Opioid Initiation Within One Year After Starting a Digital Musculoskeletal (MSK) Program: An Observational, Longitudinal Study with Comparison Group

Abstract

Background

In-person, conservative care may decrease opioid use for chronic musculoskeletal (MSK) pain, but the impact of digitally delivered conservative care on opioid use is unknown. This study examines associations between a digital MSK program and opioid initiation and prescriptions among opioid naive adults with chronic MSK pain.

Methods

This observational study used commercial medical and pharmacy claims data to compare digital MSK program members to matched physical therapy (PT) patients. Outcomes were any opioid prescriptions and opioid prescriptions per 100 participants within the 12-months after starting a digital MSK program. After propensity-score matching, we conducted multivariate regression models that controlled for demographic, comorbidity, and baseline MSK healthcare use.

Results

The study included 4195 members and 4195 matched PT patients. For opioid initiation, 7.89% (95% Confidence Interval [CI]: 7.07%, 8.71%) of members had opioid prescriptions within 12 months after starting the digital MSK program versus 13.64% (95% CI: 12.60%, 14.67%) of matched PT patients (p < 0.001). Members had significantly fewer opioid prescriptions (16.73 per 100 participants; 95% CI: 14.11, 19.36) versus PT patients (22.36 per 100 participants; 95% CI: 19.99, 24.73). Members had lower odds (OR: 0.52, 95% CI: 0.45, 0.60) of initiating opioids and significantly fewer prescriptions per 100 participants (beta: −6.40, 95% CI: −9.88, −2.93) versus PT patients after controlling for available confounding factors.

Conclusion

An MSK program that delivers conservative care digitally may be a promising approach for decreasing opioid initiation among individuals with chronic MSK pain given the limitations of the observational design and matching on only available covariates.

Keywords:

• musculoskeletal pain
• telemedicine
• telerehabilitation
• opioid
• claims analysis

Abbreviations

CDC, Centers for Disease Control and Prevention; CI, Confidence interval; DME, Durable medical equipment; ED, Emergency department; E&M, Evaluation and management; MSK, Musculoskeletal; PT, Physical therapy.

Data Sharing Statement

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Ethics Approval and Informed Consent

Hinge Health contracts the independent entity WIRB-Copernicus Group^® Institutional Review Board (OHRP/FDA IRB registration number IRB00000533) at WIRB-Copernicus Group^® (1019 39th Avenue SE Suite 120, Puyallup, Washington 98374–2115) to conduct reviews. WIRB-Copernicus Group^® Institutional Review Board reviewed this study, deemed it exempt, and waived informed consent.

WIRB-Copernicus Group^® Institutional Review Board believes the study is exempt under 45 CFR § 46.104(d)(4), because information is recorded in such a manner that the identity of the human subjects cannot readily by ascertained directly or through identifiers linked to the subjects, the investigator does not contact the subjects, and the investigator will not re-identify subjects.

Author Contributions

All authors made substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data; took part in drafting the article or revising it critically for important intellectual content; agreed to submit to the current journal; gave final approval of the version to be published; and agree to be accountable for all aspects of the work.

Disclosure

GW and LL are employed by and have equity interest in Hinge Health, Inc. LG and JB declare that they have no competing interests.

Additional information

Funding

Hinge Health, Inc., provided the digital MSK program to participants. Hinge Health, Inc. employees and manuscript authors GW and LL designed the study, interpreted results, and wrote the manuscript. Hinge Health, Inc. employees GW and LL analyzed data.