Feasibility of a mobile application to track longitudinal pain outcomes after epidural joint injections

Tracking spine intervention outcomes is costly and time-consuming, hindering research. Mobile health (mhealth) applications offer a promising solution to reduce the need to hire personnel to recruit patients and collect data. However, evidence supporting the use of mHealth to study pain and spine interventions is limited and heterogeneous.

This study aims to understand how recruitment methods influence patient recruitment and retention in a digital study tracking pain. We hypothesize that in-person recruitment, especially with a physician rather than a research assistant, leads to higher recruitment and retention.

We designed a prospective observational study of patients scheduled for spine injections at an academic outpatient surgical center. Eligible patients were recruited via three methods: in-person research assistant, remote research assistant via phone, or in-person clinician. Upon enrollment, a mHealth application prompted patients to complete post-injection surveys at pre-defined intervals based on injection type. Enrollment and retention rates were then compared across recruitment groups.

Of 194 patients approached, enrollment rates differed significantly by recruitment strategy: 94.1 % for in-person physicians (N = 32 enrolled/34 approached), 85.0 % for in-person research assistants (N = 51/60), and 30.0 % for remote research assistants (N = 30/100) (p < 0.009, Fisher's exact test). Of those recruited, survey completion rates were 74.4 % (physician-recruited patients), 55.1 % (in-person research assistant), and 58.4 % (remote research assistant). Neither demographic factors (age, sex, employment, payer type) nor injection type influenced enrollment. Retention differed significantly across groups (p = 0.0174, Kruskal-Wallis test), with physician-recruited patients completing the most surveys. Moreover, Medicare patients had significantly higher completion rates than those with Medicaid.

Tracking post-injection pain using mHealth applications is feasible, though success depends heavily on recruitment strategy. In-person physician-led enrollment resulted in the highest recruitment and retention rates though the drop-out rates were still significant. Future studies should focus on refining recruitment approaches to optimize patient participation.