Digital Care Programs for Chronic Hip Pain: A Prospective Longitudinal Cohort Study
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design
2.2. Participants
2.3. Intervention
2.4. Outcomes Measures
- Pain intensity assessed by the 11-point Numerical Pain Rating Score (NPRS) through the question “Please rate your average pain over the last 7 days: 0 (no pain at all) to 10 (worst pain imaginable)” [44].
- Self-reported surgery intent assessed by the question “How likely are you to seek surgery to address your condition in the next 12 months?” (range 0 (not likely)–100 (extremely likely)).
- Generalized Anxiety Disorder 7-item scale (GAD-7) (scores 0–21) was applied to assess anxiety severity in clinical practice and research, and was chosen due to strong validity and reliability: Cronbach’s alpha = 0.92 (excellent), ICC = 0.83 (excellent) [45,46]. Patient Health 9-item questionnaire (PHQ-9) (scores 0–27) was chosen for its strong scale validity (area under the curve in diagnosing major depression = 0.95), and reliability (Cronbach’s alpha = 0.89 (excellent)) as a brief measure of depression severity. Both scales evaluated symptomatology in the past two weeks. A cut-off threshold of ≥5 indicates at least mild anxiety/depression, respectively [45,47].
- Work productivity assessed by Work Productivity and Activity Impairment questionnaire for general health (WPAI), comprising the sub-scores: WPAI overall (combines presenteeism and absenteeism), WPAI work (presenteeism), WPAI time (absenteeism) in employed participants, and WPAI activities (non-work related activities impairment) in the entire cohort (range 0–100%, higher scores depicting greater impairment) [48].
- Patient engagement assessed by completion of the program (completion rate), cumulative time dedicated to exercise, number of completed exercise sessions, and number of sessions per week.
- Satisfaction by the question: “On a scale from 0 to 10, how likely is it that you would recommend this intervention to a friend or neighbor?”.
2.5. Safety and Adverse Events
2.6. Data Availability
2.7. Statistical Analyses
3. Results
3.1. Participants
3.2. Clinical Outcomes
3.2.1. Primary Outcome
HOOS
3.2.2. Secondary Outcomes
Pain
Surgery Intent
Mental Health
Work productivity
4. Discussion
4.1. Main Findings
4.2. Comparison with the Literature
4.3. Strengths and Limitations
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Characteristic | Entire Cohort (N = 534) |
---|---|
Age (years), mean (SD) | 50.2 (11.3) |
Age categories (years), N (%): | |
<25 | 3 (0.6) |
25–40 | 122 (22.8) |
40–60 | 292 (54.7) |
>60 | 117 (21.9) |
Sex, N (%) | |
Female | 363 (68.0) |
Male | 171 (32.0) |
BMI, mean (SD) a | 29.1 (6.4) |
BMI categories, N (%) a: | |
Underweight (<18.5) | 2 (0.4) |
Normal (18.5–25) | 147 (27.7) |
Overweight (25–30) | 188 (35.4) |
Obese (30–40) | 159 (29.9) |
Morbidly obese (>40) | 35 (6.6) |
Laterality | |
Left | 150 (28.1) |
Right | 185 (34.6) |
Both | 199 (37.3) |
Employment status, N (%): | |
Employed (part-time or full-time) | 480 (89.9) |
Unemployed (not working or retired) | 54 (10.1) |
Hip pain-related condition, N (%): | |
Hip Osteoarthritis | 106 (19.9%) |
Others b | 428 (80.1%) |
Psychopathology comorbidity | |
GAD-7 ≥ 5 | 135 (25.3%) |
GAD-7 ≥ 10 | 46 (8.6%) |
PHQ-9 ≥ 5 | 102 (19.1%) |
PHQ-9 ≥ 10 | 34 (6.4%) |
Outcome, Mean (95%CI) | n | Baseline | End-of-Program | Mean Change | % Change |
---|---|---|---|---|---|
HOOS-Pain | 515 | 65.59 (64.33; 66.84) | 78.91 (77.17; 80.65) | 13.32 (11.67; 14.97) | 20.3% |
HOOS-Function | 251 | 75.08 (73.17; 77.00) | 86.09 (83.89; 88.30) | 11.01 (8.61; 13.41) | 14.7% |
HOOS-Qol | 515 | 52.44 (50.86; 54.02) | 66.52 (64.22; 68.81) | 14.08 (12.03; 16.12) | 26.8% |
HOOS-Sport | 251 | 65.37 (62.84; 67.90) | 78.92 (76.20; 81.63) | 13.55 (10.76; 16.33) | 20.7% |
HOOS-Symptoms | 251 | 68.18 (66.25; 70.12) | 78.62 (76.38; 80.85) | 10.43 (8.20; 12.67) | 15.3% |
Pain Level | 534 | 4.82 (4.65; 4.98) | 2.60 (2.33; 2.87) | 2.22 (1.93; 2.50) | 46.0% |
Surgery Intent > 0 | 201 | 23.67 (20.10; 27.23) | 7.07 (3.38; 10.77) | 16.59 (12.92; 20.27) | 70.1% |
Surgery Intent | 534 | 8.84 (7.14; 10.54) | 3.16 (1.67; 4.65) | 5.68 (4.01; 7.34) | 64.3% |
GAD-7 ≥ 5 | 135 | 9.19 (8.43; 9.94) | 4.22 (3.07; 5.36) | 4.97 (3.79; 6.15) | 54.1% |
GAD-7 | 534 | 3.05 (2.68; 3.42) | 1.92 (1.51; 2.33) | 1.13 (0.68; 1.57) | 36.9% |
PHQ-9 ≥ 5 | 102 | 9.86 (8.85; 10.87) | 4.48 (3.27; 5.46) | 5.38 (4.23; 6.54) | 54.6% |
PHQ-9 | 534 | 2.66 (2.29; 3.03) | 1.55 (1.22; 1.87) | 1.16 (0.75; 1.49) | 41.9% |
WPAI Overall > 0 | 224 | 30.18 (27.37; 33.00) | 11.94 (8.63; 15.24) | 18.25 (14.92; 21.58) | 60.5% |
WPAI Overall | 430 | 15.82 (13.80; 17.84) | 9.05 (6.35; 11.75) | 6.77 (3.89; 9.66) | 42.8% |
WPAI Work > 0 | 218 | 29.43 (26.72; 32.14) | 11.97 (8.72; 15.22) | 17.46 (14.18; 20.74) | 59.3% |
WPAI Work | 430 | 14.91 (13.00; 16.81) | 9.05 (6.90; 11.47) | 5.86 (2.93; 8.80) | 39.3% |
WPAI Activity > 0 | 390 | 35.70 (33.41; 37.98) | 17.14 (13.75; 20.52) | 18.56 (15.11; 22.01) | 52.0% |
WPAI Activity | 534 | 26.07 (23.94; 28.20) | 14.68 (11.88; 17.47) | 11.39 (8.40; 14.38) | 43.7% |
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Janela, D.; Costa, F.; Areias, A.C.; Molinos, M.; Moulder, R.G.; Lains, J.; Bento, V.; Scheer, J.K.; Yanamadala, V.; Cohen, S.P.; et al. Digital Care Programs for Chronic Hip Pain: A Prospective Longitudinal Cohort Study. Healthcare 2022, 10, 1595. https://doi.org/10.3390/healthcare10081595
Janela D, Costa F, Areias AC, Molinos M, Moulder RG, Lains J, Bento V, Scheer JK, Yanamadala V, Cohen SP, et al. Digital Care Programs for Chronic Hip Pain: A Prospective Longitudinal Cohort Study. Healthcare. 2022; 10(8):1595. https://doi.org/10.3390/healthcare10081595
Chicago/Turabian StyleJanela, Dora, Fabíola Costa, Anabela C. Areias, Maria Molinos, Robert G. Moulder, Jorge Lains, Virgílio Bento, Justin K. Scheer, Vijay Yanamadala, Steven P. Cohen, and et al. 2022. "Digital Care Programs for Chronic Hip Pain: A Prospective Longitudinal Cohort Study" Healthcare 10, no. 8: 1595. https://doi.org/10.3390/healthcare10081595