JMIR Publications

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:

To evaluate the efficacy of a 12-week digital care pathway (DCP) in a large population of patients with chronic knee and back pain.

Methods:

A longitudinal observational study using a remote DCP available through employers using a mobile application. Subjects participated in a 12-week multi-modal DCP administered via a mobile app incorporating education, sensor-guided exercise therapy, and behavioral health support with 1-on-1 remote health coaching. Primary outcome was VAS pain. Secondary measures included engagement levels, program completion, program satisfaction, condition-specific pain measures, depression, anxiety, and work productivity.

Results:

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 68.45% average improvement in VAS pain between baseline intake and 12 weeks. 73.1% of all participants completed the DCP into the final month. 78.6% of program completers (69.6% of all participants) achieved minimally important change in pain. Furthermore, the number of exercise therapy sessions and coaching interactions were both positively associated with improvement in pain, supporting that the amount of engagement influenced outcomes. Secondary outcomes included 57.9% and 58.3% decrease in depression and anxiety scores, respectively, and 61.5% improvement in work productivity. Lastly, three distinct clusters of pain response trajectories were identified which could be predicted with mean 76% accuracy using baseline measures.

Conclusions:

These results support the efficacy and safety 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 which has not been previously demonstrated in a DCP. Furthermore, the large sample size allowed for 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.