Digital Care Programs for Chronic Hip Pain: A Prospective Longitudinal Cohort Study

Abstract

Chronic hip pain is a cause of disability worldwide. Digital interventions (DI) may promote access while providing proper management. This single-arm interventional study assesses the clinical outcomes and engagement of a completely remote multimodal DI in patients with chronic hip pain. This home-based DI consisted of exercise (with real-time biofeedback), education, and cognitive-behavioral therapy. Outcomes were calculated between baseline and program end, using latent growth curve analysis. Primary outcome was the Hip Disability and Osteoarthritis Outcome Score (HOOS). Secondary outcomes were pain, intent to undergo surgery, mental health, productivity, patient engagement (exercise sessions frequency), and satisfaction. Treatment response was assessed using a 30% pain change cut-off. A completion rate of 74.2% (396/534), alongside high patient engagement (2.9 exercise sessions/week, SD 1.1) and satisfaction (8.7/10, SD 1.6) were observed. Significant improvements were observed across all HOOS sub-scales (14.7–26.8%, p < 0.05), with 66.8% treatment responders considering pain. Marked improvements were observed in surgery intent (70.1%), mental health (54%), and productivity impairment (60.5%) (all p < 0.001). The high engagement and satisfaction reported after this DI, alongside the clinical outcome improvement, support the potential of remote care in the management of chronic hip conditions.

Long-Term Clinical Outcomes of a Remote Digital Musculoskeletal Program: An Ad Hoc Analysis from a Longitudinal Study with a Non-Participant Comparison Group

“…In the present study, pain levels reported by both groups at baseline (4.6–4.8 points) were within the range of those described in the literature for CMP both in telerehabilitation (5.8–4.5 points) [ 31 , 32 , 33 , 34 , 52 , 53 , 89 ] and in conventional physical therapy (4.6–5.8 points) studies [ 90 , 91 , 92 ]. When analyzing the impact of telerehabilitation interventions on pain reduction at 1-year, the results varied, possibly depending on a number of factors, including baseline pain severity, type of pain management strategy, length of the intervention and particularly the affected joint (e.g., several anatomic regions (50.9%) [ 31 ], low back (44.8%) [ 93 ], knee (43.9%) [ 32 ], hip (34.5%) [ 32 ], or hip and knee (17.2%) [ 94 ]).…”

“…The DCP, previously described elsewhere [ 53 , 54 , 60 ], consisted of an 8 or 12-week program comprising exercise, education and cognitive behavioral therapy (CBT). Upon enrollment each participant was assigned to a PT.…”

“…For each sample size, 10,000 simulations were conducted to assess statistical power at the p < 0.050 level of significance. Each simulated data set was obtained with parameters from previous studies of longitudinal change in treatment outcomes [ 52 , 53 , 54 , 55 ]. Additionally, a 30% attrition rate was assumed across the simulated data set.…”

“…We have developed a multimodal digital care program (DCP) combining exercise education and cognitive behavioral therapy (CBT), which has been previously validated in chronic and acute MSK conditions [ 52 , 53 , 54 , 55 , 56 , 57 ]. Compared to in-person approaches, this DCP has demonstrated at least similar impact on pain and functionality in both the short and long term in the context of post-surgical rehabilitation [ 56 , 57 , 58 , 59 ].…”