Randomized controlled pilot study of an educational video plus telecare for the early outpatient management of musculoskeletal pain among older emergency department patients

Timothy F Platts-Mills, Allison G Hollowell, Gary F Burke, Sheryl Zimmerman, Joseph A Dayaa, Benjamin R Quigley, Montika Bush, Morris Weinberger, Mark A Weaver, Timothy F Platts-Mills, Allison G Hollowell, Gary F Burke, Sheryl Zimmerman, Joseph A Dayaa, Benjamin R Quigley, Montika Bush, Morris Weinberger, Mark A Weaver

Abstract

Background: Musculoskeletal pain is a common reason for emergency department (ED) visits. Following discharge from the ED, patients, particularly older patients, often have difficulty controlling their pain and managing analgesic side effects. We conducted a pilot study of an educational video about pain management with and without follow-up telephone support for older adults presenting to the ED with musculoskeletal pain.

Methods: ED patients aged 50 years and older with musculoskeletal pain were randomized to: (1) usual care, (2) a brief educational video only, or (3) a brief educational video plus a protocol-guided follow-up telephone call from a physician 48-72 hours after discharge (telecare). The primary outcome was the change from the average pain severity before the ED visit to the average pain severity during the past week assessed one month after the ED visit. Pain was assessed using a 0-10 numerical rating scale.

Results: Of 75 patients randomized (mean age 64 years), 57 (76%) completed follow up at one month. Of the 18 patients lost to follow up, 12 (67%) had non-working phone numbers. Among patients randomized to the video (arms 2 and 3), 46/50 viewed the entire video; among the 25 patients randomized to the video plus telecare (arm 3), 23 were reached for telecare. Baseline pain scores for the usual care, video, and video plus telecare groups were 7.3, 7.1, and 7.5. At one month, pain scores were 5.8, 4.9, and 4.5, corresponding to average decreases in pain of -1.5, -2.2, and -3.0, respectively. In the pairwise comparison between intervention groups, the video plus telecare group had a 1.7-point (95% CI 1.2, 2.1) greater decrease in pain compared to usual care, and the video group had a 1.1-point (95% CI 0.6, 1.6) greater decrease in pain compared to usual care after adjustment for baseline pain, age, and gender. At one month, clinically important differences were also observed between the video plus telecare and usual care groups for analgesic side effects, ongoing opioid use, and physical function.

Conclusion: Results of this pilot trial suggest the potential value of an educational video plus telecare to improve outcomes for older adults presenting to the ED with musculoskeletal pain. Changes to the protocol are identified to increase retention for assessment of outcomes.

Trials registration: ClinicalTrials.gov, NCT02438384 . Registered on 5 May 2015.

Keywords: Emergency medicine; Geriatrics; Musculoskeletal pain; Pain.

Conflict of interest statement

Author’s information

Not applicable.

Ethics approval and consent to participate

This study was approved by the Institutional Review Board at the University of North Carolina at Chapel Hill (IRB Number 15-0986) on May 20, 2015. All participants of this study provided informed consent.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Flow diagram of the screening and enrollment process

References

    1. Hastings SN, Smith VA, Weinberger M, Oddone EZ, Olsen MK, Schmader KE. Health services use of older veterans treated and released from Veterans Affairs Medical Center emergency departments. J Am Geriatr Soc. 2013;61:1515–21. doi: 10.1111/jgs.12417.
    1. Shah MN, Bazarian JJ, Lerner EB, et al. The epidemiology of emergency medical services use by older adults: an analysis of the National Hospital Ambulatory Medical Care Survey. Acad Emerg Med. 2007;14:441–7. doi: 10.1111/j.1553-2712.2007.tb01804.x.
    1. Lim K, Yap K. The presentation of elderly people at an emergency department in Singapore. Singapore Med J. 1999;40:742–4.
    1. Platts-Mills TF, Flannigan SA, Bortsov AV, et al. Persistent pain among older adults discharged home from the emergency department after motor vehicle crash: a prospective cohort study. Ann Emerg Med. 2016;67:166–76. doi: 10.1016/j.annemergmed.2015.05.003.
    1. Platts-Mills TF, Nicholson RJ, Richmond NL, et al. Restricted activity and persistent pain following motor vehicle collision among older adults: a multicenter prospective cohort study. BMC Geriatr. 2016;16:1. doi: 10.1186/s12877-016-0260-z.
    1. Control CfD, Prevention Prevalence and most common causes of disability among adults–United States, 2005. MMWR Morb Mortal Wkly Rep. 2009;58:421–6.
    1. Hunold KM, Esserman DA, Isaacs CG, et al. Side effects from oral opioids in older adults during the first week of treatment for acute musculoskeletal pain. Acad Emerg Med Off J Soc Acad Emerg Med. 2013;20:872–9. doi: 10.1111/acem.12212.
    1. Budnitz DS, Pollock DA, Weidenbach KN, Mendelsohn AB, Schroeder TJ, Annest JL. National surveillance of emergency department visits for outpatient adverse drug events. JAMA. 2006;296:1858–66. doi: 10.1001/jama.296.15.1858.
    1. Barnett ML, Olenski AR, Jena AB. Opioid-prescribing patterns of emergency physicians and risk of long-term use. N Engl J Med. 2017;376:663–73. doi: 10.1056/NEJMsa1610524.
    1. Warsi A, LaValley MP, Wang PS, Avorn J, Solomon DH. Arthritis self-management education programs: a meta-analysis of the effect on pain and disability. Arthritis Rheum. 2003;48:2207–13. doi: 10.1002/art.11210.
    1. Lorig KR, Holman HR. Self-management education: history, definition, outcomes, and mechanisms. Ann Behav Med. 2003;26:1–7. doi: 10.1207/S15324796ABM2601_01.
    1. Bair MJ, Matthias MS, Nyland KA, et al. Barriers and facilitators to chronic pain self-management: a qualitative study of primary care patients with comorbid musculoskeletal pain and depression. Pain Med. 2009;10:1280–90. doi: 10.1111/j.1526-4637.2009.00707.x.
    1. Kroenke K, Krebs EE, Wu J, Yu Z, Chumbler NR, Bair MJ. Telecare collaborative management of chronic pain in primary care: a randomized clinical trial. JAMA. 2014;312:240–8. doi: 10.1001/jama.2014.7689.
    1. Friedman BW, Dym AA, Davitt M, et al. Naproxen with cyclobenzaprine, oxycodone/acetaminophen, or placebo for treating acute low back pain: a randomized clinical trial. JAMA. 2015;314:1572–80. doi: 10.1001/jama.2015.13043.
    1. Chang AK, Bijur PE, Baccelieri A, Gallagher EJ. Efficacy and safety profile of a single dose of hydromorphone compared with morphine in older adults with acute, severe pain: a prospective, randomized, double-blind clinical trial. Am J Geriatr Pharmacother. 2009;7:1–10. doi: 10.1016/j.amjopharm.2009.02.002.
    1. Callahan CM, Unverzagt FW, Hui SL, Perkins AJ, Hendrie HC. Six-item screener to identify cognitive impairment among potential subjects for clinical research. Med Care. 2002;40:771–81. doi: 10.1097/00005650-200209000-00007.
    1. Ware JE, Sherbourne CD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care. 1992;30:473–83. doi: 10.1097/00005650-199206000-00002.
    1. Barrett LL. Prescription drug use among midlife and older Americans: AARP, Knowledge Management; 2005. . Accessed 28 Dec 2017.
    1. Breivik H, Collett B, Ventafridda V, Cohen R, Gallacher D. Survey of chronic pain in Europe: prevalence, impact on daily life, and treatment. Eur J Pain. 2006;10:287–333. doi: 10.1016/j.ejpain.2005.06.009.
    1. Simonsick EM, Newman AB, Nevitt MC, et al. Measuring higher level physical function in well-functioning older adults: expanding familiar approaches in the Health ABC study. J Gerontol A Biol Sci Med Sci. 2001;56:M644–9
    1. Salaffi F, Stancati A, Silvestri CA, Ciapetti A, Grassi W. Minimal clinically important changes in chronic musculoskeletal pain intensity measured on a numerical rating scale. Eur J Pain. 2004;8:283–91. doi: 10.1016/j.ejpain.2003.09.004.
    1. Hess EP, Grudzen CR, Thomson R, Raja AS, Carpenter CR. Shared decision‐making in the emergency department: respecting patient autonomy when seconds count. Acad Emerg Med. 2015;22:856–64.
    1. Flynn D, Knoedler MA, Hess EP, et al. Engaging patients in health care decisions in the emergency department through shared decision-making: a systematic review. Acad Emerg Med Off J Soc Acad Emerg Med. 2012;19:959–67. doi: 10.1111/j.1553-2712.2012.01414.x.
    1. Holland WC, Hunold KM, Mangipudi SA, Rittenberg AM, Yosipovitch N, Platts-Mills TF. A prospective evaluation of shared decision-making regarding analgesics selection for older emergency department patients with acute musculoskeletal pain. Acad Emerg Med Off J Soc Acad Emerg Med. 2016;23:306–14. doi: 10.1111/acem.12888.
    1. Isaacs CG, Kistler C, Hunold KM, et al. Shared decision-making in the selection of outpatient analgesics for older individuals in the emergency department. J Am Geriatr Soc. 2013;61:793–8. doi: 10.1111/jgs.12207.
    1. Platts-Mills TF, Quigley BR, Duronio JP, et al. Development and validation of a brief interactive educational video to improve outpatient treatment of older adults’ acute musculoskeletal pain. J Am Geriatr Soc. 2016;64:880–1. doi: 10.1111/jgs.14043.
    1. Kincaid JP, Fishburne RP, Rogers RL, Chissom BS. Derivation of new readability formulas (automated readability index, fog count, and Flesch reading ease formula) for Navy enlisted personnel. Naval Air Station Memphis: Chief of Naval Technical Training; 1975.
    1. Krebs EE, Carey TS, Weinberger M. Accuracy of the pain numeric rating scale as a screening test in primary care. J Gen Intern Med. 2007;22:1453–8. doi: 10.1007/s11606-007-0321-2.
    1. Platts-Mills TF, Burke GF, Lee YM, et al. Pain and interference of pain with function and mood in elderly adults involved in a motor vehicle collision: a pilot study. Exp Aging Res. 2012;38:330–43. doi: 10.1080/0361073X.2012.672139.
    1. Nicks BA, Shah MN, Adler DH, et al. Minimizing attrition for multi‐site emergency care research. Acad Emerg Med. 2017;24:458–66.
    1. Freedland KE, Mohr DC, Davidson KW, Schwartz JE. Usual and unusual care: existing practice control groups in randomized controlled trials of behavioral interventions. Psychosom Med. 2011;73:323. doi: 10.1097/PSY.0b013e318218e1fb.
    1. Jensen MP, Turner JA, Romano JM, Fisher LD. Comparative reliability and validity of chronic pain intensity measures. Pain. 1999;83:157–62. doi: 10.1016/S0304-3959(99)00101-3.
    1. Krebs EE, Lorenz KA, Bair MJ, et al. Development and initial validation of the PEG, a three-item scale assessing pain intensity and interference. J Gen Intern Med. 2009;24:733–8. doi: 10.1007/s11606-009-0981-1.
    1. Johns Hopkins University AIfPSaQ. Improving the emergency department discharge process: environmental scan report. Rockville, MD: Johns Hopkins University; 2014.
    1. Kroenke K, Unutzer J. Closing the false divide: sustainable approaches to integrating mental health services into primary care. J Gen Intern Med. 2017;32:404–10. doi: 10.1007/s11606-016-3967-9.
    1. Thota AB, Sipe TA, Byard GJ, et al. Collaborative care to improve the management of depressive disorders: a community guide systematic review and meta-analysis. Am J Prev Med. 2012;42:525–38. doi: 10.1016/j.amepre.2012.01.019.
    1. Paasche-Orlow MK, Wolf MS. The causal pathways linking health literacy to health outcomes. Am J Health Behav. 2007;31:S19–26. doi: 10.5993/AJHB.31.s1.4.

Source: PubMed

Sponsor e collaboratori

Condizioni mediche

Interventi farmacologici

3
Sottoscrivi