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Jan 05, 2018;19 (1): 10.

Randomized controlled pilot study of an educational video plus telecare for the early outpatient management of musculoskeletal pain among older emergency department patients.

Timothy F Platts-Mills, Allison G Hollowell, Gary F Burke, Sheryl Zimmerman, Joseph A Dayaa, Benjamin R Quigley, Montika Bush, Morris Weinberger, Mark A Weaver
Author Information
  1. Timothy F Platts-Mills: Department of Emergency Medicine and Division of Geriatrics, Department of Medicine, University of North Carolina Chapel Hill, 101 Manning Drive, CB #7010, Chapel Hill, NC, 27599-7010, USA. tplattsm@med.unc.edu.
  2. Allison G Hollowell: School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
  3. Gary F Burke: Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
  4. Sheryl Zimmerman: School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
  5. Joseph A Dayaa: Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
  6. Benjamin R Quigley: School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
  7. Montika Bush: Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
  8. Morris Weinberger: Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
  9. Mark A Weaver: Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
PMID: 29304831 DOI: 10.1186/s13063-017-2403-8

Abstract

BACKGROUND: Musculoskeletal pain is a common reason for emergency department (ED) visits. Following discharge from the ED, patients, particularly older patients, often have difficulty controlling their pain and managing analgesic side effects. We conducted a pilot study of an educational video about pain management with and without follow-up telephone support for older adults presenting to the ED with musculoskeletal pain.
METHODS: ED patients aged 50 years and older with musculoskeletal pain were randomized to: (1) usual care, (2) a brief educational video only, or (3) a brief educational video plus a protocol-guided follow-up telephone call from a physician 48-72 hours after discharge (telecare). The primary outcome was the change from the average pain severity before the ED visit to the average pain severity during the past week assessed one month after the ED visit. Pain was assessed using a 0-10 numerical rating scale.
RESULTS: Of 75 patients randomized (mean age 64 years), 57 (76%) completed follow up at one month. Of the 18 patients lost to follow up, 12 (67%) had non-working phone numbers. Among patients randomized to the video (arms 2 and 3), 46/50 viewed the entire video; among the 25 patients randomized to the video plus telecare (arm 3), 23 were reached for telecare. Baseline pain scores for the usual care, video, and video plus telecare groups were 7.3, 7.1, and 7.5. At one month, pain scores were 5.8, 4.9, and 4.5, corresponding to average decreases in pain of -1.5, -2.2, and -3.0, respectively. In the pairwise comparison between intervention groups, the video plus telecare group had a 1.7-point (95% CI 1.2, 2.1) greater decrease in pain compared to usual care, and the video group had a 1.1-point (95% CI 0.6, 1.6) greater decrease in pain compared to usual care after adjustment for baseline pain, age, and gender. At one month, clinically important differences were also observed between the video plus telecare and usual care groups for analgesic side effects, ongoing opioid use, and physical function.
CONCLUSION: Results of this pilot trial suggest the potential value of an educational video plus telecare to improve outcomes for older adults presenting to the ED with musculoskeletal pain. Changes to the protocol are identified to increase retention for assessment of outcomes.
TRIALS REGISTRATION: ClinicalTrials.gov, NCT02438384 . Registered on 5 May 2015.

Keywords

Emergency medicine Geriatrics Musculoskeletal pain Pain

Associated Data

ClinicalTrials.gov | NCT02438384

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Grants

  1. K23 AG038548/NIA NIH HHS
  2. K23AG038548/National Institute on Aging

MeSH Term

Age Factors
Aged
Ambulatory Care
Analgesics
Emergency Service, Hospital
Female
Humans
Male
Middle Aged
Musculoskeletal Pain
Pain Measurement
Patient Education as Topic
Pilot Projects
Southeastern United States
Telemedicine
Telephone
Time Factors
Treatment Outcome
Video Recording

Chemicals

Analgesics
Journal Article Randomized Controlled Trial
Article has an altmetric score of 4

Word Cloud

Created with Highcharts 10.0.0painvideopatientstelecareED1plusoldereducationalusualcare25musculoskeletalrandomized3onemonthpilotaveragegroups7Musculoskeletalemergencydepartmentdischargeanalgesicsideeffectsstudymanagementfollow-uptelephoneadultspresentingyearsbriefseverityvisitassessedPainagefollowamongscores40group95%CIgreaterdecreasecompared6outcomesBACKGROUND:commonreasonvisitsFollowingparticularlyoftendifficultycontrollingmanagingconductedwithoutsupportMETHODS:aged50to:protocol-guidedcallphysician48-72hoursprimaryoutcomechangepastweekusing0-10numericalratingscaleRESULTS:75mean645776%completed18lost1267%non-workingphonenumbersAmongarms46/50viewedentire25arm23reachedBaseline89correspondingdecreases-1-2-3respectivelypairwisecomparisonintervention7-point1-pointadjustmentbaselinegenderclinicallyimportantdifferencesalsoobservedongoingopioidusephysicalfunctionCONCLUSION:ResultstrialsuggestpotentialvalueimproveChangesprotocolidentifiedincreaseretentionassessmentTRIALSREGISTRATION:ClinicalTrialsgovNCT02438384RegisteredMay2015RandomizedcontrolledearlyoutpatientEmergencymedicineGeriatrics

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