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急性肌肉骨骼多系统疾病的远程康复:前瞻性、单臂、干预性研究。

Telerehabilitation of acute musculoskeletal multi-disorders: prospective, single-arm, interventional study.

机构信息

SWORD Health Technologies, Inc, Draper, UT, USA.

Rovisco Pais Medical and Rehabilitation Centre, Tocha, Portugal.

出版信息

BMC Musculoskelet Disord. 2022 Jan 4;23(1):29. doi: 10.1186/s12891-021-04891-5.


DOI:10.1186/s12891-021-04891-5
PMID:34983488
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8728982/
Abstract

BACKGROUND: Acute musculoskeletal (MSK) pain is very common and associated with impaired productivity and high economic burden. Access to timely and personalized, evidence-based care is key to improve outcomes while reducing healthcare expenditure. Digital interventions can facilitate access and ensure care scalability. OBJECTIVE: Present the feasibility and results of a fully remote digital care program (DCP) for acute MSK conditions affecting several body areas. METHODS: Interventional single-arm study of individuals applying for digital care programs for acute MSK pain. Primary outcome was the mean change between baseline and end-of-program in self-reported Numerical Pain Rating Scale (NPRS) score and secondary outcomes were change in analgesic consumption, intention to undergo surgery, anxiety (GAD-7), depression (PHQ-9), fear-avoidance beliefs (FABQ-PA), work productivity (WPAI-GH) and engagement. RESULTS: Three hundred forty-three patients started the program, of which 300 (87.5%) completed the program. Latent growth curve analysis (LGCA) revealed that changes in NPRS between baseline and end-of-program were both statistically (p < 0.001) and clinically significant: 64.3% reduction (mean - 2.9 points). Marked improvements were also noted in all secondary outcomes: 82% reduction in medication intake, 63% reduction in surgery intent, 40% in fear-avoidance beliefs, 54% in anxiety, 58% in depression and 79% recovery in overall productivity. All outcomes had steeper improvements in the first 4 weeks, which paralleled higher engagement in this period (3.6 vs 3.2 overall weekly sessions, p < 0.001). Mean patient satisfaction score was 8.7/10 (SD 1.26). STRENGTHS AND LIMITATIONS: This is the first longitudinal study demonstrating the feasibility of a DCP for patients with acute MSK conditions involving several body areas. Major strengths of this study are the large sample size, the wide range of MSK conditions studied, the breadth of outcomes measured, and the very high retention rate and adherence level. The major limitation regards to the absence of a control group. CONCLUSIONS: We observed very high completion and engagement rates, as well as clinically relevant changes in all health-related outcomes and productivity recovery. We believe this DCP holds great potential in the delivery of effective and scalable MSK care. TRIAL REGISTRATION: NCT, NCT04092946 . Registered 17/09/2019.

摘要

背景:急性肌肉骨骼(MSK)疼痛非常常见,与生产力下降和高经济负担有关。及时获得个性化、基于证据的治疗对于改善结果和降低医疗支出至关重要。数字干预可以促进获得治疗的机会并确保治疗的可扩展性。 目的:介绍一种针对多个身体部位急性 MSK 疾病的全远程数字护理计划(DCP)的可行性和结果。 方法:对申请急性 MSK 疼痛数字护理计划的个人进行干预性单臂研究。主要结局是自我报告的数字疼痛评分量表(NPRS)评分在基线和方案结束时的平均变化,次要结局是镇痛药物消耗、手术意向、焦虑(GAD-7)、抑郁(PHQ-9)、恐惧回避信念(FABQ-PA)、工作生产力(WPAI-GH)和参与度的变化。 结果:343 名患者开始了该计划,其中 300 名(87.5%)完成了该计划。潜在增长曲线分析(LGCA)显示,NPRS 从基线到方案结束的变化在统计学上(p < 0.001)和临床上均具有显著意义:疼痛减轻 64.3%(平均减少 2.9 分)。所有次要结局也有显著改善:药物摄入减少 82%,手术意向减少 63%,恐惧回避信念减少 40%,焦虑减少 54%,抑郁减少 58%,整体生产力恢复 79%。所有结局在最初的 4 周内都有更陡峭的改善,这与该期间更高的参与度相平行(3.6 次与总体每周 3.2 次治疗,p < 0.001)。患者满意度平均评分为 8.7/10(SD 1.26)。 优势与局限性:这是第一项针对涉及多个身体区域的急性 MSK 疾病患者的 DCP 可行性的纵向研究。本研究的主要优势是样本量大、研究的 MSK 疾病范围广泛、测量的结果广泛,以及保留率和依从性水平非常高。主要限制在于缺乏对照组。 结论:我们观察到非常高的完成率和参与率,以及所有健康相关结局和生产力恢复的临床相关变化。我们相信,这种 DCP 在提供有效和可扩展的 MSK 护理方面具有巨大潜力。 试验注册:NCT,NCT04092946。注册于 2019 年 9 月 17 日。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b17e/8728982/216056f8970f/12891_2021_4891_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b17e/8728982/06d9fe707ffb/12891_2021_4891_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b17e/8728982/216056f8970f/12891_2021_4891_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b17e/8728982/06d9fe707ffb/12891_2021_4891_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b17e/8728982/216056f8970f/12891_2021_4891_Fig2_HTML.jpg

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[6]
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[8]
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本文引用的文献

[1]
Effectiveness of App-Delivered, Tailored Self-management Support for Adults With Lower Back Pain-Related Disability: A selfBACK Randomized Clinical Trial.

JAMA Intern Med. 2021-10-1

[2]
Digitally Assisted Versus Conventional Home-Based Rehabilitation After Arthroscopic Rotator Cuff Repair: A Randomized Controlled Trial.

Am J Phys Med Rehabil. 2022-3-1

[3]
Pathophysiology of musculoskeletal pain: a narrative review.

Ther Adv Musculoskelet Dis. 2021-2-26

[4]
Rehabilitative Good Practices in the Treatment of Sarcopenia: A Narrative Review.

Am J Phys Med Rehabil. 2021-3-1

[5]
Transition from acute to chronic pain: where cells, systems and society meet.

Pain Manag. 2020-11

[6]
An Employer-Sponsored Musculoskeletal Care Coordination Service Can Improve Clinical Outcomes and Self-Reported Productivity.

J Occup Environ Med. 2020-11

[7]
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. 2020-7-6

[8]
Digital Care for Chronic Musculoskeletal Pain: 10,000 Participant Longitudinal Cohort Study.

J Med Internet Res. 2020-5-11

[9]
Sensitivity to change and minimal clinically important difference of the 7-item Generalized Anxiety Disorder Questionnaire (GAD-7).

J Affect Disord. 2020-3-15

[10]
Musculoskeletal pain as a predictor for depression in the general working population of Denmark.

Scand J Public Health. 2021-8

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