Feasibility, Usability and Implementation Context of an Internet-Based Pain Education and Exercise Program for Chronic Musculoskeletal Pain: a pilot trial of the REABILITADOR program (Preprint)

Abstract

Internet-based self-management programs and telerehabilitation initiatives have grown with the development of new technologies and have been extensively used for delivering healthcare in many areas. These programs overcome common barriers that patients face with traditional face-to-face healthcare, such as travel, lack of time, and high demand on the public health system. In the past years, during the emergence of the COVID-19 pandemic, this mode of delivery has become even more popular. However, there is still a lack of studies testing this mode of delivery, especially in low- and middle-income countries. To gain a better understanding of the context, feasibility and factors involved in the implementation of an online program, pilot and implementation studies are necessary. These studies can better inform whether a strategy is feasible, acceptable and adequate for its purposes and optimising resource allocation.

To evaluate the feasibility, usability, and implementation context of a self-management internet-based program based on exercises and pain education in people with chronic musculoskeletal pain compared with an online self-management booklet.

Design: Parallel pilot study of a prospectively registered, assessor blinded, 2-arm randomised controlled trial with economic evaluation. Settings: Waiting lists of physiotherapy and rehabilitation centres and advertisements in social media networks. Participants: 65 patients with chronic musculoskeletal pain with an age between 18 and 60 years. Interventions: A 8-week telerehabilitation program based on exercises and pain education (intervention group) compared with an online self-management booklet (control group). Main outcome measures: Implementation outcomes of patient’s perceptions of acceptability, appropriateness, feasibility and usability of the program; societal costs and feasibility to the main trial at 8-week post treatment follow-up. Adverse events were also analysed.

56 participants were analysed at the 8-week follow-up. Intervention group showed responses with a mean (SD) of 4.5 points (0.62) for acceptability, 4.5 points (0.5) for appropriateness and 4.5 points (0.57) for feasibility measured on a 1 to 5 scale. All patients in the intervention group showed satisfactory responses to the system usability outcome. Fifty-five patients were costs analysed (interventions, healthcare, patients, and lost productivity costs) at 8-week follow-up. A total of US$278.3 per patient was expended by the intervention group and US$141.52 per patient expended by the control group. There is satisfactory evidence of the feasibility of the main trial.

We found that the telerehabilitation program is feasible, appropriate, and acceptable from the users’ implementation perspective. The system has been considered usable by all participants and the main trial seems feasible. Cost data were viable to be collected and the program is unlikely to cause harm as no adverse events were reported during the intervention period. Both groups reported being overall satisfied with the platform and the proposed program content.

NCT04274439