Background & Aims

Chronic musculoskeletal pain is defined as persistent pain for more than 12 weeks1,2. The most common chronic musculoskeletal pain are low back pain, neck pain, and knee and hip osteoarthritis3-5. Musculoskeletal pain is high prevalent, is the leading cause of years lived with disability that generates enormous economic costs, impacting health services globally5,6. Clinical guidelines recommend exercise, pain education, and psychological therapies as first-line options7-11. However, many people do not have access to adequate and affordable treatments due to geographical barriers or overstretched healthcare systems12. Telerehabilitation can be a solution of this issue12,13. Although telerehabilitation strategies has been investigated in researchers in high-income countries, there is a lack of studies in low, and middle-income countries12,14. Thus, the aim of this study is to investigate the effectiveness and cost-effectiveness of the telerehabilitation for chronic musculoskeletal pain.

Methods

This is a randomized controlled trial with economic evaluation. This is study was prospectively registered (NCT04274439). Adults (aged 18 to 60 years old) with musculoskeletal pain, and internet access were included in this study. Patients received a login/password to the study website and were automatically randomized at first access to the intervention (telerehabilitation based on exercises videos, asynchronous videos and animations on pain education and physical activity promotion, weekly text messages, and health coaching) or control (online booklet) group. The outcome measures were pain, function, health-related quality of life [HRQoL], kinesiophobia, global perceived effect (GPE), anxiety and depression, pain catastrophizing, self-efficacy, and adverse effects at baseline, 8 weeks, 6 and 12 months after randomization. The economic evaluation from the societal perspective was conducted for pain and quality-adjusted life years (QALYs).

Results

A total of 160 patients with chronic musculoskeletal pain were recruited between February 2020 and June 2020 and randomized to intervention (n=84) and control (n=76) group. The patients were mostly women (67%), with a mean age of 39 (SD: 11) years, mean pain intensity of 6.3 (SD: 1.6) points, and a median duration of symptoms of 36 (IQR: 11-90) months. There was no difference between groups at baseline. The results of the linear mixed models showed statically significant improvement in pain at 8 weeks (mean difference: -0.85, 95% confidence interval: -1.66 to -0.04), but there were no differences between groups at 6 and 12 months. Furthermore, there were no significant differences between groups for function, HRQoL, kinesiophobia, GPE, anxiety and depression, pain catastrophizing, and self-efficacy at 8 weeks, 6 and 12 months after randomization. Patients did not report any adverse events. The results of the economic evaluation will be present at the congress if this study is approved.

Conclusions

The results of this randomized controlled trial with economic evaluation suggests that an internet-based self-management program (i.e., telerehabilitation based on exercises videos, asynchronous videos and animations on pain education and physical activity promotion, weekly text messages, and health coaching) was more effective than an online booklet for pain at short-term (8 weeks) in the treatment of patients with chronic musculoskeletal pain, but the difference between groups was not clinically relevant. Furthermore, there were no differences between groups for any other clinical outcome.

References

1. Treede R, Rief W, Barke A, et al. A classification of chronic pain for ICD-11. Pain. 2015 Jun;156(6):1003–1007.
2. Harvey AM. Classification of Chronic Pain—Descriptions of Chronic Pain Syndromes and Definitions of Pain Terms. The Clinical Journal of Pain. 1995;11(2):163.
3. Carvalho R, Maglioni C, Machado G. et al. Prevalence and characteristics of chronic pain in Brazil: a national internet-based survey study. Brazilian Journal Of Pain 2018. 2018;1(4):331–338.
4. Marinho F, de Azeredo Passos Vm, Carvalho Malta D, et al. Burden of disease in Brazil, 1990–2016: a systematic subnational analysis for the Global Burden of Disease Study 2016. The Lancet. 2018 Sep;392(10149):760–775.
5. GBD 2019 Diseases Injuries Collaborators. Global burden of 369 diseases and injuries in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2020 Oct 17;396(10258):1204–1222.
6. Phillips CJ. The Cost and Burden of Chronic Pain. Rev Pain. 2009 Jun;3(1):2–5.
7. de Oliveira RF, Fandim JV, Fioratti I, et al. The contemporary management of nonspecific lower back pain. Pain Manag. 2019 Sep;9(5):475–482.
8. Woby S, Roach N, Urmston M, et al. The relation between cognitive factors and levels of pain and disability in chronic low back pain patients presenting for physiotherapy. Eur J Pain. 2007 Nov;11(8):869–77.
9. Lotze M, Moseley G Lorimer. Theoretical Considerations for Chronic Pain Rehabilitation. Phys Ther. 2015 Sep;95(9):1316–20.
10. Stewart M, Loftus S. Sticks and Stones: The Impact of Language in Musculoskeletal Rehabilitation. J Orthop Sports Phys Ther. 2018 Jul;48(7):519–522.
11. Truchon M. Determinants of chronic disability related to low back pain: towards an integrative biopsychosocial model. Disabil Rehabil. 2001 Nov 20;23(17):758–67.
13. WHO Global Observatory for eHealth. WHO Global Observatory for eHealth. Geneva: World Health Organization; 2010. Telemedicine: opportunities and developments in member states: report on the second global survey on eHealth.
14. Tuckson RV, Edmunds M, Hodgkins ML. Telehealth. N Engl J Med. 2017 Oct 19;377(16):1585–1592.
15. Digital Physical Therapy Task Force. Alan Lee, Karen Finnin, Lesley Holdsworth, et al. Report of the world physiotherapy/INPTRA digital physical therapy practice task force. World Confederation for Physiotherapy. 2019. May 15, [2022-07-12].

Presenting Author

Gisela Cristiane Miyamoto

Poster Authors

Gisela Cristiane Miyamoto

PhD

Universidade Cidade de São Paulo

Lead Author

Bruno Saragiotto

Universidade Cidade de São Paulo and University of Technology Sydney

Lead Author

Iuri Fioratti

Universidade Cidade de São Paulo

Lead Author

Felipe Reis

Instituto Federal do Rio de Janeiro

Lead Author

Vitor Vallio

Universidade Cidade de São Paulo

Lead Author

Junior Fandim

Universidade Cidade de São Paulo

Lead Author

Tiê Parma Yamato

Universidade Cidade de São Paulo and University of Sydney

Lead Author

Chris G. Maher - DMedSc

Institute for Musculoskeletal Health, The University of Sydney

Lead Author

Leonardo Costa

Universidade Cidade de São Paulo

Lead Author

Topics

  • Evidence, Clinical Trials, Systematic Review, Guidelines, and Implementation Science