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Evaluation of a Musculoskeletal Digital Assessment Routing Tool (DART): Crossover Noninferiority Randomized Pilot

Cabella Lowe¹, Ruth Sephton², William Marsh³

¹Centre for Sports & Exercise Medicine, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom.

JMIR Formative Research

|July 30, 2024

Summary

This pilot study shows that the digital assessment routing tool (DART) has potential for improving musculoskeletal care pathways, demonstrating good patient satisfaction and feasibility for a definitive trial.

Keywords:

acceptability assess assessment crossover digital health digital technology digital triage eHealth mHealth musculoskeletal physiotherapy physiotherapy triage primary care randomized controlled trial referrals triage triaging usability validation

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Area of Science:

Digital health interventions
Musculoskeletal conditions
Healthcare technology assessment

Background:

Musculoskeletal conditions cause significant global disability and healthcare burden.
Effective triage is crucial for improving patient outcomes and healthcare efficiency.
A mobile health (mHealth) system, the digital assessment routing tool (DART), was developed for musculoskeletal triage.

Purpose of the Study:

To evaluate trial design and procedures for a definitive randomized trial of DART.
To assess the feasibility of implementing DART in NHS primary care.
To collect exploratory data on DART's safety and efficacy.

Main Methods:

A crossover, noninferiority pilot trial was conducted in NHS primary care.
Participants with musculoskeletal conditions completed both DART and physiotherapist assessments.
The primary outcome was the agreement between DART and physiotherapist triage recommendations.

Main Results:

High participant recruitment (92%) and retention (0% dropout) were achieved.
Initial DART-physiotherapist agreement was poor (41%), but improved to 78% after adjustments.
Participant satisfaction with DART was high, scoring an "excellent" 84.0 on the System Usability Scale.

Conclusions:

DART shows potential to enhance the musculoskeletal care pathway, evidenced by improved agreement and high patient satisfaction.
The pilot study confirmed the feasibility of conducting a definitive, adequately powered trial.
Further consensus is recommended for defining safety criteria, appropriateness, and noninferiority margins for DART implementation.