FEASIBILITY AND USABILITY OF AN INTERNET-BASED PAIN EDUCATION AND EXERCISE PROGRAMME FOR CHRONIC MUSCULOSKELETAL PAIN: PILOT STUDY OF REABILITADOR TRIAL

I. Fioratti¹, J.V. Fandim¹, F.J.J. Reis², G.C. Miyamoto¹, H. Lee³, T.P. Yamato¹, A.S. Palomo¹, C.P.P. Ribeiro¹, G.D. Batista¹, G.E. Freitas¹, B. Dear⁴, C.G. Maher⁵, L.O.P. Costa¹, B.T. Saragiotto¹

Background: Chronic musculoskeletal pain is a major cause of years of living with disabilities and the search for treatment strategies has been growing annually. The treatment of chronic musculoskeletal pain has been shown to be primarily multimodal, including exercise programs, pain education, control of psycho-emotional aspects and daily activities. We have found in the last decades the appearance and development of remote strategies for the management and self-management of chronic pain. Telerehabilitation can be delivered through telephone calls, smartphone applications, websites or digital platforms that guarantee the population's access to multimodal treatment strategies for chronic pain. For the proper functioning of these platforms, several feasibility and usability studies were conducted, in order to reduce the barriers to their applicability and optimizing the results of the intervention when testing its effectiveness.

Purpose: To test and evaluate the feasibility and usability of a self-management internet-based program based on exercises and pain education.

Methods: This is a parallel pilot study of a randomized controlled trial, prospectively registered, with two arms and blind to the evaluators. The study included patients between 18 and 60 years of age, with internet access and chronic pain (lasting more than 12 weeks) of musculoskeletal origin of at least 3 points of intensity on a scale of 0 to 10. Patients were randomized into Telerehabilitation Group (n = 26) and Online Booklet Group (n = 30). Primary outcomes included implementation outcomes and will be measured by the Acceptability of Intervention Measure (AIM), Intervention Appropriateness Measure (IAM) and Feasibility of Intervention Measure (FIM). We consider the study feasible and the intervention appropriate from the observation of 70% of the sample responding with satisfactory values for each scale (results greater than 2 points on a scale of 1 to 5). We perform the usability analysis of the system using the System Usability Scale. We consider the system's usability greater than 53 points on a scale from 0 to 100 to be satisfactory in at least 70% of the responses observed. The primary outcome of the main study (pain post-intervention) was also collected and demonstrated through the difference between means.

Results: For patients in the Telerehabilitation Group, satisfactory scores were found in 96% of responses for AIM, 96% for IAM and 95% for FIM. All patients in the Telerehabilitation group show satisfactory responses to the usability outcome, with 16 patients responding as "best imaginable", 7 responding as "excellent" and 4 responding as "good". For the outcome pain in post-intervention, we obtained a difference between the averages of 2.2 points on a scale of 0 to 10, favorable to the Telerehabilitation group.

Conclusion(s): Based on the observed results, we consider the proposed intervention feasible for its use in a clinical study of greater relevance and there is no need to adapt it to the main study.

Implications: Based on the measurement of the implementation outcomes, we can continue a more relevant clinical study and suggest new ways to test the observed intervention.

Funding, acknowledgements:  Fundação de Amparo à Pesquisa do Estado de São Paulo (Sao Paulo Research Foundation – FAPESP, process number 2016/24217-7).

Keywords: Telerehabilitation, Pain, Feasibility

Topic: Pain & pain management

Did this work require ethics approval? Yes

Institution: Universidade Cidade de São Paulo - UNICID

Committee: 8084 - Universidade Cruzeiro do Sul

Ethics number: 3046362