Background & Aims

Non-pharmacologic self-management strategies including education and exercise are recommended in treatment for patient with chronic pain. Telemedicine is a practice of medicine using electronic communication, information technology, or other means between a physician in one location and a patient in another location. Telemedicine for pain focuses on supporting self-management, physical activity, and providing education, with a duration of 6 weeks to 6 months. Telemedicine reduces pain related outcomes in chronic pain patients, but the effect on pain is limited compared to usual care. The present randomized controlled clinical trial aimed to compare the effects of home-based telemedicine with wearable device and usual care, compared with usual care, on pain-related outcomes in patients with chronic musculoskeletal pain. This trial tested the hypothesis that home-based telemedicine with a wearable device has an additional effect on pain-related outcomes, compared with usual care.

Methods

The patients with chronic musculoskeletal pain were randomly allocated into usual care group or telemedicine group. All patients in both groups received usual care following recommendations from clinical practice guidelines. The in person face-to-face treatment by orthopedics and physical therapy in clinic was performed once a month for 6 months. Telemedicine group received telemedicine with wearable devices and usual care. Telemedicine was performed 20 minutes per session, every week, for 6 months, by the referring physical therapist. The patients used a wrist-worn wearable device, Fitbit Inspire HR (Fitbit, Inc., San Francisco, California, USA), all day and all night. A primary outcome measure was a pain-Numeric Rating Scale (NRS). Secondary outcome measures were Pain Catastrophizing Scale (PCS), Hospital Anxiety and Depression Scale (HADS), Pain Disability Assessment Scale (PDAS), and EuroQol-5 Dimensions-3 level (EQ-5D-3L).

Results

Seventy-one participants were analyzed. The mean scores for pain-NRS at baseline were 6.0 ± 1.8 points in usual care group, and 6.4 ± 2.3 points in telemedicine group. The mean score for EQ-5D-3L at baseline was 0.57 ± 0.16 points in usual care group, and 0.60 ± 0.16 points in telemedicine group. The pain-NRS score was significantly decreased at 6 months, but not early periods in telemedicine group compared with baseline. Pain-NRS score at 6 months in telemedicine group was significantly lower than usual care group (p=0.039*, d=0.424). The number of participants with improvement of 2 points or more in pain-NRS score was 8 of 34 (23.5 %) in usual care group, while 16 of 37 (43.2 %) in telemedicine group (p=0.079, d=0.208). Telemedicine group had a superior effect at 6 months on PCS (p=0.020*, d=0.501), HADS (p=0.028*, d=0.461), PDAS (p=0.044*, d=0.411), and EQ-5D-3L (p=0.049*, d=0.398), compared with usual care group.

Conclusions

The present randomized controlled clinical trial firstly showed home-based telemedicine with wearable devices and usual care has a modest effect on pain-related outcomes than those usual care in patients with chronic musculoskeletal pain. The home-based telemedicine with a wearable device could have an additional therapeutic effect on symptoms in patients with chronic musculoskeletal pain. The telemedicine or wearable devices lead to provide better knowledge and concrete feedback on physical activity, motivate behavior change, facilitate daily exercise at home, reinforce wellness group activities and goals, and close at a distance between physicians and patients. A limited evidence shows cost-effectiveness and cost savings associated with travel in telemedicine. Electronic tools also help support physician time management, reduce the burden on clinic time, and prioritize issues which may need further attention.

References

Cottrell MA, Galea OA, O’Leary SP, Hill AJ, Russell TG. Real-time telerehabilitation for the treatment of musculoskeletal conditions is effective and comparable to standard practice: a systematic review and meta-analysis. Clin Rehabil. 2017; 31:625–638.
O’Brien KM, Hodder RK, Wiggers J, Williams A, Campbell E, Wolfenden L, Yoong SL, Tzelepis F, Kamper SJ, Williams CM. Effectiveness of telephone-based interventions for managing osteoarthritis and spinal pain: a systematic review and meta-analysis. PeerJ. 2018; 6:e5846.
Adamse C, Dekker-Van Weering MG, van Etten-Jamaludin FS, Stuiver MM. The effectiveness of exercise-based telemedicine on pain, physical activity and quality of life in the treatment of chronic pain: A systematic review. J Telemed Telecare. 2018; 24:511–526.

Presenting Author

Kazuhiro Hayashi

Poster Authors

Kazuhiro Hayashi

PhD

Kyoto University, Kyoto, Japan

Lead Author

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Kenji Miki

Hayaishi Hospital, Osaka, Japan, Osaka Yukioka College of Health Science, Osaka, Japan

Lead Author

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Yukiko Shiro

Nagoya Gakuin University

Lead Author

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Tomoko Tetsunaga

Department of Orthopedic Surgery, Okayama University Hospital

Lead Author

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Toshifumi Takasusuki

Lead Author

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Masako Hosoi

Kyushu University Hospital

Lead Author

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Masao Yukioka

Lead Author

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Topics

  • Treatment/Management: Complementary and Alternative therapies