RESUMO
Objective: To evaluate the effects of an interdisciplinary care team (ICT) model delivered by telemedicine on patients with low back pain (LBP). Design: Retrospective analysis of deidentified pre-existing data. Setting: Retrospective observational study of patients presenting with LBP to a nationwide telemedicine practice using an ICT model. Participants: Over a 9-month period all patients with a diagnosis related to LBP and who had an ICT evaluation (medical doctor, advanced practice provider, health coach, and physical therapist) were included in the study (n=36). A minimum of 2 follow-up physical therapy visits were required for inclusion. Interventions: Patients were evaluated for LBP, received a diagnosis, and were offered a multidisciplinary treatment plan. Additional real-time audio visual medical, health coaching, registered dietician, and physical therapy services were received as deemed clinically appropriate. Main Outcome Measures: Baseline, 30 day, and final pain (mean 81 day) measurements via numerical pain rating scale (NPRS). Baseline and final Patient-Reported Outcomes Measurement Information System (PROMIS)-10 Global Mental/Physical domains. Secondary Outcome Measures: Use of prescription medication, referral for imaging, need for injections, or surgery. Results: 36 patients met criteria. Pain levels included mild (n=6, 16.7%), moderate (n=19, 52.8%), and severe (n=11, 30.6%). Clinically significant pain improvements were noted in 83.3% (n=25) of those with moderate or severe pain. PROMIS Mental and Physical Health categorization from Fair/Poor to Good/Excellent significantly improved over time. The initial 20% (n=7) in Fair/Poor Mental Health improved to 6.3% (n=2) at finish, while the 80% (n=28) in Good/Excellent Mental Health at start improved to 93.8% (n=30) at finish. Regarding Physical Health, 51.4% (n=18) rated Fair/Poor at start and 31.3% (n=10) at finish, while the 48.6% (n=17) rated Good/Excellent at start improved to 68.8% (n=22) at finish. The need for prescription medication was low (n=6, 16.7%) and spinal imaging orders were negligible (n=1, 2.8%). Injections were warranted in 11.4% (n=4) of patients and surgical referral with operative treatment in 2.8% (n=1). Conclusion: Interdisciplinary care delivered through telemedicine can significantly improve pain and support improved health-related quality of life in patients with LBP, with low rates of imaging, prescription, and interventional use.
RESUMO
BACKGROUND: As the need for effective scalable interventions for mental health conditions such as depression, anxiety, and stress has grown, the digital delivery of mindfulness-based stress reduction (MBSR) has gained interest as a promising intervention in this domain. OBJECTIVE: This study aims to evaluate the changes in perceived stress following a 10-week digital MBSR program that combined an app-based digital program with weekly one-on-one remote sessions with a health coach. METHODS: This study used a retrospective, observational design. A total of 229 participants with moderate-to-high perceived stress scores as assessed by the Perceived Stress Scale (PSS)-10 enrolled in the 10-week Vida Health MBSR program. The program included weekly remote sessions with a certified health coach and digital content based on concepts fundamental to mindfulness practice. The PSS-10 was used to evaluate perceived stress. Of the 229 participants, 131 (57.2%) were considered program completers and provided at least one follow-up PSS-10. A secondary analysis examined the changes in stress scores at 6 months. This analysis was restricted to participants who had been enrolled in the program for at least 6 months (n=121). To account for random and fixed effects, linear mixed effects modeling was used to assess changes in stress scores over time. An intention-to-treat approach was used to evaluate the changes in perceived stress across the entire study cohort, including those who were lost to follow-up. In addition, a reliable change index was computed to evaluate the changes in scores from the baseline. RESULTS: The findings revealed a significant positive association between program time and stress reduction (B=-0.365; P<.001) at 12 weeks. We observed an average reduction in stress scores of 3.17 points (95% CI -3.93 to -2.44) by program week 6 and 4.86 points (95% CI -5.86 to -3.85) by program week 12. Overall, 83.2% (109/131) of participants showed a reduction in stress scores by week 12, with 40.5% (53/131) of participants showing reliable improvement at 12 weeks and 47.8% (56/131) of participants showing a shift to a lower stress level category (ie, moderate-to-low stress). The intention-to-treat analysis revealed a significant, although attenuated, reduction in stress scores at 12 weeks (B=-0.23; P<.001). Participants who completed more lessons had an increased likelihood of moving down at least one stress level category (odds ratio 1.512, 95% CI 1.056 to 2.166; P=.02). In assessing medium-term outcomes, among participants who had completed at least 6 months in the program, 48.8% (59/121) of members provided a 6-month assessment. We observed a significant reduction in stress scores at 6 months (t58=10.24; P<.001), with 61% (36/59) of participants showing reliable improvement. CONCLUSIONS: The findings of this retrospective, observational study suggest that a blended, digital mindfulness-based intervention may support program uptake and meaningful, sustained reduction in stress outcomes.