Asynchronous and Tailored Digital Rehabilitation of Chronic Shoulder Pain: A Prospective Longitudinal Cohort Study

Dora Janela, Fabíola Costa, Maria Molinos, Robert G Moulder, Jorge Lains, Gerard E Francisco, Virgílio Bento, Steven P Cohen, Fernando Dias Correia, Dora Janela, Fabíola Costa, Maria Molinos, Robert G Moulder, Jorge Lains, Gerard E Francisco, Virgílio Bento, Steven P Cohen, Fernando Dias Correia

Abstract

Background: Chronic shoulder pain (SP) is responsible for significant morbidity, decreased quality of life and impaired work ability, resulting in high socioeconomic burden. Successful SP management is dependent on adherence and compliance with effective evidence-based interventions. Digital solutions may improve accessibility to such treatments, increasing convenience, while reducing healthcare-related costs.

Purpose: Present the results of a fully remote digital care program (DCP) for chronic SP.

Patients and methods: Interventional, single-arm, cohort study of individuals with chronic SP applying for a digital care program. Primary outcome was the mean change between baseline and 12 weeks on the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) questionnaire. Secondary outcomes were change in pain (NPRS), analgesic consumption, intention to undergo surgery, anxiety (GAD-7), depression (PHQ-9), fear-avoidance beliefs (FABQ-PA), work productivity (WPAI) and engagement.

Results: From 296 patients at program start, 234 (79.1%) completed the intervention. Changes in QuickDASH between baseline and end-of-program were both statistically (p < 0.001) and clinically significant, with a mean reduction of 51.6% (mean -13.45 points, 95% CI: 11.99; 14.92). Marked reductions were also observed in all secondary outcomes: 54.8% in NPRS, 44.1% ceased analgesics consumption, 55.5% in surgery intent, 37.7% in FABQ-PA, 50.3% in anxiety, 63.6% in depression and 66.5% in WPAI overall. Higher engagement was associated with higher improvements in disability. Mean patient satisfaction score was 8.7/10.0 (SD 1.6).

Conclusion: This is the first real-world cohort study reporting the results of a multimodal remote digital approach for chronic SP rehabilitation. High completion and engagement rates were observed, which were associated with clinically significant improvement in all health-related outcomes, as well as marked productivity recovery. These promising results support the potential of digital modalities to address the global burden of chronic musculoskeletal pain.

Keywords: chronic pain; digital therapeutic; eHealth; physical therapy; telerehabilitation.

Conflict of interest statement

Dora Janela, Fabíola Costa, Maria Molinos, Virgílio Bento and Fernando Dias Correia are employees at SWORD Health, the study sponsor. Robert Glen Moulder, Jorge Lains, Gerard E Francisco and Steven Paul Cohen are independent scientific consultants who were funded by SWORD Health in connection with the development and execution of this article. In addition Dr Steven Paul Cohen reports personal fees from Releviate, personal fees from Persica, grants from Scilex, outside the submitted work. The authors report no other conflicts of interest in this work.

© 2022 Janela et al.

Figures

Graphical abstract
Graphical abstract
Figure 1
Figure 1
Study flow diagram.
Figure 2
Figure 2
Longitudinal changes across time for all filtered variables. Primary outcome: QuickDASH; Secondary outcomes: (A) Pain level; (B) Surgery intent; (C) WPAI - overall; (D) GAD-7; (E) PHQ-9; (F) FABQ-PA. Cases filtered according to the following baseline thresholds – surgery intent scores > 0 points; GAD-7 scores ≥ 5 points; PHQ-9 scores ≥ 5 points; WPAI overall > 0 points.

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Source: PubMed

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