Veterans’ Electronic Patient-reported Outcomes Inform Evaluation of a Telehealth Pain Management Program

Research Objectives: To evaluate the quantitative portion of a larger longitudinal mixed-methods implementation of the TelePain-Empower Veterans Program (EVP), a non-pharmacological chronic pain intervention. Chronic pain is a leading cause of disability and negatively impacts biological/physical, psychological, and social aspects of life resulting in pain interference or disability. The quantitative portion of this project followed veterans enrolled in TelePain- EVP from 12/2021-6/2023 to examine: (1) electronic patient-reported outcome measures (ePROs) including primary pain-related and secondary outcomes to determine TelePain-EVP effectiveness; and (2) dosing effects to understand relationships between TelePain-EVP use and ePROs.

Design: The quantitative portion of this evaluation project leveraged a within-participants repeated-measured design to examine veteran ePROs across multiple time points [weeks: 1 (baseline), 10 (post-EVP), 26 (follow-up)]. Linear-mixed models were fit to assess changes for each primary and secondary ePRO.

Setting: TelePain-EVP is telehealth intervention delivered from an urban Veterans Affairs medical center in the southeast United States.

Participants: In total, 442 veterans with chronic pain attended at-least one TelePain-EVP session. Of these veterans, 221 (survey response = 50.00%) completed at-least one ePRO survey response and were included in analyses.

Interventions: TelePain-EVP is a 10-week program. Each week, veterans participate in three hourly group sessions (Acceptance and Commitment Therapy; Mindful Movement; and Whole Health).

Main Outcome Measures: Primary pain-related ePROS were intensity, interference, catastrophizing, and kinesiophobia. Secondary ePROS included physical functioning, psychological (depression, anxiety, sleep disturbance), social isolation, acceptance (activities engagement, pain willingness), and readiness for change (motivation, self-efficacy).

Results: Participants (n=221) reported a significant decrease in pain catastrophizing from baseline to post TelePain-EVP (p <.001). Catastrophizing returned to baseline levels at 6-months (p=.116). Pain interference decreased from baseline to post-treatment (p=.05), but this improvement did not exceed the adjusted significance threshold. Pre-post improvements were also observed for certain secondary ePROs (p <.01): psychological (anxiety, depression), acceptance (activities engagement). The activities engagement effect persisted at 6-months (p <.001). TelePain-EVP dose was not associated with primary and secondary outcomes.

Conclusions: Evidence from this evaluation indicate TelePain-EVP has positive outcomes for pain, psychological, and acceptance for veterans with chronic pain. Studies are needed with comparative and cost effectiveness methods to determine patient benefits and economic value of TelePain programs.

Author(s) Disclosures: This project was supported in part by the James A Haley Veterans’ Hospital Research and Development Service, and the VA's Pain Management, Opioid Safety and Prescription Drug Monitoring Program. The contents do not represent the views of the Department of Veterans Affairs of the United States Government.