and what factors contribute for greater compliance and patient engagement.

Objective:

This retrospective analysis was designed to help identify factors that predicted benefit from and future use of a smartphone pain app among chronic pain patients.

Methods:

An app designed for both Android and iOS devices was developed by Brigham and Women’s Hospital Pain Management Center (BWH-PMC) for users with chronic pain to assess, monitor, and communicate with their providers. The pain app offered chronic pain assessment, push notification reminders/communication, personalized goal setting, relaxation sound files, topics of interest with psychological and medical pain management strategies, and line graphs from the daily assessments. BWH-PMC recruited 253 chronic pain patients over time to use the pain app. All subjects completed baseline measures and were asked to record their progress every day using push-notification daily assessments. After 3 months, participants completed follow-up questionnaires and answered helpfulness questions. We defined the number of completed daily assessments as a measure of patient engagement in using the pain app.

Results:

Average age of the participants was 51.4 (range 18-92), 72.8% were female and 36.8% reported low back pain as their primary pain site. The number of daily assessments ranged from 1 to 426 (average 62.0; standard deviation 49.9). The app was found to be easily introduced and well accepted. Those who completed more daily assessments (greater patient engagement) throughout the study tended to report higher pain intensity, more activity interference, and greater disability, and were generally overweight. These higher-patient-engagement individuals rated the app as offering greater benefit in coping with their pain and expressed most willingness to use the app in the future (p<0.05). Those with fewer daily assessments reported less pain intensity, less daily activity interference, less pain-related disability and tended to use the 2-way messaging less often than those who were more engaged with the pain app (p<0.05).

Conclusions:

Persons who appeared to manage their pain better tended to report less benefit from a smartphone pain app designed for persons with chronic pain. They demonstrated lower patient engagement in reporting their daily progress, in part, due to perceived burden of regularly using an app without perceived benefit. Intrinsic differences in a pain app designed and targeted for individuals based on early identification of user characteristics and adapted for each individual would likely improve compliance and app-related patient engagement.