JMIR Mhealth Uhealth. 2023 Feb 2. doi: 10.2196/44316. Online ahead of print.
ABSTRACT
BACKGROUND: Musculoskeletal (MSK) conditions are the number one cause of disability worldwide. Digital care programs (DCPs) for MSK pain management have risen 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 the present study was to assess the impact of urban and rural residencies on engagement and clinical outcomes after a multimodal DCP for MSK pain.
METHODS: The 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 (RUCA) code, and grouped into rural and urban cohorts. Their engagement, as well as clinical outcome changes from baseline to program-end were assessed. Latent growth curve analysis was performed to estimate change trajectories adjusting for the following covariates: age, gender, body mass index, employment status and pain acuity. Outcomes included engagement, self-reported pain, Generalized Anxiety Disorder 7-item scale, Patient Health Questionnaire 9-item, and Work Productivity and Activity Impairment. A minimum clinically important difference (MCID) of 30% was considered for pain.
RESULTS: Patients from urban and rural residencies across all the U.S. participated in the program (N= 9992). A 73.8% 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 without inter-group statistical significance, including pain, mental health and work productivity. The percentage of patients meeting the MCID was similar in both groups (urban: 67%, rural: 68.7%, P=.24).
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.
CLINICALTRIAL: ClinicalTrials.gov NCT04092946.
PMID:36735933 | DOI:10.2196/44316
