Development and validation of a pain monitoring app for patients with musculoskeletal conditions (The Keele pain recorder feasibility study).

BACKGROUND: Assessing daily change in pain and related symptoms help in diagnosis, prognosis, and monitoring response to treatment. However, such changes are infrequently assessed, and usually reviewed weeks or months after the start of treatment. We therefore developed a smartphone application (Keele Pain Recorder) to record information on the severity and impact of pain on daily life. Specifically, the study goal was to assess face, content and construct validity of data collection using the Pain Recorder in primary care patients receiving new analgesic prescriptions for musculoskeletal pain, as well as to assess its acceptability and clinical utility. METHODS: The app was developed with Keele's Research User Group (RUG), a clinical advisory group (CAG) and software developer for use on Android devices. The app recorded pain levels, interference, sleep disturbance, analgesic use, mood and side effects. In a feasibility study, patients aged >?18 attending their general practitioner (GP) with a painful musculoskeletal condition were recruited to use the app twice per day for 28?days. Face and construct validity were assessed through baseline and post-study questionnaires (Spearman's rank correlation coefficient). Usability and acceptability were determined through post-study questionnaires, and patient, GP, RUG and CAG interviews. RESULTS: An app was developed which was liked by both patients and GPs. It was felt that it offered the opportunity for GPs to discuss pain control with their patients in a new way. All participants found the app easy to use (it did not interfere with their activities) and results easy to interpret. Strong associations existed between the first 3?days (Spearman r?=?0.79) and last 3?days (r?=?0.60) of pain levels and intensity scores on the app with the validated questionnaires. CONCLUSIONS: Collaborating with patient representatives and clinical stakeholders, we developed an app which can be used to help clinicians and patients monitor painful musculoskeletal conditions in response to analgesic prescribing. Recordings were accurate and valid, especially, for pain intensity ratings, and it was easy to use. Future work needs to examine how pain trajectories can help manage changes in a patient's condition, ultimately assisting in self-management

Development and validation of a pain monitoring app for patients with musculoskeletal conditions (The Keele pain recorder feasibility study)

Background: Assessing daily change in pain and related symptoms help in diagnosis, prognosis, and monitoring response to treatment. However, such changes are infrequently assessed, and usually reviewed weeks or months after the start of treatment. We therefore developed a smartphone application (Keele Pain Recorder) to record information on the severity and impact of pain on daily life. Specifically, the study goal was to assess face, content and construct validity of data collection using the Pain Recorder in primary care patients receiving new analgesic prescriptions for musculoskeletal pain, as well as to assess its acceptability and clinical utility. Methods: The app was developed with Keele’s Research User Group (RUG), a clinical advisory group (CAG) and software developer for use on Android devices. The app recorded pain levels, interference, sleep disturbance, analgesic use, mood and side effects. In a feasibility study, patients aged > 18 attending their general practitioner (GP) with a painful musculoskeletal condition were recruited to use the app twice per day for 28 days. Face and construct validity were assessed through baseline and post-study questionnaires (Spearman’s rank correlation coefficient). Usability and acceptability were determined through post-study questionnaires, and patient, GP, RUG and CAG interviews. Results: An app was developed which was liked by both patients and GPs. It was felt that it offered the opportunity for GPs to discuss pain control with their patients in a new way. All participants found the app easy to use (it did not interfere with their activities) and results easy to interpret. Strong associations existed between the first 3 days (Spearman r = 0.79) and last 3 days (r = 0.60) of pain levels and intensity scores on the app with the validated questionnaires. Conclusions: Collaborating with patient representatives and clinical stakeholders, we developed an app which can be used to help clinicians and patients monitor painful musculoskeletal conditions in response to analgesic prescribing. Recordings were accurate and valid, especially, for pain intensity ratings, and it was easy to use. Future work needs to examine how pain trajectories can help manage changes in a patient’s condition, ultimately assisting in self-management

Validade, fiabilidade e usabilidade de uma aplicação móvel para avaliar a dor em utentes com patologia músculo-esquelética

Enquadramento: A dor tem um carácter multidimensional e um enorme impacto no dia a dia das pessoas. É necessária uma avaliação rigorosa e biopsicossocial. As aplicações móveis são uma forma de realizar esta avaliação a custos reduzidos, em qualquer lugar e de forma continuada. Contudo, as aplicações móveis para avaliar a dor em Português Europeu são escassas. Assim, são objetivos destes trabalho: definir os requisitos funcionais e desenvolver uma aplicação móvel para avaliar a dor (AvaliaDor) em utentes com patologia músculo-esquelética e avaliar a usabilidade, a validade e a fiabilidade dessa aplicação. Métodos: A aplicação AvaliaDor foi desenvolvida com base na literatura e nas recomendações de 5 fisioterapeutas e 5 utentes em ciclos de avaliação, inclusão das recomendações e nova avaliação até não existirem novas alterações a realizar. A AvaliaDor permite avaliar a intensidade, localização e fenótipo da dor, incapacidade, catastrofização e medo do movimento. Posteriormente, a AvaliaDor foi utilizada por 52 utentes com dor musculosquelética que, também, preencheram um conjunto de escalas de avaliação da dor em papel (inventário resumido da dor, PainDETECT, escala de catastrofização da dor e escala TAMPA de cinesiofobia), assim como o questionário Pós-Estudo de Usabilidade do Sistema, para avaliar a usabilidade da aplicação. A avaliação da dor com recurso à aplicação foi repetida novamente num segundo momento. Resultados: Os dados recolhidos pela aplicação, quando correlacionados com os dados em papel respetivos, indicam excelente correlação para a intensidade da dor (r=0.81), incapacidade (r=0,84), fenótipo da dor (r=0,84), localização da dor (r=0,93), e moderada a boa para a catastrofização (r=0,59) e medo de movimento (r=0,41). A fiabilidade teste-reteste foi moderada a boa para a intensidade e da dor e incapacidade (CCI=0,86), para o fenótipo da dor (CCI=0,90), catastatrofização (CCI=0,76) e medo do Movimento (CCI=0,67). Quanto à usabilidade a aplicação obteve 1,16 ±0,27 no questionário Pós-Estudo de Usabilidade do Sistema, sendo que valores próximos de 1 indicam boa usabilidade. Conclusão: A aplicação AvaliaDor tem boa usabilidade e permite a avaliação da dor numa perspetiva biopsicossocial de forma válida e fiável.Background: Pain has a multidimensional nature and has an enormous impact on people's daily lives. It requires a comprehensive biopsychosocial assessment. Mobile applications provide one way to make this evaluation continuously, anywhere and at reduced costs. However, mobile applications for pain evaluation in European Portuguese are scarce. The objectives of this work are: to define the functional requirements and develop a mobile application for pain assessment (AvaliaDor) in patients with musculoskeletal pain and assess the application in terms of usability, validity and reliability. Methods: The AvaliaDor application was developed based on the literature and on the recommendations of 5 physical therapists and 5 users in cycles of evaluation, inclusion of recommendations and new evaluation until no further changes were required. AvaliaDor allows the assessment of pain intensity, location, phenotype, disability, catastrofization and fear of movement. Subsequently, the AvaliaDor app was used by 52 patients with musculoskeletal pain who also completed a set of pain evaluation scales on paper (Brief Pain Inventory, PainDETECT, Pain Catastrofizing Scale and TAMPA Scale of Kinesiophobia), as well as the Post-Study System Usability questionnaire, to evaluate the usability of the application. The pain evaluation using the application was repeated again in a second moment. Results: Data collected with the application when correlated with the respective paper scale showed excellent correlation for pain intensity (r= 0.81), disability (r= 0.84), pain phenotype (r= 0.84), painlocation (r= 0.93), and moderate to good correlation for catastrofizing (r= 0.59) and fear of movement (r= 0.41). Test-retest reliability was moderate to good for pain intensity, disability (ICC= 0.86), pain phenotype (ICC= 0.90), catastatrofizing (ICC= 0.76) and fear of movement (ICC= 0.67). As for usability, the score was 1.16 ± 0.27 in the Post-System Usability Study survey, and values close to 1 indicate good usability Conclusion The AvaliaDor application has good usability and allows the evaluation of pain in a biopsychosocial perspective in a valid and reliable way.Mestrado em Fisioterapi

Development and validation of a pain monitoring app for patients with musculoskeletal conditions (The Keele pain recorder feasibility study)

Abstract Background Assessing daily change in pain and related symptoms help in diagnosis, prognosis, and monitoring response to treatment. However, such changes are infrequently assessed, and usually reviewed weeks or months after the start of treatment. We therefore developed a smartphone application (Keele Pain Recorder) to record information on the severity and impact of pain on daily life. Specifically, the study goal was to assess face, content and construct validity of data collection using the Pain Recorder in primary care patients receiving new analgesic prescriptions for musculoskeletal pain, as well as to assess its acceptability and clinical utility. Methods The app was developed with Keele’s Research User Group (RUG), a clinical advisory group (CAG) and software developer for use on Android devices. The app recorded pain levels, interference, sleep disturbance, analgesic use, mood and side effects. In a feasibility study, patients aged > 18 attending their general practitioner (GP) with a painful musculoskeletal condition were recruited to use the app twice per day for 28 days. Face and construct validity were assessed through baseline and post-study questionnaires (Spearman’s rank correlation coefficient). Usability and acceptability were determined through post-study questionnaires, and patient, GP, RUG and CAG interviews. Results An app was developed which was liked by both patients and GPs. It was felt that it offered the opportunity for GPs to discuss pain control with their patients in a new way. All participants found the app easy to use (it did not interfere with their activities) and results easy to interpret. Strong associations existed between the first 3 days (Spearman r = 0.79) and last 3 days (r = 0.60) of pain levels and intensity scores on the app with the validated questionnaires. Conclusions Collaborating with patient representatives and clinical stakeholders, we developed an app which can be used to help clinicians and patients monitor painful musculoskeletal conditions in response to analgesic prescribing. Recordings were accurate and valid, especially, for pain intensity ratings, and it was easy to use. Future work needs to examine how pain trajectories can help manage changes in a patient’s condition, ultimately assisting in self-management

Enhancing the Benefits Management Model for Complex eHealth Efforts

This thesis suggests five ways to improve BM in complex eHealth efforts. First, the concept of BR was defined to clarify the existing conflation of the BR and BM concepts. Second, an extended and enhanced BMM was developed that incorporated the BM context, levels of complexity for both organizational and interorganizational initiatives, and the critical aspects of learning and governance. Third, three propositions concerning learning and governance in BM were suggested based on the new model, which can be used to inform future BM studies and guide empirical work. Fourth, the propositions were further translated into a six-question checklist to stimulate learning from the BM process itself. Finally, I provide suggestions for BM governance in interorganizational ICT efforts aiming to realize societal benefits.publishedVersio

Opioids for musculoskeletal pain and their associations with reproductive and sexual function in women: an epidemiological study

BackgroundOne fifth of primary care attendees report chronic non cancer pain (CNCP) most of which is related to musculoskeletal conditions, 12% of these are prescribed strong opioid analgesics. Evidence suggests long-term opioid use causes hypogonadism in men (including sexual reproductive dysfunction), but in women, the relationship is not known.AimTo investigate the relationship between opioid use and reproductive and sexual dysfunction in women aged 18-55 years old.MethodsA systematic review summarised existing evidence for sexual and reproductive dysfunction in women prescribed opioids (>1 month) for CNCP. Two further original studies investigated women prescribed opioids for musculoskeletal pain. A clinical practice research datalink (a UK primary care database) cohort study compared the risk of four outcomes (irregular/absent menstrual cycles, menopausal symptoms, low libido and infertility) for long-term (>/3 months) and short-term opioid users. A crosssectional study investigated the risk of female sexual dysfunction (FSD) dependent on daily oral morphine equivalent dose (MED).ResultsThe systematic review identified 12 small papers, mainly from secondary care. Opioid use was associated with irregular menstruation, decreased libido and decreased sex hormone levels. In the cohort study (n=44260) there was an increased risk of abnormal menstruation (Hazard ratio (HR) 1.13; 95% CI 1.05, 1.21) and menopause (HR 1.16; 95% CI 1.10, 1.23) in long-term opioid users when compared to short-term users, but no association with infertility or low libido. The cross-sectional survey (n=153) found FSD in 50% of those receiving >/20mg MED daily, falling to 31.7% in those not currently using opioids (OR 2.29; 95% CI 0.94, 5.55).ConclusionThis thesis highlights that there is an increased risk of menstrual disturbances and menopausal symptoms with opioids and these should be considered when opioids are prescribed for CNCP. These findings may help management decisions in CNCP when discussing treatment options with patients

Opioids for musculoskeletal pain and their associations with reproductive and sexual function in women: an epidemiological study

Background One fifth of primary care attendees report chronic non cancer pain (CNCP) most of which is related to musculoskeletal conditions, 12% of these are prescribed strong opioid analgesics. Evidence suggests long-term opioid use causes hypogonadism in men (including sexual reproductive dysfunction), but in women, the relationship is not known. Aim To investigate the relationship between opioid use and reproductive and sexual dysfunction in women aged 18-55 years old. Methods A systematic review summarised existing evidence for sexual and reproductive dysfunction in women prescribed opioids (>1 month) for CNCP. Two further original studies investigated women prescribed opioids for musculoskeletal pain. A clinical practice research datalink (a UK primary care database) cohort study compared the risk of four outcomes (irregular/absent menstrual cycles, menopausal symptoms, low libido and infertility) for long-term (>/3 months) and short-term opioid users. A crosssectional study investigated the risk of female sexual dysfunction (FSD) dependent on daily oral morphine equivalent dose (MED). Results The systematic review identified 12 small papers, mainly from secondary care. Opioid use was associated with irregular menstruation, decreased libido and decreased sex hormone levels. In the cohort study (n=44260) there was an increased risk of abnormal menstruation (Hazard ratio (HR) 1.13; 95% CI 1.05, 1.21) and menopause (HR 1.16; 95% CI 1.10, 1.23) in long-term opioid users when compared to short-term users, but no association with infertility or low libido. The cross-sectional survey (n=153) found FSD in 50% of those receiving >/20mg MED daily, falling to 31.7% in those not currently using opioids (OR 2.29; 95% CI 0.94, 5.55). Conclusion This thesis highlights that there is an increased risk of menstrual disturbances and menopausal symptoms with opioids and these should be considered when opioids are prescribed for CNCP. These findings may help management decisions in CNCP when discussing treatment options with patients

Exploring the barriers and facilitators experienced by physiotherapists and patients with musculoskeletal conditions when using Digital Health Interventions as a self management approach in Saudi Arabia: a sequential explanatory mixed method study

Background: Musculoskeletal (MSK) conditions constitute a significant public health challenge due to their increasing incidence and potential severe negative impact on patients' quality of life. One recommended treatment is self management, endorsed in MSK management guidelines, including the National Institute for Health and Care Excellence guideline (2021). Self management for MSKs can be delivered via digital health interventions (DHIs), which is the term referred to as the delivery of healthcare and the translatio n of information, knowledge, and communication via digital technologies to help the individual manage their health and well being. Purpose: The present thesis aims to determine and identify barriers and facilitators to recommending and using DHIs by MSK patients and physiotherapists in Saudi Arabia. Methods: This study used sequential explanatory mixed methods. A cross sectional design utilised an online questionnaire based on the Unified Theory of Acceptance and Use of Technology (UTAUT) and cultural factors for two populations (MSK patients and physiotherap ists). Eighteen users (11 physiotherapists and seven patients with different MSKs) were interviewed within seven physiotherapy departments. This study was conducted during the time period when the use of DHIs was made mandatory by the Ministry of Health (MOH). An audio recording, verbatim transcription, and English translation of the interviews were conducted. Descriptive analysis was used to interpret the quantitative data, and reflexive thematic analysis was used to analyse the qualitative data. Findings: The questionnaire was completed by 143 respondents (76 physiotherapists and 67 MSK patients). Regarding the patient's characteristics, the most common condition for patients was low back pain (LBP) 46.3% and arthritis 25.4 %, with the majority being chron ic conditions (71.6 %). The experience level of utilising DHIs up to two months was common for physiotherapists and less than two months for patients. Almost 90% of patients received no training before using DHIs. Regarding the UTAUT framework, there were mixed views on the compatibility of DHIs with patients’ needs. However, both physiotherapists and patients agreed that DHIs improved their therapeutic relationships. Notably, both the physiotherapists and patients also had a substantial level of agreement about their intentions to use and expectations of using DHIs in the future. their rate of agreement was lower for using DHI regularly. Four themes were identified under thematic analysis, revealing the areas that support the utilisation of DHIs DHIs. Concepts reported within all four themes included aspects, such as perceived effectiveness, patients' willingness to use DHIs, cultural impact, and social influences. The study indicate d that physiotherapists who used DHIs before the health delivery organisation deemed this type of delivery mandatory were likely to recommend DHIs to patients with MSKs. Conclusion: The study reveals that despite initials challenges, such as lack of training and mixed views on compatibility with patient needs, DHIs were viewed positively by both physiotherapists and patients for managing MSK disorders. Although there is a high agreement among physiotherapists and patients about their intentions and expectations to use DHIs in the future, efforts should be made to enhance their regular use in Saudi Arabia. Implications and recommendations: The study contributes both theoretical and practical implications. Concerning its theoretical contribution, it enriches the literature on DHIs by using the associated constructs of the UTAUT model. Its practical contribution offers valuable information to guide and support the implementation of DHI and training of public hospital physiotherapists and enhance MSK patients' awareness of the benefits of using DHIs. Having physiotherapists who are familiar with DHIs and can demonstrate ways to apply them is a physiotherapists who are familiar with DHIs and can demonstrate ways to apply them is a potentially effective strategy to increase the use of this treatment method potentially effective strategy to increase the use of this treatment method Further research is Further research is needed to provide insight into the barriers and facilitators that nonneeded to provide insight into the barriers and facilitators that non--users of DHIs may users of DHIs may encounter because the current study only included users of DHIs.encounter because the current study only included users of DHIs