Engagement and Utilization of a Complete Remote Digital Care Program for Musculoskeletal Pain Management in Urban and Rural Areas Across the United States: Longitudinal Cohort Study

Abstract

Background Musculoskeletal (MSK) conditions are the number one cause of disability worldwide. Digital care programs (DCPs) for MSK pain management have arisen as alternative care delivery models to circumvent challenges in accessibility of conventional therapy. Despite the potential of DCPs to reduce inequities in accessing care, the outcomes of such interventions in rural and urban populations have yet to be studied. Objective The aim of this study was to assess the impact of urban or rural residency on engagement and clinical outcomes after a multimodal DCP for MSK pain. Methods This study consists of an ad hoc analysis of a decentralized single-arm investigation into engagement and clinical-related outcomes after a multimodal DCP in patients with MSK conditions. Patients were coded according to their zip codes to a specific rural-urban commuting area code and grouped into rural and urban cohorts. Changes in their engagement and clinical outcomes from baseline to program end were assessed. Latent growth curve analysis was performed to estimate change trajectories adjusting for the following covariates: age, gender, BMI, employment status, and pain acuity. Outcomes included engagement, self-reported pain, and the results of the Generalized Anxiety Disorder 7-item, Patient Health Questionnaire 9-item, and Work Productivity and Activity Impairment scales. A minimum clinically important difference (MCID) of 30% was considered for pain. Results Patients with urban and rural residency across the United States participated in the program (n=9992). A 73.8% (7378/9992) completion rate was observed. Both groups reported high satisfaction scores and similar engagement with exercise sessions, with rural residents showing higher engagement with educational content (P<.001) and higher program completion rates (P=.02). All groups showed a significant improvement in all clinical outcomes, including pain, mental health, and work productivity, without statistically significant intergroup differences. The percentage of patients meeting the MCID was similar in both groups (urban: 67.1%, rural: 68.3%; P=.30). Conclusions This study advocates for the utility of a DCP in improving access to MSK care in urban and rural areas alike, showcasing its potential to promote health equity. High engagement, satisfaction, and completion rates were noted in both groups, as well as significant improvements in clinical outcomes. Trial Registration ClinicalTrials.gov NCT04092946; https://clinicaltrials.gov/ct2/show/NCT04092946

Mapping Factors That Affect the Uptake of Digital Therapeutics Within Health Systems: Scoping Review

“…At the patient level, the most reported relative advantages were improvements in health outcomes and shortened disease duration through novel health care options, faster diagnoses, decrease in adverse medical events, and improved monitoring of clinical and patient-reported outcome measures [ 11 , 17 , 41 , 43 , 45 , 47 - 49 , 53 , 60 , 61 , 69 , 71 , 74 , 80 , 81 , 88 , 92 , 94 , 95 , 100 , 102 , 105 , 124 , 128 , 130 , 132 , 133 , 135 , 137 , 138 , 146 , 153 , 163 , 172 , 173 , 179 , 189 , 202 , 207 , 218 , 224 , 226 , 228 , 229 , 231 , 232 , 234 , 239 - 242 , 244 , 246 , 248 , 257 , 260 , 262 , 263 , 265 , 266 , 270 , 275 ], as well as changes in the quality of life, well-being, and life expectancy [ 13 , ...…”

“…Furthermore, digital therapeutics could improve access to health care, reduce waiting times, and lower thresholds for seeking out health services [ 1 , 41 , 43 , 45 , 48 , 49 , 53 , 55 , 61 , 62 , 67 , 70 , 71 , 74 , 76 , 80 , 88 , 90 , 91 , 95 , 99 , 102 , 111 , 113 , 120 , 124 , 130 - 133 , 137 - 139 , 142 , 150 , 151 , 162 , 171 , 173 , 181 , 183 , 185 , 193 , 196 , 203 , 216 , 217 , 224 - 226 , 229 , 232 , 234 , 239 , 240 , 242 , 247 , 249 , 253 , 256 , 261 , 262 , 269 , 273 , 275 ]. They can also aid in the development of (digital) health literacy [ 4 , 13 , 41 , …”

Managing Musculoskeletal Pain in Older Adults Through a Digital Care Solution: Secondary Analysis of a Prospective Clinical Study

“…A robust sandwich estimator was used for standard errors. Gender, BMI, race or ethnicity (White, non-White, and prefer not to specify), rurality (rural vs urban [ 38 ]), and symptomatic anatomical areas (upper limb, lower limb, and spine) were used as covariates for all the above-mentioned models.…”

The potential of a multimodal digital care program in addressing healthcare inequities in musculoskeletal pain management

“…In the past we have validated this DCP for several acute and chronic MSK conditions 16 – 19 , and reported on its effectiveness regardless of race/ethnicity 20 and geographical location (rural vs urban) 21 , suggesting its potential in mitigating some health inequities. The present study applies a social deprivation index (SDI) to a broad cohort of patients with chronic MSK pain who underwent this DCP, aiming to assess the impact of socioeconomic context on clinical outcomes and engagement.…”