Accepted for/Published in: JMIR Rehabilitation and Assistive Technologies
Date Submitted: Jun 5, 2023
Open Peer Review Period: Jun 5, 2023 - Jul 17, 2023
Date Accepted: Jul 19, 2023
Date Submitted to PubMed: Jul 19, 2023
(closed for review but you can still tweet)
Managing musculoskeletal pain in older adults through a digital care solution: a secondary analysis of a prospective clinical study
ABSTRACT
Background:
Aging is closely associated with an increased prevalence of musculoskeletal (MSK) conditions. Digital MSK care interventions emerged to deliver timely and proper rehabilitation; however, older adults frequently face specific barriers and concerns with virtual care programs.
Objective:
To investigate whether known barriers and concerns of older adults impacted their participation in or engagement with a digital care program (DCP), or the observed clinical outcomes, in comparison with younger individuals.
Methods:
Secondary analysis of a single-arm investigation assessing the recovery of patients with MSK conditions following a DCP for up to 12 weeks. Patients were categorized according to age: ≤44 (young adults), 45-64 (middle-aged adults) and ≥65 (older adults). Access to DCP and engagement were evaluated by assessing starting proportions, completion rates, ability to perform exercises autonomously, assistance requests, communication with their physical therapist and program satisfaction. Clinical outcomes included change between baseline and program-end for pain (including response rate to a minimal clinically important difference of 30%), analgesic usage, mental health, work productivity and non-work-related activities impairment.
Results:
From 16 229 patients, 12 082 started the program: 38.3% (4629) young adults, 55.7% (6726) middle-aged adults and 6% (727) older adults. Older patients were more likely to start the intervention and to complete the program compared to young adults (odds ratio (OR) 1.72, 95%CI 1.45;2.06 P<.001, and OR: 2.40, 95%CI 1.97;2.92; P<.001, respectively) and middle-aged adults (OR 1.22, 95%CI 1.03;1.45 P=.03 and OR: 1.38, 95%CI 1.14;1.68; P=.001, respectively). Whereas older patients requested more technical assistance and exhibited a slower learning curve in exercise performance, their engagement was higher as reflected by higher adherence with both exercise and education pieces. Older patients interacted more with the physical therapist (12.6, SD 18.4 versus 10.7, SD 14.7 of young adults) and showed higher satisfaction scores (8.7, SD 1.9). Significant improvements were observed in all clinical outcomes, and were similar between groups, including pain response rates (young adults: 62.6% (949/1516); middle-aged adults: 65.2% (1848/2834); older adults: 62.3% (241/387); P=.17).
Conclusions:
Older adults showed high adherence, engagement and satisfaction with the DCP, which were greater than in younger counterparts, together with significant clinical improvements in all studied outcomes. This suggests digital care programs can successfully address and overcome some of the barriers surrounding the participation and adequacy of digital models in the older adults population. Clinical Trial: ClinicalTrials.gov NCT04092946; https://clinicaltrials.gov/ct2/show/NCT04092946
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