Development and Validation of a Digital Pain-Reduction Kit for Musculoskeletal Injuries

Study Overview
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Brief Summary
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This study will test the effectiveness of an evidence-based, multi-modal, digital pain-reduction kit as a non-pharmacological supplement to managing patients with pain due to musculoskeletal injuries. Outpatients will be randomized to receive either the pain reduction kit or active control. The kit will contain a virtual reality (VR) headset, therapeutic VR visualization software, and a low-cost wearable transcutaneous electrical nerve stimulation (TENS) unit. Clinical staff will monitor progress and provide scheduled coaching and outreach to patients in the intervention group. The control group will receive the low-cost wearable transcutaneous electrical nerve stimulation (TENS) unit alone; they will not receive VR or remote coaching. Study devices will be delivered to the patient's home with instructions for use; patients will receive remote clinical and technical support. Patients will be followed for 60 days and monitored for functional status, pain levels, use of pain medications (including opioids), satisfaction with care, and time to returning to work.

Official Title
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Development and Validation of a Digital Pain-Reduction Kit for Musculoskeletal Injuries

Conditions
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Pain, Acute, Pain, Chronic

Intervention / Treatment
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* Device: Digital Pain Reduction Kit
* Device: Active Control


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Provision of signed and dated informed consent form Stated willingness to comply with all study procedures and availability for the duration of the study Male or female, age 18 or older Seeking care for a musculoskeletal injury Experiencing pain greater than 3 out of 10 on a visual analog scale English or Spanish speaking Owns a compatible Android or iOS smartphone device (excluding tablets) Exclusion Criteria: Unable to understand the goals of the study due to cognitive difficulty Use of a cardiac pacemaker, implanted defibrillator, or other implanted metallic or electronic device or high-frequency surgical equipment. (contraindication for TENS units) Pregnant (contraindication for TENS unit) Current diagnosis of epilepsy, dementia, or other neurological disease that may prevent use of VR hardware or software Hypersensitivity to flashing light or motion Injury to the eyes, face, neck, or arms that prevents comfortable use of VR hardware or software, or safe use of other study hardware (e.g., open sores, wounds, or skin rash on face)

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Digital Pain Reduction Kit<br>Participants in the experimental arm will be assigned the digital pain reduction kit consisting of a transcutaneous electrical nerve stimulation unit to be used as needed and a virtual reality headset to be used as needed or at least once a day. Remote clinical support is provided for patients who volunteer information to be viewed by clinicians. | Device: Digital Pain Reduction Kit<br>* A two-component intervention consisting of (1) virtual reality, experiences lasting 3-30 minutes used to distract individuals from pain and to teach skills related to chronic pain; (2) TENS unit, used to reduce acute localized pain.<br>|
| Active Comparator: Active Control<br>Participants in the active control arm will receive standard of care as provided by their physician in addition to a transcutaneous electrical nerve stimulation unit. | Device: Active Control<br>* An active control TENS unit used to reduce acute localized pain.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| PROMIS - Physical Function Short Form 8b | PROMIS Physical Function instruments measure self-reported capability rather than actual performance of physical activities. A single Physical Function capability score is obtained from a short form. The forms are universal rather than disease-specific. A higher PROMIS T-score represents more of the concept. For Physical Function, a T-score of 60 is one SD better than average. By comparison, a Physical Function T-score of 40 is one SD worse than average. | 60 days | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| PROMIS - Pain Interference Short Form 8a | PROMIS - Pain Interference instruments assess self-reported consequences of pain on relevant aspects of one's life. This includes the extent to which pain hinders engagement with social, cognitive, emotional, physical, and recreational activities. A single Pain interference score is obtained from a short form. The forms are universal rather than disease-specific. A higher PROMIS T-score represents more of the concept. For Pain Interference, a T-score of 60 is one SD higher pain than average. By comparison, a Pain Interference T-score of 40 is one SD lower pain than average. | 60 days | 
| Work Productivity and Activity Impairment Questionnaire : Lower Back Pain (WPAI:SHP v2.0) | The WPAI:LBP was created as a patient-reported quantitative assessment of the amount of absenteeism, presenteeism and daily activity impairment attributable to Lower Back Pain. The WPAI:LBP productivity loss subscale consists of a single item (During the past seven days, how much did your pain affect your productivity while you were working?) with a 0-10 response scale where 0 indicates pain had no effect, and 10 indicates pain completely prevented work. The presenteeism sub-scale consists of a comparison two items, yielding percent of hours missed due to pain. Finally, the activity impairment subscale consists of one item(During the past seven days, how much did your pain affect your ability to do your regular daily activities, other than work at a job?) with a 0-10 response scale where 0 indicated pain had no effect, and 10 indicated pain completely prevented daily activities. | 60 days | 
| Patient Satisfaction Questionnaire (PSQ) 18 | Patient Satisfaction Questionnaire (PSQ) 18 which includes questions in 3 relevant domains: general satisfaction, communication, and accessibility of care. All subscales are scored so that high scores reflect satisfaction with medical care. Each domain averages responses to items with a range of 1-5, with 5 indicating the highest satisfaction. | 60 days | 
| Binary, Self-reported Opioid Use | Investigators will examine opioid utilization using binary self-reported opioid use (e.g. 0=did not use opioidss;1=used opioids). | 60 days | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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virtual reality, transcutaneous electrical nerve stimulation, analgesia