Telehealth Care Improved Chronic Pain Sick Leave in Primary Care
Key Takeaways
- Among working-age adults on sick leave for chronic nonmalignant pain recruited from Swedish primary care, remote PCC added to usual care was associated with a significant 6-month advantage on the prespecified composite of self-efficacy and sick leave.
- Deterioration was less common with the intervention, while stability over follow-up was more common than with usual care alone.
- Self-efficacy differed significantly at 6 months, and sick leave differed significantly at 3 months.
- Scheduled remote support was delivered without reported withdrawals, major protocol violations, adverse events, or deaths.
In Gothenburg, Sweden, investigators conducted EAPER-P, a nonblinded randomized controlled trial (RCT) reported in the JMIR Formative Research randomized trial. The analyzed cohort included 59 adults aged 18 to 65 years who were on sick leave for chronic nonmalignant pain lasting more than 3 months, were recruited from 10 primary health care centers, and were assigned equally to usual care alone or to usual care plus 6 months of remote person-centered care (PCC) delivered through scheduled telephone support and the MyHealth eHealth platform.
The prespecified primary endpoint was a 6-month composite of change in general self-efficacy (GSE) and self-reported sick leave, with participants categorized as improved, deteriorated, or unchanged. The primary analysis used intention to treat with last-observation-carried-forward imputation. Recruitment stopped early because accrual was slower than expected: 654 people were screened, 60 were randomized, and the original power calculation had targeted 91 participants per group.
At 6 months, the primary composite differed between groups (P=.04). Deterioration was reported in 11/30 (36.7%) of controls and 3/29 (10.3%) of participants receiving remote PCC, and the same direction was seen in the nonimputed analysis (P=.04).
On the component measures, mean GSE was higher in the intervention group at 6 months (P=.03), and mean sick leave differed between groups at 3 months (P=.02). The overall pattern was more consistent with reduced deterioration and greater stability than with broad improvement. Feasibility was supportive, with a median of 7 telephone contacts, a documented health plan for every intervention participant, and no reported withdrawals, major protocol violations, adverse events, or deaths.
Interpretation remains limited by early stopping and the smaller-than-planned sample. The intervention was delivered in a research setting with dedicated staff rather than routine primary care operations, sick leave and self-efficacy were self-reported, and neither participants nor clinicians were blinded. Because the intervention group also received additional structured attention, performance bias may have contributed to a pattern that looked more like stabilization than broad recovery.
The authors concluded that remote PCC delivered by telephone and an eHealth platform may influence sick leave and self-efficacy among adults on sick leave for chronic pain, but larger studies are needed to confirm the signal.
Clinician Questions
Which patients were included in the remote person-centered chronic pain trial?
Adults aged 18 to 65 years were eligible if they were on sick leave because of chronic nonmalignant pain lasting more than 3 months and were recruited from 10 primary health care centers in Gothenburg, Sweden; pain diagnoses could include ICD-10 categories M25, M54, M79, or R52. The trial excluded people with full-time sick leave for at least 24 months, severe impairment that prevented eHealth use, severe non-pain disease with limited expected survival, substance abuse, inability to understand Swedish, no internet-enabled device access, or no registered address.
How was the primary endpoint defined in the EAPER-P chronic pain trial?
The 6-month primary endpoint combined change in general self-efficacy and self-reported sick leave. Participants were classified as improved if GSE increased by at least 5 points and sick leave decreased from baseline, deteriorated if GSE decreased by at least 5 points and/or sick leave increased, and unchanged otherwise. Sick leave was self-reported in the legally defined Swedish categories of 25%, 50%, 75%, or 100% of full-time work.
What did remote person-centered care involve for adults on sick leave with chronic pain?
Remote person-centered care consisted of usual care plus telephone calls with health care professionals and access to the MyHealth eHealth platform over 6 months. The calls were used to elicit the patient narrative, identify resources, set short- and long-term goals, and create or update a jointly agreed health plan, with follow-up calls typically scheduled every 2 to 4 weeks according to participant needs. Participants could review or revise the plan online, message the care team, view the next scheduled call, invite others, and track symptoms on 5-point scales.