Areias Anabela C, Molinos Maria, Moulder Robert G, Janela Dora, Scheer Justin K, Bento Virgílio, Yanamadala Vijay, Cohen Steven P, Correia Fernando Dias, Costa Fabíola
Sword Health, Inc, Draper, UT, USA.
Institute for Cognitive Science, University of Colorado Boulder, Boulder, CO, USA.
NPJ Digit Med. 2023 Oct 10;6(1):188. doi: 10.1038/s41746-023-00936-2.
Digital interventions have emerged as a solution for time and geographical barriers, however, their potential to target other social determinants of health is largely unexplored. In this post-hoc analysis, we report the impact of social deprivation on engagement and clinical outcomes after a completely remote multimodal musculoskeletal (MSK) digital care program managed by a culturally-sensitive clinical team. Patients were stratified in five categories according to their social deprivation index, and cross-referenced with their race/ethnicity, rurality and distance to healthcare facilities. From a total of 12,062 patients from all U.S. states, 8569 completed the program. Higher social deprivation was associated with greater baseline disease burden. We observed that all categories reported pain improvements (ranging from -2.0 95%CI -2.1, -1.9 to -2.1 95%CI -2.3, -1.9, p < 0.001) without intergroup differences in mean changes or responder rates (from 59.9% (420/701) to 66.6% (780/1172), p = 0.067), alongside reduction in analgesic consumption. We observed significant improvements in mental health and productivity across all categories, with productivity and non-work-related functional recovery being greater within the most deprived group. Engagement was high but varied slightly across categories. Together these findings highlight the importance of a patient-centered digital care program as a tool to address health inequities in musculoskeletal pain management. The idea of investigating social deprivation within a digital program provides a foundation for future work in this field to identify areas of improvement.
数字干预已成为解决时间和地理障碍的一种方法，然而，其针对其他健康社会决定因素的潜力在很大程度上尚未得到探索。在这项事后分析中，我们报告了社会剥夺对由一个具有文化敏感性的临床团队管理的完全远程多模式肌肉骨骼（MSK）数字护理项目后的参与度和临床结果的影响。根据社会剥夺指数将患者分为五类，并与他们的种族/民族、农村地区以及到医疗设施的距离进行交叉对照。在美国所有州的总共12062名患者中，8569名完成了该项目。较高的社会剥夺与更大的基线疾病负担相关。我们观察到所有类别均报告疼痛有所改善（范围从-2.0 95%CI -2.1，-1.9至-2.1 95%CI -2.3，-1.9，p<0.001），组间平均变化或缓解率无差异（从59.9%（420/701）至66.6%（780/1172），p = 0.067），同时镇痛药消费量减少。我们观察到所有类别在心理健康和生产力方面都有显著改善，最贫困组的生产力和与工作无关的功能恢复情况更好。参与度较高，但各类别之间略有差异。这些发现共同凸显了以患者为中心的数字护理项目作为解决肌肉骨骼疼痛管理中健康不平等问题的工具的重要性。在数字项目中研究社会剥夺的想法为该领域未来的工作提供了基础，以确定改进领域。
