Impacts of Digital Care Programs for Musculoskeletal Conditions on Depression and Work Productivity: Longitudinal Cohort Study
BackgroundComorbidity between musculoskeletal (MSK) pain and depression is highly common, and is associated with a greater symptom burden and greater loss of work productivity than either condition alone. Multimodal care programs tackling both physical and mental health compo...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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JMIR Publications
2022-07-01
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| Series: | Journal of Medical Internet Research |
| Online Access: | https://www.jmir.org/2022/7/e38942 |
| _version_ | 1797734861458374656 |
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| author | Fabíola Costa Dora Janela Maria Molinos Robert Moulder Vírgilio Bento Jorge Lains Justin Scheer Vijay Yanamadala Steven Cohen Fernando Dias Correia |
| author_facet | Fabíola Costa Dora Janela Maria Molinos Robert Moulder Vírgilio Bento Jorge Lains Justin Scheer Vijay Yanamadala Steven Cohen Fernando Dias Correia |
| author_sort | Fabíola Costa |
| collection | DOAJ |
| description |
BackgroundComorbidity between musculoskeletal (MSK) pain and depression is highly common, and is associated with a greater symptom burden and greater loss of work productivity than either condition alone. Multimodal care programs tackling both physical and mental health components may maximize productivity recovery and return to work. Digital delivery of such programs can facilitate access, ensure continuity of care, and enhance patient engagement.
ObjectiveThe aim of this study was to assess the impact of a completely remote multimodal digital care program (DCP) for MSK pain on mental health and work-related outcomes stratified by baseline depression levels.
MethodsAd hoc analysis of an interventional, single-arm, cohort study of individuals with MSK pain undergoing a DCP was performed. Three subgroups with different baseline depression severity levels were established based on responses to the Patient Health Questionnaire (PHQ-9): cluster 1 (score<5: minimal depression), cluster 2 (scores 5-10: mild depression), and cluster 3 (score≥10: moderate depression). The mean changes in depression, anxiety, fear-avoidance beliefs, work productivity, and activity impairment and adherence between baseline and end of program (8-12 weeks) were assessed across subgroups by latent growth curve analysis.
ResultsFrom a total of 7785 eligible participants, 6137 (78.83%) were included in cluster 1, 1158 (14.87%) in cluster 2, and 490 (6.29%) in cluster 3. Significant improvements in depression and anxiety scores were observed in clusters 2 and 3 but not in cluster 1, with average end-of-the program scores in clusters 2 and 3 below the initially defined cluster thresholds (score of 5 and 10, respectively). All clusters reported significant improvements in productivity impairment scores (mean changes from –16.82, 95% CI –20.32 to –13.42 in cluster 1 to –20.10, 95% CI –32.64 to –7.57 in cluster 3). Higher adherence was associated with higher improvements in depression in clusters 2 and 3, and with greater recovery in activities of daily living in cluster 3. Overall patient satisfaction was 8.59/10.0 (SD 1.74).
ConclusionsA multimodal DCP was able to promote improvements in productivity impairment scores comparable to those previously reported in the literature, even in participants with comorbid depression and anxiety. These results reinforce the need to follow a biopsychosocial framework to optimize outcomes in patients with MSK pain.
Trial RegistrationClinicalTrials.gov NCT04092946; https://clinicaltrials.gov/ct2/show/NCT04092946 |
| first_indexed | 2024-03-12T12:50:39Z |
| format | Article |
| id | doaj.art-865af90e920044b29bbff276926e550d |
| institution | Directory Open Access Journal |
| issn | 1438-8871 |
| language | English |
| last_indexed | 2024-03-12T12:50:39Z |
| publishDate | 2022-07-01 |
| publisher | JMIR Publications |
| record_format | Article |
| series | Journal of Medical Internet Research |
| spelling | doaj.art-865af90e920044b29bbff276926e550d2023-08-28T22:44:53ZengJMIR PublicationsJournal of Medical Internet Research1438-88712022-07-01247e3894210.2196/38942Impacts of Digital Care Programs for Musculoskeletal Conditions on Depression and Work Productivity: Longitudinal Cohort StudyFabíola Costahttps://orcid.org/0000-0001-8981-7049Dora Janelahttps://orcid.org/0000-0002-8440-2044Maria Molinoshttps://orcid.org/0000-0002-9679-4639Robert Moulderhttps://orcid.org/0000-0001-7504-9560Vírgilio Bentohttps://orcid.org/0000-0001-6025-8511Jorge Lainshttps://orcid.org/0000-0002-8737-7569Justin Scheerhttps://orcid.org/0000-0003-2536-601XVijay Yanamadalahttps://orcid.org/0000-0002-2456-5888Steven Cohenhttps://orcid.org/0000-0001-5928-2127Fernando Dias Correiahttps://orcid.org/0000-0001-8028-926X BackgroundComorbidity between musculoskeletal (MSK) pain and depression is highly common, and is associated with a greater symptom burden and greater loss of work productivity than either condition alone. Multimodal care programs tackling both physical and mental health components may maximize productivity recovery and return to work. Digital delivery of such programs can facilitate access, ensure continuity of care, and enhance patient engagement. ObjectiveThe aim of this study was to assess the impact of a completely remote multimodal digital care program (DCP) for MSK pain on mental health and work-related outcomes stratified by baseline depression levels. MethodsAd hoc analysis of an interventional, single-arm, cohort study of individuals with MSK pain undergoing a DCP was performed. Three subgroups with different baseline depression severity levels were established based on responses to the Patient Health Questionnaire (PHQ-9): cluster 1 (score<5: minimal depression), cluster 2 (scores 5-10: mild depression), and cluster 3 (score≥10: moderate depression). The mean changes in depression, anxiety, fear-avoidance beliefs, work productivity, and activity impairment and adherence between baseline and end of program (8-12 weeks) were assessed across subgroups by latent growth curve analysis. ResultsFrom a total of 7785 eligible participants, 6137 (78.83%) were included in cluster 1, 1158 (14.87%) in cluster 2, and 490 (6.29%) in cluster 3. Significant improvements in depression and anxiety scores were observed in clusters 2 and 3 but not in cluster 1, with average end-of-the program scores in clusters 2 and 3 below the initially defined cluster thresholds (score of 5 and 10, respectively). All clusters reported significant improvements in productivity impairment scores (mean changes from –16.82, 95% CI –20.32 to –13.42 in cluster 1 to –20.10, 95% CI –32.64 to –7.57 in cluster 3). Higher adherence was associated with higher improvements in depression in clusters 2 and 3, and with greater recovery in activities of daily living in cluster 3. Overall patient satisfaction was 8.59/10.0 (SD 1.74). ConclusionsA multimodal DCP was able to promote improvements in productivity impairment scores comparable to those previously reported in the literature, even in participants with comorbid depression and anxiety. These results reinforce the need to follow a biopsychosocial framework to optimize outcomes in patients with MSK pain. Trial RegistrationClinicalTrials.gov NCT04092946; https://clinicaltrials.gov/ct2/show/NCT04092946https://www.jmir.org/2022/7/e38942 |
| spellingShingle | Fabíola Costa Dora Janela Maria Molinos Robert Moulder Vírgilio Bento Jorge Lains Justin Scheer Vijay Yanamadala Steven Cohen Fernando Dias Correia Impacts of Digital Care Programs for Musculoskeletal Conditions on Depression and Work Productivity: Longitudinal Cohort Study Journal of Medical Internet Research |
| title | Impacts of Digital Care Programs for Musculoskeletal Conditions on Depression and Work Productivity: Longitudinal Cohort Study |
| title_full | Impacts of Digital Care Programs for Musculoskeletal Conditions on Depression and Work Productivity: Longitudinal Cohort Study |
| title_fullStr | Impacts of Digital Care Programs for Musculoskeletal Conditions on Depression and Work Productivity: Longitudinal Cohort Study |
| title_full_unstemmed | Impacts of Digital Care Programs for Musculoskeletal Conditions on Depression and Work Productivity: Longitudinal Cohort Study |
| title_short | Impacts of Digital Care Programs for Musculoskeletal Conditions on Depression and Work Productivity: Longitudinal Cohort Study |
| title_sort | impacts of digital care programs for musculoskeletal conditions on depression and work productivity longitudinal cohort study |
| url | https://www.jmir.org/2022/7/e38942 |
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