Impacts of Digital Care Programs for Musculoskeletal Conditions on Depression and Work Productivity: Longitudinal Cohort Study

Abstract

Background Comorbidity between musculoskeletal (MSK) pain and depression is highly common, and is associated with a greater symptom burden and greater loss of work productivity than either condition alone. Multimodal care programs tackling both physical and mental health components may maximize productivity recovery and return to work. Digital delivery of such programs can facilitate access, ensure continuity of care, and enhance patient engagement. Objective The aim of this study was to assess the impact of a completely remote multimodal digital care program (DCP) for MSK pain on mental health and work-related outcomes stratified by baseline depression levels. Methods Ad hoc analysis of an interventional, single-arm, cohort study of individuals with MSK pain undergoing a DCP was performed. Three subgroups with different baseline depression severity levels were established based on responses to the Patient Health Questionnaire (PHQ-9): cluster 1 (score<5: minimal depression), cluster 2 (scores 5-10: mild depression), and cluster 3 (score≥10: moderate depression). The mean changes in depression, anxiety, fear-avoidance beliefs, work productivity, and activity impairment and adherence between baseline and end of program (8-12 weeks) were assessed across subgroups by latent growth curve analysis. Results From a total of 7785 eligible participants, 6137 (78.83%) were included in cluster 1, 1158 (14.87%) in cluster 2, and 490 (6.29%) in cluster 3. Significant improvements in depression and anxiety scores were observed in clusters 2 and 3 but not in cluster 1, with average end-of-the program scores in clusters 2 and 3 below the initially defined cluster thresholds (score of 5 and 10, respectively). All clusters reported significant improvements in productivity impairment scores (mean changes from –16.82, 95% CI –20.32 to –13.42 in cluster 1 to –20.10, 95% CI –32.64 to –7.57 in cluster 3). Higher adherence was associated with higher improvements in depression in clusters 2 and 3, and with greater recovery in activities of daily living in cluster 3. Overall patient satisfaction was 8.59/10.0 (SD 1.74). Conclusions A multimodal DCP was able to promote improvements in productivity impairment scores comparable to those previously reported in the literature, even in participants with comorbid depression and anxiety. These results reinforce the need to follow a biopsychosocial framework to optimize outcomes in patients with MSK pain. Trial Registration ClinicalTrials.gov NCT04092946; https://clinicaltrials.gov/ct2/show/NCT04092946

Improvements in Work Productivity and Activity Impairment Among Adults With Anxiety or Depressive Symptoms Participating in a Relational Agent–Delivered Digital Mental Health Intervention

“…Although the magnitude of the reduction in absenteeism was not statistically significant, there were significant improvements in presenteeism, work productivity impairment, and overall activity impairment in both unadjusted and adjusted analyses of approximately 20% each. This findings in our study targeting those seeking help with mood and anxiety management is consistent with the magnitude of the effect seen in other studies examining work productivity improvements among interventions targeting comorbid conditions such as pain (~20% reduction in work productivity impairment), 22 insomnia (~14% reduction in activity impairment), 23 and musculoskeletal disorders (~20% in work productivity impairment) 24 . This is not surprising given the strong correlation between depressive symptoms, anxiety symptoms, and work productivity found in prior studies 1–5 (2004) as well as our own (eg, the correlations ranged from 0.52 to 0.63 in the present study).…”

“…28 Respondents are asked about various symptoms over the past 2 weeks and to indicate whether symptoms occurred not at all (0), on several days (1), more than half the days (2), or nearly every day (3). Summed scores range from 0 to 24, categorized according to severity level as minimal/less than mild (0-4), mild (5-9), moderate (10)(11)(12)(13)(14), moderately severe (15)(16)(17)(18)(19), and severe (20)(21)(22)(23)(24).…”

“…In addition, a few studies of digital health interventions reported improvements specifically in work productivity among those with several different types of health conditions, including chronic pain and insomnia. 22,23 One such study by Costa et al 24 reported improvements in work productivity among users of a digital care program for musculoskeletal disorders for patients with and without depressive or anxiety symptoms. To our knowledge, however, no published study has focused on potential cost savings from improved work productivity associated with enrollment in a DMHI intended to help users manage their mood and/or anxiety, nor have any focused specifically on a DMHI that incorporates cognitive behavioral therapy (CBT) components delivered via relational agent technology and powered by natural language processing and artificial intelligence models.…”

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

“…The prevalence of depression and anxiety has been reported to be higher in residents of rural areas compared to urban areas [ 76 ], with those from rural areas facing a shortage of mental health services [ 77 ]. Since mental health and MSK pain are tightly associated [ 38 , 78 ], the scarcity of psychological support can seriously impact the recovery rates of rural populations. This study confirms a higher depression burden in patients from rural areas but found similar improvement in mental health scores in both rural and urban patients, reinforcing the notion that lack of access to mental health resources may be the main driver for the higher burden of disease in rural areas.…”

“…This program encourages patients to develop strategies and self-management skills to manage their pain and has been validated in several acute and chronic MSK conditions [15][16][17][34][35][36]. Additionally, the impact of race and ethnicity [37], as well as baseline mental health [38] and fear-avoidance beliefs [39], on final clinical outcomes have also been explored. The purpose of this study was to assess the impact of geographical location on engagement and clinical outcomes after a multimodal DCP, with the hypothesis being that patients from both rural and urban areas would have similar engagement and significant improvement in outcomes after program completion.…”