Digital rehabilitation for hand and wrist pain: a single-arm prospective longitudinal cohort study

Fabíola Costa; Dora Janela; Maria Molinos; Robert G Moulder; Jorge Lains; Gerard E Francisco; Virgílio Bento; Vijay Yanamadala; Steven P Cohen; Fernando Dias Correia

doi:10.1097/PR9.0000000000001026

Digital rehabilitation for hand and wrist pain: a single-arm prospective longitudinal cohort study

Pain Rep. 2022 Aug 19;7(5):e1026. doi: 10.1097/PR9.0000000000001026. eCollection 2022 Sep-Oct.

Authors

Fabíola Costa¹, Dora Janela¹, Maria Molinos¹, Robert G Moulder², Jorge Lains^{3

4}, Gerard E Francisco⁵, Virgílio Bento¹, Vijay Yanamadala^{1

6

7}, Steven P Cohen^{8

9}, Fernando Dias Correia^{1

10}

Affiliations

¹ Clinical Research, SWORD Health Technologies, Inc, Draper, UT, USA.
² Institute for Cognitive Science, University of Colorado Boulder, Boulder, CO, USA.
³ Rovisco Pais Medical and Rehabilitation Centre, Tocha, Portugal.
⁴ PM&R, Faculty of Medicine, Coimbra University, Coimbra, Portugal.
⁵ Department of Physical Medicine and Rehabilitation, McGovern Medical School, The University of Texas Health Science Center, and TIRR Memorial Hermann, Houston, TX, USA.
⁶ Department of Surgery, Frank H. Netter School of Medicine, Quinnipiac University, Hamden, CT, USA.
⁷ Department of Neurosurgery, Hartford Healthcare Medical Group, Westport, CT, USA.
⁸ Departments of Anesthesiology & Critical Care Medicine, Physical Medicine and Rehabilitation, Neurology, and Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA.
⁹ Departments of Anesthesiology and Physical Medicine and Rehabilitation and Anesthesiology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
¹⁰ Neurology Department, Centro Hospitalar e Universitário do Porto, Porto, Portugal.

Abstract

Introduction: Wrist and hand represent the third most common body part in work-related injuries, being associated with long-term absenteeism. Telerehabilitation can promote access to treatment, patient adherence, and engagement, while reducing health care-related costs.

Objective: Report the results of a fully remote digital care program (DCP) for wrist and hand pain (WP).

Methods: A single-arm interventional study was conducted on individuals with WP applying for a DCP. Primary outcome was the mean change in the Numerical Pain Rating Scale after 8 weeks (considering a minimum clinically important change of 30%). Secondary outcomes were: disability (Quick Disabilities of the Arm, Shoulder, and Hand questionnaire), analgesic intake, surgery intention, mental health (patient health questionnaire [PHQ-9] and generalized anxiety disorder [GAD-7]), fear-avoidance beliefs (FABQ-PA), work productivity and activity impairment, and engagement.

Results: From 189 individuals starting the DCP, 149 (78.8%) completed the intervention. A significant pain improvement was observed (51.3% reduction (2.26, 95% CI 1.73; 2.78)) and 70.4% of participants surpassing minimum clinically important change. This change correlated with improvements in disability (52.1%), FABQ-PA (32.2%), and activities impairment recovery (65.4%). Improvements were also observed in other domains: surgery intent (76.1%), mental health (67.0% in anxiety and 72.7% in depression), and overall productivity losses (68.2%). Analgesic intake decreased from 22.5% to 7.1%. Mean patient satisfaction score was 8.5/10.0 (SD 1.8).

Conclusions: These findings support the feasibility and utility of a fully remote DCP for patients with WP. Clinically significant improvements were observed in all health-related and productivity-related outcomes, alongside very high patient adherence rates and satisfaction. This study strengthens that management of WP is possible through a remote DCP, decreasing access barriers and potentially easing health care expenditure.

Keywords: Digital therapeutic; Musculoskeletal pain; Physical therapy; Telerehabilitation; eHealth.