Text-Messaging Platform for Musculoskeletal Disorders

Overseen By Paul Tornetta III, MD

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Boston Medical Center

Disqualifiers: Limited readers, Incarcerated, No cell phone

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: Unknown

3000 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial explores a new method to communicate with patients who have certain bone or joint injuries, such as ankle fractures or spine surgeries. By using a text-messaging platform (Memora Platform for PROMIS), the trial aims to gather patient-reported outcomes data to better understand recovery and adjust the number of clinic visits needed. It involves two phases: the first collects data on recovery times, and the second uses this data to potentially adjust clinic visit schedules. People who have recently had specific injuries or surgeries and use a mobile phone with internet access might be a good fit for this trial. As an unphased trial, it offers a unique opportunity to contribute to innovative communication methods in healthcare.

Do I need to stop my current medications for this trial?

The trial information does not specify whether you need to stop taking your current medications.

What prior data suggests that this text-messaging platform is safe for collecting patient-reported outcomes?

Research has shown that Memora Health's text-messaging platform for healthcare communication is generally safe. This platform sends automated reminders to patients and answers common questions, improving follow-up care. No direct evidence indicates any safety issues from using this technology.

Regarding adjusting clinic visits based on patient feedback, studies have indicated that telehealth for musculoskeletal issues can be helpful. One study found that patients needed fewer visits to resolve their symptoms when using this method. This suggests the approach is not only safe but also makes treatment more efficient.

Overall, both the text-messaging platform and the adjusted visit schedule appear well-tolerated and safe for patients. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about this trial because it explores how a text-messaging platform could optimize clinic visits for people with musculoskeletal disorders. Unlike traditional treatment approaches that rely on fixed schedules for follow-up appointments, this method adjusts visit frequency based on real-time patient-reported outcomes. This personalized approach could enhance recovery by ensuring patients receive the right level of care precisely when they need it, potentially improving recovery times and patient satisfaction.

What evidence suggests that this text-messaging platform is effective for musculoskeletal disorders?

Research has shown that using text messages to collect patient feedback can be effective. In this trial, Memora Health's platform, which participants in Phase 2 may use, demonstrated a 75.8% patient engagement rate over 30 days, indicating that most patients actively participate. The platform also reduced hospital readmissions by 16%, supporting better patient care. Regarding clinic visits, studies suggest that adjusting the number of visits based on patient needs does not affect shoulder pain and disability outcomes. In Phase 2 of this trial, participants may have their clinic visits tailored based on recovery curves, potentially leading to a 17% reduction in the number of visits needed for symptom improvement. This approach allows patients to recover with fewer visits, saving time and costs. ^{1 6 7 8 9}

Who Is on the Research Team?

Paul Tornetta III, MD

Principal Investigator

Boston Medical Center

Are You a Good Fit for This Trial?

This trial is for orthopedic patients with specific conditions like lumbar fusion, ACL reconstruction, or rotator cuff repair. Participants must have a personal cell phone with internet and speak English primarily. It's not for incarcerated individuals, those who can't read well, or without a cell phone.

Inclusion Criteria

I have a broken ankle.

I have been diagnosed with lumbar stenosis.

I have had surgery to repair my rotator cuff.

Exclusion Criteria

Limited and non-readers

Vulnerable populations - incarcerated patients

Patients with no cell phone to use for scoring

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Phase 1

Participants complete PROMIS CAT questionnaires via SMS or secure weblink to assess health status and develop recovery curves

1 year

Standard follow-up clinic visits

Phase 2

Clinic visits are adjusted based on recovery curves; participants receive phone calls or in-person visits based on PROMs

1 year

Follow-up

Participants are monitored for safety and effectiveness after treatment

4 weeks

What Are the Treatments Tested in This Trial?

Interventions

• Memora Platform for PROMIS
• Right-Size Clinic Visits

Trial Overview

The study tests the use of Memora Health's text-messaging platform to collect patient-reported outcomes via PROMIS CAT surveys and then tailor clinic visits accordingly. The goal is to improve communication and care efficiency in two phases.

How Is the Trial Designed?

Group I: Phase 2 Experimental Treatment 1 Intervention

Participants in Phase 2 will have their clinic visits potentially revised based on the phase 1 recovery curves which may increase or decrease the number of clinic visits they receive based on the PROMs reported.

Group II: Phase 1 Active Control 1 Intervention

Participants in phase 1 will be observed and data about their recovery time will be collected from which recovery curves will be calculated for Phase 2

Who Is Running the Clinical Trial?

Boston Medical Center

Lead Sponsor

Trials

410

Recruited

890,000+

Published Research Related to This Trial

This study aims to systematically review and map the existing literature on mobile messaging interventions for adults with musculoskeletal pain, focusing on their efficacy, effectiveness, and economic impact, based on both experimental and observational studies.

The review will help identify optimal configurations for mobile messaging systems, including content presentation and patient preferences, to enhance support for individuals suffering from acute or chronic musculoskeletal pain.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Development and use of mobile messaging for individuals with musculoskeletal pain conditions: a scoping review protocol. Scotti Requena, S., Sterling, M., Elphinston, RA., et al.[2021]

A study using electronic health records (EHR) from English general practices found that 31.9% of adults aged 35 and older with non-inflammatory musculoskeletal disorders experienced high impact chronic pain in 2016/17.

The research identified that women, older individuals, and those from deprived neighborhoods reported worse musculoskeletal health, highlighting the potential of EHR data to provide valuable insights into population health trends over time.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Estimating the population health burden of musculoskeletal conditions using primary care electronic health records. Yu, D., Peat, G., Jordan, KP., et al.[2021]

This systematic review analyzed 11 studies on the use of text message interventions for managing musculoskeletal pain, finding that while the overall quality of the studies was limited, there were some positive effects on treatment adherence and other outcomes like pain intensity and quality of life.

Text messages, when combined with usual care or multicomponent interventions, showed potential benefits in managing musculoskeletal pain, suggesting they could be a low-cost addition to treatment strategies, but further research is needed to confirm these findings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effects of using text message interventions for the management of musculoskeletal pain: a systematic review. Fritsch, CG., Ferreira, PH., Prior, JL., et al.[2021]

From 1999 to 2005, there were 41,804 visits for musculoskeletal complaints, showing stable prescribing patterns for nonsteroidal anti-inflammatory drugs (NSAIDs), but a shift occurred as COX-2 inhibitors were initially used as substitutes for nonselective NSAIDs until safety concerns led to a decline in COX-2 prescriptions.

Following the withdrawal of some COX-2 inhibitors, there was a notable increase in the prescribing of nonselective NSAIDs and nonnarcotic analgesics, while opiate and adjuvant analgesics also saw increased usage, indicating a shift in pain management strategies without directly substituting for NSAIDs.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Analgesic prescribing for musculoskeletal complaints in the ambulatory care setting after the introduction and withdrawal of cyclooxygenase-2 inhibitors. Wilson, RD.[2015]

The study aims to rigorously test the usability of the Digital Assessment Routing Tool (DART) for musculoskeletal conditions, involving 20-30 participants over 4 months to ensure it meets usability standards before clinical trials.

By optimizing DART's user experience, the goal is to create a safe and effective mobile health solution that improves patient access to care and reduces the burden on healthcare services, setting a precedent for future mobile health innovations.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Usability Testing of a Digital Assessment Routing Tool: Protocol for an Iterative Convergent Mixed Methods Study. Lowe, C., Hanuman Sing, H., Browne, M., et al.[2021]

This scoping review aims to identify and map existing literature on minimal clinical data sets for spine-related musculoskeletal disorders, focusing on their use in primary care and outpatient settings, which is crucial for improving healthcare quality.

The review will include a variety of study designs and languages, ensuring a comprehensive understanding of how these data sets can be utilized to measure and monitor health status in patients, ultimately benefiting clinicians and researchers in the field.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Minimal clinical data sets for spine-related musculoskeletal disorders in primary care and outpatient settings: a scoping review protocol. Mikhail, J., Hofstetter, L., Côté, P., et al.[2022]

A cohort study involving 121 mining workers successfully used daily text messages to collect data on low back pain (LBP) over 5 weeks, achieving a high response rate of 93%.

The method allowed for effective clustering of LBP into subgroups based on pain intensity (low, medium, high) and helped characterize the episodic nature of LBP, demonstrating its potential for ongoing pain assessment.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Daily text messages used as a method for assessing low back pain among workers. Burström, L., Jonsson, H., Björ, B., et al.[2016]

The 'Relieve my back' smartphone application significantly reduced pain intensity and disability in office workers with chronic low back pain after six weeks of use, compared to a control group that received a placebo version.

Participants using the application also experienced a notable improvement in their quality of life, as measured by the Short-Form Health Survey, indicating its potential as an effective management tool for low back pain.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Efficacy of an innovative smartphone application for office workers with chronic non-specific low back pain: a pilot randomized controlled trial. Almhdawi, KA., Obeidat, DS., Kanaan, SF., et al.[2022]

A study involving 42 patients with chronic musculoskeletal conditions found that telehealth assessments showed substantial agreement (83.3%) with in-person assessments regarding recommended management pathways.

The agreement for clinical diagnostics and further investigations was also high (83.3% and 81% respectively), indicating that telehealth is a viable and effective option for assessing patients who cannot attend in person.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Agreement between telehealth and in-person assessment of patients with chronic musculoskeletal conditions presenting to an advanced-practice physiotherapy screening clinic. Cottrell, MA., O'Leary, SP., Swete-Kelly, P., et al.[2019]

Musculoskeletal (MSK) conditions are a major global health issue, and eHealth technologies can significantly improve the accessibility and integration of care models for these conditions.

The implementation of eHealth in MSK models of care can enhance system efficiency, sustainability, and reduce disparities in access to treatment, particularly for conditions like osteoarthritis and persistent MSK pain.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Use of eHealth technologies to enable the implementation of musculoskeletal Models of Care: Evidence and practice. Slater, H., Dear, BF., Merolli, MA., et al.[2022]

The musculoskeletal Digital Assessment Routing Tool (DART) was successfully developed and tested with 22 adult participants, resolving all serious usability issues and achieving a high mean satisfaction score of 84.3, indicating it is user-friendly and effective for self-assessment in musculoskeletal disorders.

The study demonstrated that DART can provide immediate care recommendations without errors, paving the way for future randomized controlled trials to evaluate its safety and effectiveness compared to traditional care methods.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Usability Testing of a Digital Assessment Routing Tool for Musculoskeletal Disorders: Iterative, Convergent Mixed Methods Study. Lowe, C., Browne, M., Marsh, W., et al.[2022]

Digital physiotherapy assessments show acceptable to excellent validity and reliability for various components, such as clinical tests and patient-reported outcomes, based on a systematic review of 10 studies involving 193 participants.

Patients reported satisfaction with digital assessments, although they rated them lower than face-to-face assessments, indicating that while digital options are viable, they may not fully replace in-person evaluations.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Digital physiotherapy assessment vs conventional face-to-face physiotherapy assessment of patients with musculoskeletal disorders: A systematic review. Bernhardsson, S., Larsson, A., Bergenheim, A., et al.[2023]

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