A digital musculoskeletal (MSK) care program reduced patients' pain levels and improved secondary measures like anxiety, depression, surgery intent and medication use, according to a study published in BMC Musculoskeletal Disorders. 

The study was sponsored by SWORD Health, which provided the digital MSK program used in the research, and the authors were SWORD employees or scientific advisors. 

TOP-LINE DATA

Study participants reported a statistically significant 64.3% reduction in pain between the baseline and end of the program, an average of nearly three points lower on the Numerical Pain Rating Scale.

The study also found an 81.9% reduction in painkiller consumption and a 62.7% reduction in surgery intent.

Though a low number of participants had anxiety and depression, those that screened positively for anxiety saw an average reduction of 54.2%, and those with depression had a 58.2% reduction at the end of the program.

The study also measured fear and avoidance beliefs, with a 39.5% reduction. Those who scored highly on the Fear-Avoidance Beliefs Questionnaire saw a higher decrease. 

Though most study participants were not missing work due to their MSK disorder, more reported a decrease in productivity. Researchers noted an overall 81.4% reduction in presenteeism, where a person reports to work but can't function fully due to their condition. 

HOW IT WAS DONE

The study included 343 patients who started the program, while 300 finished. Patients were included if they reported MSK pain that lasted less than 12 weeks in the neck, lower back, shoulder, elbow, hip, knee or ankle.

Participants rated their pain on the Numerical Pain Rating Scale, which scores pain levels between zero (no pain) and 10 (worst pain imaginable). They were also asked if they used pain medication and how frequently, and how likely they were to have surgery in the next year.

They also completed the Generalized Anxiety Disorder (GAD-7) questionnaire, the Patient Health (PHQ-9) survey for depression, the Fear-Avoidance Beliefs Questionnaire for physical activity and the Work Productivity and Activity Impairment (WPAI) questionnaire.

The program included exercise and educational content, including topics derived from cognitive behavioral therapy. Patients were remotely monitored by a physical therapist, and the intervention lasted between eight and 12 weeks, depending on their needs.

THE BACKGROUND

MSK conditions are common worldwide, and can be expensive to manage. According to a study published in JAMA, lower back and neck pain accounted for the highest amount of healthcare spending in 2016 among 154 other conditions, costing an estimated $134.5 billion. Other MSK disorders took the number two spot.

Digital MSK care and physical therapy companies are scooping up more funding, arguing they can cut costs while improving access to care.

In November, SWORD, whose technology was used in this study, raised $163 million in Series D funding plus another $26 million in a secondary round. Another digital MSK offering, Hinge Health, landed $600 million in new investments in late October. 

Other companies in the space include DarioHealth, Kaia Health, Omada Health, RecoveryOne and SpineZone.

CONCLUSION

Researchers noted the strengths of their study included the sample size, the variety of MSK conditions included, the number of outcomes studied and the high rate of retention and adherence.

However, the study did not include a control group, and it could benefit from a longer follow-up period.

"We observed very high completion and engagement rates, as well as clinically relevant changes in all health-related outcomes and productivity recovery," the study's authors wrote. "We believe this DCP [digital care program] holds great potential in the delivery of effective and scalable MSK care."