P-078 - (Poster #78) No Effect of Educational Video and Telecare for Acute Musculoskeletal Pain on Physical Health: A Randomized Controlled Trial Secondary Outcome

We evaluated the effect of a multicomponent pain recovery intervention to improve perceived overall physical health among older adults with acute MSP in ED or urgent care (UC) settings.

Methods:

We carried out the Brief Educational video plus Telecare To Enhance Recovery from Pain (BETTER from Pain) three-arm randomized controlled trial among southeastern academic EDs and an orthopedic UC from 2020 to 2023. We randomized patients aged ≥50 years presenting with acute MSP and an average pain score ≥4 into one of three arms: 1) usual care, 2) interactive educational pain management video, and 3) full intervention (video, nurse telecare 48-72 hours after acute care visit, and electronic communication to the patient's primary care provider). Exclusion criteria included non-English speakers; patients with pain not related to MSP; and patients with baseline self-reported daily opioid use. Results are presented for our secondary outcome of physical health measured using the Patient-Reported Outcomes Measurement Information System Scale Global Health Physical (GPH) 2a, a self-report of physical health and activity ability. A T-score of 50 represents the general population norm; each 10 points lower represents one standard deviation worse than the general population. We administered the GPH at 1, 3, 6, and 12 months after enrollment. Study arms were compared using generalized estimating equation models controlling for age; access to a primary care provider; and baseline and pre-injury GPH. Secondary analyses included pairwise contrasts.

Results:

Participants (n=330) had a mean age of 64.7 years (SD: 9.1): 68.5% were female, 73.3% were white, and 66.3% had college education. Baseline mean GPH scores were 41.9 (8.4) overall, which was not significantly different across arms, and indicated GPH 0.8 SD worse than the general population. At one year, mean (SD) GPH was 47.78 (8.58) for usual care, 49.16 (8.69) for video only, and 50.08 (7.92) for full intervention, indicating improvement in all 3 arms. The outcome analysis comparing GPH among the three arms across all time points was not significant (p=0.19). At 12 months, mean GPH differences (95% confidence interval (CI)) were 1.5 (95% CI: -0.32, 3.41; p=0.10) between video only and usual care and 1.61 (95% CI: -0.07, 3.29; p=0.06) between full intervention and usual care. In a post-hoc comparison of participants assigned to an intervention (i.e., video or full intervention) versus usual care found that GPH at 12 months was also higher, 1.57 (95% CI: 0.04, 3.11; p=0.04).

Conclusions/Implications for future research and/or clinical care: The trial results did not show an effect on the trial’s secondary outcome of global physical health through 12 months. A post hoc analysis of the pooled effect of either intervention versus usual care suggests better physical health through 12 months. This suggests that a general pain self-management intervention alone may not be sufficient to improve physical health. Further research of ED-based early educational interventions is needed to identify the most important treatment components (or combination of components) that are likely to have an impact on physical health outcomes.