L. Fernandes1, H. Devan2, I. Fioratti1, S. Kamper3, C. Williams4, B. Saragiotto1
1Universidade Cidade de São Paulo, Physiotherapy, São Paulo, Brazil, 2University of Otago, Physiotherapy, Wellington, New Zealand, 3Nepean Blue Mountains Local Health District, Physiotherapy, Sydney, Australia, 4University of Newcastle, School of Medicine and Public Health, Newcastle, Australia
Background: Chronic musculoskeletal pain represents an enormous burden in society globally. Best practice care for chronic musculoskeletal pain suggests adoption of self-management strategies. Telehealth interventions (e.g. videoconferencing) are a promising approach to promote self-management and have the potential to overcome geographical barriers between patient and care providers. Understanding patients’ perspectives will inform and identify practical challenges towards applying self-management strategies using telehealth.
Purpose: The aim of this study was to synthesize the perceptions of individuals with musculoskeletal pain with regards to enablers and barriers for engaging in telehealth interventions for chronic musculoskeletal pain self-management.
Methods: We performed a systematic review of qualitative studies. We searched on MEDLINE, EMBASE, CINAHL, LILACS and PsycINFO databases from inception up to December 2019. We included qualitative studies and analysis methods (e.g. thematic analysis or phenomenological analysis) focused on exploring perceptions/experiences or attitudes of people with chronic musculoskeletal pain engaging in telehealth interventions. Two reviewers screened titles, abstracts and full texts. Data were extracted in pairs from relevant articles and their methodological quality was assessed using Critical Appraisal Skills Programme (CASP) qualitative research checklist. A thematic synthesis approach was used to derive analytical themes and subthemes.
Results: Sixteen studies were included retrieving qualitative data from 280 participants with regards enablers and barriers for engaging in telehealth interventions. All studies were conducted in high-income countries. Telehealth interventions comprised web-, videoconference-, telephone-, video-, and smartphone app-based programs delivered solely or combined. We included people with osteoarthritis (hip and/or knee), chronic low back pain, persistent pain, and functional fatigue syndrome. Two major themes were found as enablers for engaging in telehealth interventions: 1) ‘in my own pace, space and pace’, 2) empowered patient; and four major themes were found as barriers for engaging in telehealth interventions: 1) impersonal, 2) technology challenges, 3) irrelevant content, 4) limited digital (health) literacy. Major themes served as an umbrella encompassing several subthemes (e.g., under the major theme ‘in my own pace, space and place’, the subtheme entitled ‘convenience’ assembles patients’ perception of flexibility in engaging telehealth, making it easy to fit the proposed activities in their daily routine). The majority of included articles failed to consider accurately researcher and patient relationship and researcher’s possible influence during data collection (CASP item 6).
Conclusion(s): Interventions with well-designed interactive platforms, flexibility to fit patients’ routine and a broad availability of material may provide important motivation input and favor further engagement. Encourage of self-efficacy and self-identification is strongly linked with successful self-management programs.
Implications: Decision making process and implementation strategies must consider enablers and barriers for engaging in telehealth interventions to develop effective initiatives in telehealth. The evidence is limited to high-income countries.
Funding, acknowledgements: Ms. Fernandes holds a master scholarship from Sao Paulo Research Foundation (FAPESP/ process number 2019/14032-8).
Keywords: Telehealth, self-management, chronic pain
Topic: Innovative technology: information management, big data and artificial intelligence
Did this work require ethics approval? No
Institution: Universidade Cidade de São Paulo
Committee: Ethical Committee of Universidade Cidade de São Paulo
Reason: The study was a review of the literature. There was no data collection with patients.
All authors, affiliations and abstracts have been published as submitted.
