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Musculoskeletal pain did not improve with use of mobile health app
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Use of a mobile-health-supported single-patient multi-crossover trial was feasible and correlated with a satisfactory user experience for patients with chronic musculoskeletal pain. However, patients’ participation in the trial did not lead to significantly improved pain interference at 6 months vs. usual care.
“We conducted this study to see if personalized (n-of-1) trials could help people with chronic pain achieve better outcomes,” Richard L. Kravitz, MD, MSPH, told Healio.com/Orthopedics. “We found the use of a phone app made participating in these trials easy and patients appreciated the opportunity to collect their own data. However, the primary outcome failed, contrary to our expectations. Patients randomized to undertake an n-of-1 trial had no better pain impairment at 6 months than controls.”
In the study, which was published in the Journal of the American Medical Association Internal Medicine, researchers randomized 108 patients to an individually designed single-patient multi-crossover n-of-1 trial supported by a mobile health (mHealth) application and randomized 107 patients to received usual care. The patients, who were enrolled in the study from July 2014 to July 2016 in northern California, experienced chronic musculoskeletal pain for at least 6 weeks, had a smartphone or tablet with a data plan, and were followed for at least 1 year by 48 clinicians.
Patients in the mHealth group met with clinicians and used a desktop interface to choose treatment options, as well as trial parameters for a trial that compared two pain management regimens. They were also reminded through the app to take treatments on assigned days and upload answers to daily questions on pain and adverse effects correlated with treatment whereas the control group received usual pain management care.
Outcomes assessed included change in the patent-reported outcomes measurement information system pain-related interface 8-item short-form scale from baseline to 6 months, patient-reported pain intensity, overall health, analgesic adherence, clinician trust, satisfaction with care and medication-related shared decision-making. Participant engagement and experience were also assessed for patients the mHealth app group.
Results showed pain interference decreased in both groups at the 6-month follow-up although the decrease was not different for mobile application users and patients who received usual care. Investigators noted there was an advantage in secondary outcomes for patients who used mHealth vs. those who received usual care, apart from higher medication-related shared decision-making at 6 months. Among mHealth app users, 88% of patients reported the app may help people similar to them better manage their musculoskeletal pain. – by Monica Jaramillo
Disclosure: This research was supported by the National Institute of Nursing Research (1RO1NR013938) and the National Center for Advancing Translational Sciences of the NIH through grant UL1 TR000002.
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Kravitz RL, et al. JAMA Intern Med. 2018;doi:10.1001/jamainternmed.2018.3981.
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