Sleep Disturbance in Musculoskeletal Conditions: Impact of a Digital Care Program

Overview

Journal J Pain Res

Publisher Dove Medical Press

Date 2023 Jan 13

PMID 36636267

Authors

Justin K Scheer

Fabiola Costa

Dora Janela

Maria Molinos

Anabela C Areias

Robert G Moulder

Jorge Lains

Virgilio Bento

Vijay Yanamadala

Fernando Dias Correia

Affiliations

Soon will be listed here.

Abstract

Background: Musculoskeletal (MSK) pain is highly prevalent worldwide, resulting in significant disability, and comorbid sleep disturbances. Digital therapy for MSK pain can provide significant improvements in care access, alongside pain and disability reductions. However, studies on the effect of such programs on sleep are lacking.

Purpose: To evaluate the impact on pain-related sleep impairment after a 12-week remote multimodal digital care program (DCP) for MSK conditions.

Patients And Methods: This is an ad-hoc analysis of a decentralized single-arm study into engagement and clinical outcomes after a DCP for MSK rehabilitation. Patients were stratified by baseline sleep disturbance, based on sleep questions in the questionnaires: Oswestry Disability Index, Neck Disability Index, and the Quick Disabilities of the Arm, Shoulder and Hand questionnaire. Additional outcomes were pain, Generalized Anxiety Disorder 7-item scale, Patient Health 9-item questionnaire, Work Productivity, and Activity Impairment, and program engagement.

Results: At baseline, 5749 patients reported sleep disturbance (78.0% of eligible patients). These reported significantly worse clinical outcomes at baseline than patients without sleep disturbance (all p<0.001). Patients with comorbid sleep disturbance showed improvements in sleep, with a significant proportion reporting full recovery at program completion: 56% of patients with upper limb conditions (including 10% of patients with severe sleep disturbance at baseline), and 24% with spine conditions. These patients also reported significant improvements in all clinical outcomes at program completion. Engagement and satisfaction were high, and also higher than in patients without sleep impairment.

Conclusion: This is the first study of its kind investigating the effect of a completely remote DCP for MSK pain on sleep. Patients reporting comorbid sleep disturbance had significant improvement in sleep, alongside pain, mental health and work productivity at program completion. The results suggest that a DCP for MSK pain can improve sleep disturbances in patients with upper limb and spine conditions.

Citing Articles

Rehabilitation Applications Based on Behavioral Therapy for People With Knee Osteoarthritis: Systematic Review.

Zhu D, Zhao J, Wang M, Cao B, Zhang W, Li Y JMIR Mhealth Uhealth. 2024; 12:e53798.

PMID: 38696250 PMC: 11099817. DOI: 10.2196/53798.

Lumbar Paravertebral Muscle Pain Management Using Kinesitherapy and Electrotherapeutic Modalities.

Silisteanu S, Antonescu E, Duica L, Totan M, Cucu A, Costea A Healthcare (Basel). 2024; 12(8).

PMID: 38667615 PMC: 11050304. DOI: 10.3390/healthcare12080853.

Managing Musculoskeletal Pain in Older Adults Through a Digital Care Solution: Secondary Analysis of a Prospective Clinical Study.

Areias A, Janela D, Molinos M, Moulder R, Bento V, Yanamadala V JMIR Rehabil Assist Technol. 2023; 10:e49673.

PMID: 37465960 PMC: 10466151. DOI: 10.2196/49673.

References

Wijnhoven H, de Vet H, Picavet H . Prevalence of musculoskeletal disorders is systematically higher in women than in men. Clin J Pain. 2006; 22(8):717-24. DOI: 10.1097/01.ajp.0000210912.95664.53. View

Cottrell M, Russell T . Telehealth for musculoskeletal physiotherapy. Musculoskelet Sci Pract. 2020; 48:102193. PMC: 7261082. DOI: 10.1016/j.msksp.2020.102193. View

Louie G, Tektonidou M, Caban-Martinez A, Ward M . Sleep disturbances in adults with arthritis: prevalence, mediators, and subgroups at greatest risk. Data from the 2007 National Health Interview Survey. Arthritis Care Res (Hoboken). 2010; 63(2):247-60. PMC: 3461323. DOI: 10.1002/acr.20362. View

Zeng L, Zong Q, Yang Y, Zhang L, Xiang Y, Ng C . Gender Difference in the Prevalence of Insomnia: A Meta-Analysis of Observational Studies. Front Psychiatry. 2020; 11:577429. PMC: 7714764. DOI: 10.3389/fpsyt.2020.577429. View

Husak A, Bair M . Chronic Pain and Sleep Disturbances: A Pragmatic Review of Their Relationships, Comorbidities, and Treatments. Pain Med. 2020; 21(6):1142-1152. DOI: 10.1093/pm/pnz343. View

Yang P, Ho K, Chen H, Chien M . Exercise training improves sleep quality in middle-aged and older adults with sleep problems: a systematic review. J Physiother. 2012; 58(3):157-63. DOI: 10.1016/S1836-9553(12)70106-6. View

Kelley G, Kelley K . Exercise and sleep: a systematic review of previous meta-analyses. J Evid Based Med. 2017; 10(1):26-36. PMC: 5527334. DOI: 10.1111/jebm.12236. View

Nieminen L, Pyysalo L, Kankaanpaa M . Prognostic factors for pain chronicity in low back pain: a systematic review. Pain Rep. 2021; 6(1):e919. PMC: 8108595. DOI: 10.1097/PR9.0000000000000919. View

Tseng T, Chen H, Wang L, Chien M . Effects of exercise training on sleep quality and heart rate variability in middle-aged and older adults with poor sleep quality: a randomized controlled trial. J Clin Sleep Med. 2020; 16(9):1483-1492. PMC: 7970583. DOI: 10.5664/jcsm.8560. View

10.

St-Onge M . Sleep-obesity relation: underlying mechanisms and consequences for treatment. Obes Rev. 2017; 18 Suppl 1:34-39. DOI: 10.1111/obr.12499. View

11.

Hartescu I, Morgan K, Stevinson C . Increased physical activity improves sleep and mood outcomes in inactive people with insomnia: a randomized controlled trial. J Sleep Res. 2015; 24(5):526-34. DOI: 10.1111/jsr.12297. View

12.

Cieza A, Causey K, Kamenov K, Wulf Hanson S, Chatterji S, Vos T . Global estimates of the need for rehabilitation based on the Global Burden of Disease study 2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2020; 396(10267):2006-2017. PMC: 7811204. DOI: 10.1016/S0140-6736(20)32340-0. View

13.

Spitzer R, Kroenke K, Williams J, Lowe B . A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006; 166(10):1092-7. DOI: 10.1001/archinte.166.10.1092. View

14.

Nitter A, Pripp A, Forseth K . Are sleep problems and non-specific health complaints risk factors for chronic pain? A prospective population-based study with 17 year follow-up. Scand J Pain. 2018; 3(4):210-217. DOI: 10.1016/j.sjpain.2012.04.001. View

15.

Herrero Babiloni A, De Koninck B, Beetz G, De Beaumont L, Martel M, Lavigne G . Sleep and pain: recent insights, mechanisms, and future directions in the investigation of this relationship. J Neural Transm (Vienna). 2019; 127(4):647-660. DOI: 10.1007/s00702-019-02067-z. View

16.

Mecklenburg G, Smittenaar P, Erhart-Hledik J, Perez D, Hunter S . Effects of a 12-Week Digital Care Program for Chronic Knee Pain on Pain, Mobility, and Surgery Risk: Randomized Controlled Trial. J Med Internet Res. 2018; 20(4):e156. PMC: 5943627. DOI: 10.2196/jmir.9667. View

17.

Correia F, Nogueira A, Magalhaes I, Guimaraes J, Moreira M, Barradas I . Medium-Term Outcomes of Digital Versus Conventional Home-Based Rehabilitation After Total Knee Arthroplasty: Prospective, Parallel-Group Feasibility Study. JMIR Rehabil Assist Technol. 2019; 6(1):e13111. PMC: 6416534. DOI: 10.2196/13111. View

18.

Sun Y, Laksono I, Selvanathan J, Saripella A, Nagappa M, Pham C . Prevalence of sleep disturbances in patients with chronic non-cancer pain: A systematic review and meta-analysis. Sleep Med Rev. 2021; 57:101467. DOI: 10.1016/j.smrv.2021.101467. View

19.

Longo U, Facchinetti G, Marchetti A, Candela V, Risi Ambrogioni L, Faldetta A . Sleep Disturbance and Rotator Cuff Tears: A Systematic Review. Medicina (Kaunas). 2019; 55(8). PMC: 6723368. DOI: 10.3390/medicina55080453. View

20.

Adamse C, Dekker-Van Weering M, van Etten-Jamaludin F, Stuiver M . The effectiveness of exercise-based telemedicine on pain, physical activity and quality of life in the treatment of chronic pain: A systematic review. J Telemed Telecare. 2017; 24(8):511-526. DOI: 10.1177/1357633X17716576. View