Digital Care for Chronic Musculoskeletal Pain: 10,000 Participant Longitudinal Cohort Study
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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: This study aimed to evaluate the efficacy of a 12-week digital care program (DCP) in a large population of patients with chronic knee and back pain. Methods: A longitudinal observational study was conducted using a remote DCP available through a mobile app. Subjects participated in a 12-week multimodal DCP incorporating education, sensor-guided exercise therapy (ET), and behavioral health support with 1-on-1 remote health coaching. The primary outcome was pain measured by the visual analog scale (VAS). Secondary measures included engagement levels, program completion, program satisfaction, condition-specific pain measures, depression, anxiety, and work productivity. Results: A total of 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 a 68.45% average improvement in VAS pain between baseline intake and 12 weeks. In all, 73.04% (7497/10,264) participants completed the DCP into the final month. In total, 78.60% (5893/7497) of program completers (7144/10,264, 69.60% of all participants) achieved minimally important change in pain. Furthermore, the number of ET sessions and coaching interactions were both positively associated with improvement in pain, suggesting that the amount of engagement influenced outcomes. Secondary outcomes included a 57.9% and 58.3% decrease in depression and anxiety scores, respectively, and 61.5% improvement in work productivity. Finally, 3 distinct clusters of pain response trajectories were identified, which could be predicted with a mean 76% accuracy using baseline measures. Conclusions: These results support the efficacy and scalability 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 that has not been previously demonstrated in a DCP. Furthermore, the large sample size allowed for the 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.
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The findings are consistent with previous large randomized controlled trials and meta-analyses demonstrating the effectiveness of digital interventions for improving symptoms of depression, anxiety, and pain-related impairment in people with chronic pain.
“Our findings are consistent with previous large randomized controlled trials and meta-analyses that have demonstrated the effectiveness of digital interventions for improving symptoms of depression, anxiety, and even pain-related impairment in people with chronic pain who have been recruited from pain management clinics, primary care clinics, and community/internet referral sources [20,21,45-47].”
From Digital Mental Health Intervention Plus Usual Care Compared With Usual Care Only and Usual Care Plus In-Person Psychological Counseling for Orthopedic Patients With Symptoms of Depression or Anxiety: Cohort Study (2022) · cites this paper as [47]
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Experimental — accuracy not yet measuredThe high engagement rates and positive clinical findings in this study are consistent with those in a study of 10,000 participants by Bailey et al [41].
“The high engagement rates and positive clinical findings in this study are consistent with those in a study of 10,000 participants by Bailey et al [41]”
From A Digital Mental Health Intervention in an Orthopedic Setting for Patients With Symptoms of Depression and/or Anxiety: Feasibility Prospective Cohort Study (2022) · cites this paper as [41]
In Bailey et al [41], 73% of participants continued engagement with the program into the third month.
“In that study, 73% of participants continued engagement with the program into the third month.”
From A Digital Mental Health Intervention in an Orthopedic Setting for Patients With Symptoms of Depression and/or Anxiety: Feasibility Prospective Cohort Study (2022) · cites this paper as [41]
In this study, the completion rate of 87.5% was higher than that reported for conventional or home-based rehabilitations (range 30-76.3%) and by other digital MSK interventions (73-87%).
“In this study, we observed a completion rate of 87.5%, higher than that reported for conventional or home-based rehabilitations (range 30–76.3%) [34, 77, 78], and by other digital MSK interventions (73–87%) [62, 79].”
From Telerehabilitation of acute musculoskeletal multi-disorders: prospective, single-arm, interventional study (2022) · cites this paper as [79]
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- Authors
- Bailey, J. F., Agarwal, V., Zheng, P., Smuck, M., Fredericson, M., Kennedy, D. J., & Krauss, J.
- Affiliations
- University of California, San Francisco (US)
- Hinge Health (US)
- Stanford University (US)
- Vanderbilt University Medical Center (US)
- Corresponding author
- Krauss, Jeffrey
- ORCID
- Venue
- Journal of Medical Internet Research
- Publisher
- JMIR Publications Inc.
- Published
- 2020-05-11
- Volume
- 22
- Issue
- 5
- Pages
- e18250
- ISSN
- 1438-8871 (ISSN-L)
- PMC
- PMC7248800
- OpenAlex
- W3012812325
- Cited by
- 109
- References
- 48
- Citations by year
- 2026: 12 · 2025: 17 · 2024: 16 · 2023: 23 · 2022: 25 · 2021: 11 · 2020: 4
- FWCI
- 9.44
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- Journal of Medical Internet Research (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Topics
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Keywords
- chronic musculoskeletal pain, low back pain, knee pain, mobile health apps, exercise therapy, health coaching, depression, anxiety, labor productivity, patient engagement, self-management, analgesia, program completion, minimally important change, recovery prediction, conservative treatment
- MeSH terms
- Adult, Chronic Disease, Female, Humans, Longitudinal Studies, Male, Cohort Studies, Musculoskeletal Pain
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