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

Abstract

Dora Janela,1 Fabíola Costa,1 Maria Molinos,1 Robert G Moulder,2 Jorge Lains,3,4 Gerard E Francisco,5 Virgílio Bento,1 Steven P Cohen,6,7 Fernando Dias Correia1,8 1SWORD Health Technologies, Inc, Clinical Validation, Draper, UT, USA; 2Institute for Cognitive Science, University of Colorado Boulder, Boulder, CO, USA; 3Rovisco Pais Medical and Rehabilitation Centre, Tocha, Portugal; 4Faculty of Medicine, Coimbra University, Coimbra, Portugal; 5Department of Physical Medicine and Rehabilitation, The University of Texas Health Science Center McGovern Medical School, and TIRR Memorial Hermann, Houston, TX, USA; 6Departments of Anesthesiology & Critical Care Medicine, Physical Medicine and Rehabilitation, Neurology, and Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA; 7Departments of Anesthesiology and Physical Medicine and Rehabilitation and Anesthesiology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA; 8Neurology Department, Centro Hospitalar e Universitário do Porto, Porto, PortugalCorrespondence: Fernando Dias CorreiaSWORD Health Technologies, Inc, Clinical Validation, 65 E Wadsworth Park Dr Ste 230, Draper, UT, 84020, USATel [phone]Fax [phone]Email [email protected]: 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, physical therapy, telerehabilitation, digital therapeutic, eHealth

Keywords

• chronic pain
• physical therapy
• telerehabilitation
• digital therapeutic
• ehealth.