Background & Aims

Effective acute musculoskeletal pain (MSP) treatment could prevent the transition to chronic MSP. (1-3) Currently, there are no ED-based approaches to encourage recovery-promoting behavior to reduce the transition to chronic MSP and reduce healthcare use. We evaluated a multicomponent intervention to improve pain recovery in older adults with acute MSP in ED or urgent care (UC) settings. (4, 5) Here we present secondary outcomes of healthcare use.

Methods

We randomized ED or UC patients ?50 years presenting with acute MSP (baseline pain intensity ?4) to either: 1) usual care, 2) interactive educational video, or 3) interactive educational video, nurse telecare at 48-72 hours, and primary care provider message. Patients using daily opioids for >2 weeks were excluded. We measured comorbidities using the Gagne Index, a score based on the presence of 20 comorbidities identified in the participant’s electronic health record. Secondary healthcare use outcomes included total hospital days, ED/UC visits, primary care provider contacts, and contacts with other clinicians assessed by self-report or electronic health record abstraction at 1, 3, 6, and 12 months. We calculated healthcare use as the rate of days/contacts per year. We compared healthcare rates across arms using a linear model adjusting for age and primary care provider (PCP) access.

Results

Participants (n=330) had a mean age of 64.7 years and median Gagne Index score of 0; 68.5% were female, 73.3% were White, 66.3% had a college education; and 95.2% had PCP access. The rate (mean (SD) per year) for hospital days was 0.44 (1.47) for usual care, 0.16 (0.71) for video, and 0.39 (1.59) for full intervention; rate per year for ER/UC visits was 1.13 (1.89) for usual care, 0.73 (1.03) for video, and 1.34 (4.51) for full intervention; rate per year for PCP contacts was 2.99 (2.26) for usual care, 2.65 (2.43) for video, and 2.96 (2.61) for full intervention; and rate per year for other clinician contacts was 7.94 (8.77) for usual care, 7.88 (9.77) for video, and 8.62 (12.60) for full intervention. Comparing among the three arms across all time points, the intervention did not have a statistically significant effect on hospital days (p=0.25), ER/UC visits (p=0.31), PCP contacts (p=0.52), or other clinician contacts (p=0.85).

Conclusions

An educational pain video and nurse telecare intervention did not show a benefit for reducing healthcare use over one year following an ED or UC visit for acute MSP. Our results may be due to the study population having high education levels and low prevalence of comorbidities. Further work is needed to assess if the intervention is beneficial in patient populations with lower education or higher prevalence of comorbidities.

References

1.Morrison RS, Flanagan S, Fischberg D, et al. A novel interdisciplinary analgesic program reduces pain and improves function in older adults after orthopedic surgery. J Am Geriatr Soc 2009;57:1-10.
2.Katz J, Seltzer Ze. Transition from acute to chronic postsurgical pain: Risk factors and protective factors. Expert review of neurotherapeutics 2009;9:723-744.
3.McLean SA, Clauw DJ, Abelson JL, et al. The development of persistent pain and psychological morbidity after motor vehicle collision: Integrating the potential role of stress response systems into a biopsychosocial model. Psychosomatic medicine 2005;67:783-790.
4.Platts-Mills TF, McLean SA, Weinberger M, et al. Brief educational video plus telecare to enhance recovery for older emergency department patients with acute musculoskeletal pain: Study protocol for the better randomized controlled trial. Trials 2020;21:615.
5.Hurka-Richardson K, Platts-Mills TF, McLean SA, et al. Brief educational video plus telecare to enhance recovery for older emergency department patients with acute musculoskeletal pain: An update to the study protocol for a randomized controlled trial. Trials 2022;23:400.

Presenting Author

Michelle L. Meyer

Poster Authors

Michelle Meyer

PhD

University of North Carolina at Chapel Hill

Lead Author

E-mail

Samuel McLean

MD MPH

The University of North Carolina at Chapel Hill

Lead Author

E-mail

Francis Keefe

Duke University

Lead Author

E-mail

Morris Weinberger

PhD

Lead Author

E-mail

Montika Bush

PhD

Lead Author

E-mail

Eugenia Quackenbush

MD

Lead Author

E-mail

Kurt Kroenke

MD

Lead Author

E-mail

Mark A. Weaver

PhD

Lead Author

E-mail

Robert D. Kerns

PhD

Lead Author

E-mail

Timothy F. Platts-Mills

MD

Lead Author

E-mail

Topics

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