Which Remote Rehabilitation Interventions Work Best for Chronic Musculoskeletal Pain and Depression? A Bayesian...

Area of Science:

• Rehabilitation Medicine
• Digital Health Interventions
• Chronic Pain Management
• Mental Health Treatment

Background:

• Chronic musculoskeletal pain and depression frequently co-occur, significantly impacting patient quality of life.
• Traditional rehabilitation methods face accessibility challenges for many patients.
• Remote rehabilitation offers a potential solution to improve access to care.

Purpose of the Study:

• To systematically evaluate the efficacy of various remote rehabilitation interventions for individuals with comorbid chronic musculoskeletal pain and depression.
• To compare the effectiveness of different remote interventions against each other and against waitlist controls using network meta-analysis.

Main Methods:

• A systematic review and network meta-analysis (NMA) of 58 randomized controlled trials (RCTs) involving 10,278 participants.
• Searched multiple databases (Cochrane, CINAHL, EMBASE, LILACS, MEDLINE, PSYNDEX, PsycINFO) up to May 2023.
• Bayesian random-effects models were employed for data synthesis, comparing interventions to waitlist controls.

Main Results:

• Interactive voice response cognitive behavioral therapy (CBT), in-person CBT, and mobile app CBT plus exercise demonstrated superiority over waitlist for pain reduction at 12 weeks (>98% probability).
• Internet-delivered CBT and telecare were superior to waitlist for depression outcomes at 12 weeks (>99% probability).
• Evidence certainty ranged from low to moderate for pain and very low to moderate for depression outcomes; dropout rates due to adverse events were unclear.

Conclusions:

• Remote CBT interventions, including interactive voice response and mobile app-based approaches, show comparable efficacy to in-person CBT for reducing chronic pain.
• Internet-delivered CBT and telecare are effective remote options for improving depressive symptoms in this patient population.
• Digital rehabilitation strategies present a viable and effective alternative for managing chronic pain and depression, enhancing accessibility to care.