Impact on productivity impairment of a digital care program for chronic low back pain: A prospective longitudinal cohort study.

Background: Low back pain (LBP) is the leading cause of disability in the United States and the main reason for absenteeism. Successful management of chronic LBP (CLBP) is dependent on multimodal evidence-based interventions. Digital interventions (DI) may ease accessibility to such treatments, increasing adherence, while reducing healthcare-related costs.
Objectives: Assess the impact of a completely remote multimodal DI on productivity impairment in a real-work context cohort of patients with CLBP.
Design: Longitudinal study.
Methods: Ad-hoc analysis of an interventional, single-arm study of individuals with CLBP undergoing a DI for 12 weeks. Outcomes included the mean change in work productivity and activity impairment (including overall and non-work related activities), pain, depression, anxiety, fear-avoidance beliefs, analgesic usage, and engagement. Minimal clinically important change (MCIC) was calculated for productivity using anchor- and distribution-based methods.
Results: From 560 patients at program start, 78.4% completed the DI. A significant improvement in overall productivity (20.21, 95%CI: 16.48-23.94) and in non-work related activities (21.36, 95%CI: 17.49-25.22) was observed, corresponding to a responder rate of 57.1-83.3% and 60.5-79.8%, respectively, and depending on the MCIC method. Significant improvements were reported for pain (2.32 points, 95%CI: 2.02-2.61), anxiety (5.24, 95%CI: 4.18-6.29), depression (6.38, 95%CI: 4.78-7.98) and fear-avoidance beliefs (8.11, 95%CI: 6.20-10.02). Both engagement (sessions per week) and patient satisfaction scores were high, 2.9 (SD 1.0) and 8.8/10 (SD 1.6), respectively.
Conclusions: This study demonstrated the utility of a multimodal DI to address productivity impairment. DIs have great potential to ease the burden of CLBP, providing an accessible and cost-effective modality of care.
Trial Registration: The study was approved by the New England IRB (protocol number 120190313) and prospectively registered in ClinicalTrials.gov, NCT04092946, on September 17th, 2019.
Competing Interests: Declaration of competing interest Anabela C. Areias, Dora Janela, Fabíola Costa, Maria Molinos, Virgílio Bento, Fernando Correia, and Vijay Yanamadala are employees at SWORD Health, the study sponsor. Justin Scheer, Robert Moulder, Jorge Lains and Steve Cohen received a scientific advisor honorarium from SWORD Health.
(Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.)