Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Jul 21, 2022
Date Accepted: Sep 30, 2022
Date Submitted to PubMed: Oct 3, 2022
Racial and ethnic differences in outcomes of a 12-week digital rehabilitation program for musculoskeletal pain: a prospective longitudinal cohort study
ABSTRACT
Background:
Musculoskeletal (MSK) pain disproportionately affects people from different ethnic backgrounds, through higher burden and less access to care. Digital care programs can improve access and help reduce inequalities. However, the outcomes of such programs based on race and ethnicity has yet to be studied.
Objective:
To assess the impact of race and ethnicity on engagement and outcomes in a multimodal Digital Care Program (DCP) for MSK pain.
Methods:
This is an ad-hoc analysis of an ongoing decentralized single-arm investigation into clinical and engagement-related outcomes after a multimodal DCP in patients with musculoskeletal conditions. Patients were stratified by self-reported racial and ethnic group(s) and 12-week outcomes between them were compared. Outcomes included self-reported pain scores, analgesic consumption, surgery likelihood, Generalized Anxiety Disorder 7-item scale (GAD-7), Patient Health 9-item questionnaire (PHQ-9), Work Productivity and Activity Impairment (WPAI), and program engagement. Minimum clinically important difference (MCID) of 30% compared with baseline was calculated for pain and multivariable logistic regression was performed to evaluate race as an independent predictor of meeting pain MCID.
Results:
A total of 1840 patients completed the program. The population studied was diverse and similar to the proportions in the US population. Black and Hispanic patients had higher baseline pain and surgery intent and lower educational levels. All race groups had a significant improvement in pain and high satisfaction rates. Black and Hispanic patients had lower engagement and higher odds ratio to drop out (P<0.05 for all), but the highest satisfaction and responder rates for pain (83.1% and 83.8%, respectively, P=0.02). The odds ratios of meeting pain MCID for Black and Hispanic patients were 2.08 (95% CI 1.1-4.0) and 2.11 (95% CI 1.1-4.2), respectively, when compared to Non-Hispanic Whites, independent of age, body mass index, therapy type, education level, gender, and employment status.
Conclusions:
This study advocates for the utility of a DCP in improving access to MSK care and in promoting health equity. Engagement and satisfaction rates were high in all groups. Black and Hispanic patients had higher MSK burden at baseline and lower engagement, but also a higher likelihood of pain improvement. Clinical Trial: ClinicalTrials.gov NCT04092946; https://clinicaltrials.gov/ct2/show/NCT04092946
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