Welcome back to SpineIQ’s Back Blog! Many of our previous blogs have discussed the importance of patient-reported outcome measures (PROMs), which PROMs to use for spine pain, and how to incorporate PROMs in your practice. Our previous blogs discuss using PROMs in your office or clinic and this week, we would like to discuss the option and evidence of using text messaging to collect PROMs in people experiencing spine pain.
Two studies1,2 have looked at the feasibility of using text messaging to collect PROMs. One of the studies was a randomized controlled trial that used monthly texting to collect the outcome measures for 12 consecutive months. The patients received a follow up text message the next day if they had not replied to the initial text message. Two questions were asked in this study via text messaging:
- “Please rate on a 0 to 10 scale (0=no pain, 10=worst pain) average pain over the last 24 hours”
- “Please rate on a 0 to 10 scale (0=no pain, 10=worst pain) average pain over the last week”
The patients only had to reply with a number for each of the questions asked. Approximately 75% of patients responded to monthly text messages over the 12 months of the study. The response rate did not decrease significantly over time and was not significantly associated with age, sex, educational level, or severity of pain.
The second study evaluated the feasibility of using text messaging to collect PROMs in patients seeking care for low back pain from a chiropractor. The text messages were sent weekly for 18 weeks, if the initial text message was not answered then a reminder text message was sent three days later. Three questions were asked in this study via text messaging:
- “Please answer how much your lower back hurts today? Choose a number: 0=no pain at all/1=some pain/2=severe pain”
- “Using a number from 0 to 7, please answer how many days you have been bothered by your lower back this week”
- “Using a number from 0 to 7, please answer how many days you have been off work because of your lower back this week (Answer with ‘X’ if you are not working)”
The response rate was high in week 1 with 90% of patients responding to the text messages. However, response rate declined to 70% by week 18 of the study.
Implication for clinicians
It is important that PROMs are taken at baseline and after an appropriate course of treatment. However, spine pain commonly recurs within a year of previous pain episode. This recurring nature of spine pain poses a potential need for clinicians to keep informed on their patients’ pain even when they’re not routinely coming in for treatment. Additionally, some patients may not seek treatment until later during a back pain episode after the pain has limited their ability to work or do their activities of daily living. Reaching out to patients routinely (weekly or monthly) may help patients seek care earlier and prevent disabling episodes from happening.
Advice/tips how to incorporate texting
Unfortunately, most PROMs are too long to be answered over text message. However, the questions used in the previous studies are an appropriate length to send through text message. There are some websites/programs that you can use to automate text messages such as eztexting. This will allow the text messages to be automatically sent at a designated time and the clinician or their employees do not have to remember to send them.
Clinicians should use the advancement of technology to their own and their patients benefit. Technology can lead to improved patient care and outcomes and text messaging has a potential to impact spine care. Stay tuned for next week’s blog when we discuss how text messaging has been used as an intervention for pain!
- Macedo LG, Maher CG, Latimer J, McAuley JH. Feasibility of using short message service to collect pain outcomes in a low back pain clinical trial. Spine. 2012;37(13):1151-1155. doi:10.1097/BRS.0b013e3182422df0
- Kongsted A, Leboeuf-Yde C. The Nordic back pain subpopulation program – individual patterns of low back pain established by means of text messaging: a longitudinal pilot study. Chiropr Osteopat. 2009;17:11. doi:10.1186/1746-1340-17-11