PMID- 36189963 OWN - NLM STAT- MEDLINE DCOM- 20221102 LR - 20221116 IS - 1438-8871 (Electronic) IS - 1439-4456 (Print) IS - 1438-8871 (Linking) VI - 24 IP - 10 DP - 2022 Oct 31 TI - Racial and Ethnic Differences in Outcomes of a 12-Week Digital Rehabilitation Program for Musculoskeletal Pain: Prospective Longitudinal Cohort Study. PG - e41306 LID - 10.2196/41306 [doi] LID - e41306 AB - BACKGROUND: Musculoskeletal (MSK) pain disproportionately affects people from different ethnic backgrounds through higher burden and less access to care. Digital care programs (DCPs) can improve access and help reduce inequities. However, the outcomes of such programs based on race and ethnicity have yet to be studied. OBJECTIVE: We aimed to assess the impact of race and ethnicity on engagement and outcomes in a multimodal DCP for MSK pain. METHODS: This was an ad hoc analysis of an ongoing decentralized single-arm investigation into engagement and clinical-related outcomes after a multimodal DCP in patients with MSK conditions. Patients were stratified by self-reported racial and ethnic group, and their engagement and outcome changes between baseline and 12 weeks were compared using latent growth curve analysis. Outcomes included program engagement (number of sessions), self-reported pain scores, likelihood of surgery, Generalized Anxiety Disorder 7-item scale, Patient Health Questionnaire 9-item, and Work Productivity and Activity Impairment. A minimum clinically important difference (MCID) of 30% was calculated for pain, and multivariable logistic regression was performed to evaluate race as an independent predictor of meeting the MCID. RESULTS: A total of 6949 patients completed the program: 65.5% (4554/6949) of them were non-Hispanic White, 10.8% (749/6949) were Black, 9.7% (673/6949) were Asian, 9.2% (636/6949) were Hispanic, and 4.8% (337/6949) were of other racial or ethnic backgrounds. The population studied was diverse and followed the proportions of the US population. All groups reported high engagement and satisfaction, with Hispanic and Black patients ranking first among satisfaction despite lower engagement. Black patients had a higher likelihood to drop out (odds ratio [OR] 1.19, 95% CI 1.01-1.40, P=.04) than non-Hispanic White patients. Hispanic and Black patients reported the highest level of pain, surgical intent, work productivity, and impairment in activities of daily living at baseline. All race groups showed a significant improvement in all outcomes, with Black and Hispanic patients reporting the greatest improvements in clinical outcomes. Hispanic patients also had the highest response rate for pain (75.8%) and a higher OR of meeting the pain MCID (OR 1.74, 95% CI 1.24-2.45, P=.001), when compared with non-Hispanic White patients, independent of age, BMI, sex, therapy type, education level, and employment status. No differences in mental health outcomes were found between race and ethnic groups. CONCLUSIONS: This study advocates for the utility of a DCP in improving access to MSK care and promoting health equity. Engagement and satisfaction rates were high in all the groups. Black and Hispanic patients had higher MSK burden at baseline and lower engagement but also reported higher improvements, with Hispanic patients presenting a higher likelihood of pain improvement. CI - (c)Justin Scheer, Fabiola Costa, Maria Molinos, Anabela Areias, Dora Janela, Robert G Moulder, Jorge Lains, Virgilio Bento, Vijay Yanamadala, Steven P Cohen, Fernando Dias Correia. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 31.10.2022. FAU - Scheer, Justin AU - Scheer J AUID- ORCID: 0000-0003-2536-601X AD - Department of Neurological Surgery, University of California, San Francisco, CA, United States. FAU - Costa, Fabiola AU - Costa F AUID- ORCID: 0000-0001-8981-7049 AD - Sword Health, Inc, Draper, UT, United States. FAU - Molinos, Maria AU - Molinos M AUID- ORCID: 0000-0002-9679-4639 AD - Sword Health, Inc, Draper, UT, United States. FAU - Areias, Anabela AU - Areias A AUID- ORCID: 0000-0002-1807-7386 AD - Sword Health, Inc, Draper, UT, United States. FAU - Janela, Dora AU - Janela D AUID- ORCID: 0000-0002-8440-2044 AD - Sword Health, Inc, Draper, UT, United States. FAU - Moulder, Robert G AU - Moulder RG AUID- ORCID: 0000-0001-7504-9560 AD - Institute for Cognitive Science, University of Colorado Boulder, Boulder, CO, United States. FAU - Lains, Jorge AU - Lains J AUID- ORCID: 0000-0002-8737-7569 AD - Faculty of Medicine, Coimbra University, Coimbra, Portugal. AD - Rovisco Pais Medical and Rehabilitation Centre, Tocha, Portugal. FAU - Bento, Virgilio AU - Bento V AUID- ORCID: 0000-0001-6025-8511 AD - Sword Health, Inc, Draper, UT, United States. FAU - Yanamadala, Vijay AU - Yanamadala V AUID- ORCID: 0000-0002-2456-5888 AD - Sword Health, Inc, Draper, UT, United States. AD - Department of Surgery, Frank H Netter School of Medicine, Quinnipiac University, Hamden, CT, United States. AD - Department of Neurosurgery, Hartford Healthcare Medical Group, Westport, CT, United States. FAU - Cohen, Steven P AU - Cohen SP AUID- ORCID: 0000-0001-5928-2127 AD - Department of Anesthesiology & Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, United States. AD - Department of Anesthesiology, Uniformed Services University of the Health Sciences, Bethesda, MD, United States. AD - Department of Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, Baltimore, MD, United States. AD - Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, United States. AD - Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, United States. AD - Department of Physical Medicine and Rehabilitation, Uniformed Services University of the Health Sciences, Bethesda, MD, United States. FAU - Correia, Fernando Dias AU - Correia FD AUID- ORCID: 0000-0001-8028-926X AD - Sword Health, Inc, Draper, UT, United States. AD - Neurology Department, Centro Hospitalar e Universitario do Porto, Porto, Portugal. LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20221031 PL - Canada TA - J Med Internet Res JT - Journal of medical Internet research JID - 100959882 SB - IM MH - Humans MH - Prospective Studies MH - *Musculoskeletal Pain/therapy MH - Longitudinal Studies MH - Activities of Daily Living MH - Cohort Studies PMC - PMC9664333 OTO - NOTNLM OT - digital therapy OT - diversity OT - eHealth OT - equity OT - ethnicity OT - mobile phone OT - musculoskeletal conditions OT - pain OT - physical therapy OT - race OT - telehealth OT - telerehabilitation COIS- Conflicts of Interest: F Costa, DJ, AA, MM, FDC, and VY are employees of Sword Health, the sponsor of this study. FDC, VY, and VB also hold equity in Sword Health, and VB is the CEO of the same company. RGM is an independent scientific consultant responsible for the statistical analysis and received consultant fees from Sword Health. JS, SPC, and JL are independent scientific and clinical consultants who received adviser honorarium from Sword Health. EDAT- 2022/10/04 06:00 MHDA- 2022/11/03 06:00 PMCR- 2022/10/31 CRDT- 2022/10/03 07:13 PHST- 2022/07/21 00:00 [received] PHST- 2022/09/30 00:00 [accepted] PHST- 2022/09/14 00:00 [revised] PHST- 2022/10/04 06:00 [pubmed] PHST- 2022/11/03 06:00 [medline] PHST- 2022/10/03 07:13 [entrez] PHST- 2022/10/31 00:00 [pmc-release] AID - v24i10e41306 [pii] AID - 10.2196/41306 [doi] PST - epublish SO - J Med Internet Res. 2022 Oct 31;24(10):e41306. doi: 10.2196/41306.