PMID- 36735933 OWN - NLM STAT- MEDLINE DCOM- 20230321 LR - 20230428 IS - 2291-5222 (Electronic) IS - 2291-5222 (Linking) VI - 11 DP - 2023 Mar 16 TI - Engagement and Utilization of a Complete Remote Digital Care Program for Musculoskeletal Pain Management in Urban and Rural Areas Across the United States: Longitudinal Cohort Study. PG - e44316 LID - 10.2196/44316 [doi] LID - e44316 AB - BACKGROUND: Musculoskeletal (MSK) conditions are the number one cause of disability worldwide. Digital care programs (DCPs) for MSK pain management have arisen as alternative care delivery models to circumvent challenges in accessibility of conventional therapy. Despite the potential of DCPs to reduce inequities in accessing care, the outcomes of such interventions in rural and urban populations have yet to be studied. OBJECTIVE: The aim of this study was to assess the impact of urban or rural residency on engagement and clinical outcomes after a multimodal DCP for MSK pain. METHODS: This study consists of an ad hoc analysis of a decentralized single-arm investigation into engagement and clinical-related outcomes after a multimodal DCP in patients with MSK conditions. Patients were coded according to their zip codes to a specific rural-urban commuting area code and grouped into rural and urban cohorts. Changes in their engagement and clinical outcomes from baseline to program end were assessed. Latent growth curve analysis was performed to estimate change trajectories adjusting for the following covariates: age, gender, BMI, employment status, and pain acuity. Outcomes included engagement, self-reported pain, and the results of the Generalized Anxiety Disorder 7-item, Patient Health Questionnaire 9-item, and Work Productivity and Activity Impairment scales. A minimum clinically important difference (MCID) of 30% was considered for pain. RESULTS: Patients with urban and rural residency across the United States participated in the program (n=9992). A 73.8% (7378/9992) completion rate was observed. Both groups reported high satisfaction scores and similar engagement with exercise sessions, with rural residents showing higher engagement with educational content (P<.001) and higher program completion rates (P=.02). All groups showed a significant improvement in all clinical outcomes, including pain, mental health, and work productivity, without statistically significant intergroup differences. The percentage of patients meeting the MCID was similar in both groups (urban: 67.1%, rural: 68.3%; P=.30). CONCLUSIONS: This study advocates for the utility of a DCP in improving access to MSK care in urban and rural areas alike, showcasing its potential to promote health equity. High engagement, satisfaction, and completion rates were noted in both groups, as well as significant improvements in clinical outcomes. TRIAL REGISTRATION: ClinicalTrials.gov NCT04092946; https://clinicaltrials.gov/ct2/show/NCT04092946. CI - (c)Justin Scheer, Anabela C Areias, Maria Molinos, Dora Janela, Robert Moulder, Jorge Lains, Virgilio Bento, Vijay Yanamadala, Fernando Dias Correia, Fabiola Costa. Originally published in JMIR mHealth and uHealth (https://mhealth.jmir.org), 16.03.2023. 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 - Areias, Anabela C AU - Areias AC AUID- ORCID: 0000-0002-1807-7386 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 - Janela, Dora AU - Janela D AUID- ORCID: 0000-0002-8440-2044 AD - Sword Health Inc, Draper, UT, United States. FAU - Moulder, Robert AU - Moulder R 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 - Rovisco Pais Medical and Rehabilitation Centre, Coimbra, Portugal. AD - Faculty of Medicine, Coimbra University, Coimbra, 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 Neurosurgery, Hartford Healthcare Medical Group, Westport, CT, United States. AD - Department of Surgery, Frank H Netter School of Medicine, Quinnipiac University, Hamden, CT, United States. FAU - Dias Correia, Fernando AU - Dias Correia F 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. FAU - Costa, Fabiola AU - Costa F AUID- ORCID: 0000-0001-8981-7049 AD - Sword Health Inc, Draper, UT, United States. LA - eng SI - ClinicalTrials.gov/NCT04092946 PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20230316 PL - Canada TA - JMIR Mhealth Uhealth JT - JMIR mHealth and uHealth JID - 101624439 SB - IM MH - Humans MH - United States MH - Longitudinal Studies MH - *Musculoskeletal Pain/therapy MH - Pain Management MH - Health Promotion MH - Cohort Studies PMC - PMC10132051 OTO - NOTNLM OT - clinical outcome OT - digital care OT - digital therapy OT - eHealth OT - engagement OT - health equity OT - health inequity OT - musculoskeletal OT - musculoskeletal conditions OT - pain OT - pain management OT - physical therapy OT - physiotherapy OT - remote care OT - rural OT - telehealth OT - telemedicine OT - telerehabilitation OT - urban COIS- Conflicts of Interest: Sword Health owns the Digital Care Program and as such this program is only available to those covered by a commercial agreement with Sword Health. FC, DJ, AA, MM, FDC, VB, and VY are employees of Sword Health, the sponsor of this study. DJ, FC, FDC, VY, and VB also hold equity in Sword Health. RM is an independent scientific consultant responsible for the statistical analysis. JS and JL are independent scientific and clinical consultants who received adviser honorariums from Sword Health. EDAT- 2023/02/04 06:00 MHDA- 2023/03/22 06:00 PMCR- 2023/03/16 CRDT- 2023/02/03 16:52 PHST- 2022/11/17 00:00 [received] PHST- 2023/02/02 00:00 [accepted] PHST- 2023/01/12 00:00 [revised] PHST- 2023/02/04 06:00 [pubmed] PHST- 2023/03/22 06:00 [medline] PHST- 2023/02/03 16:52 [entrez] PHST- 2023/03/16 00:00 [pmc-release] AID - v11i1e44316 [pii] AID - 10.2196/44316 [doi] PST - epublish SO - JMIR Mhealth Uhealth. 2023 Mar 16;11:e44316. doi: 10.2196/44316.