Core program elements for equitable, effective participation in a lifestyle medicine program for chronic musculoskeletal pain.

Abstract

Background: Despite growing interest in using lifestyle medicine to address chronic musculoskeletal pain, challenges remain in equitably and effectively delivering lifestyle-related interventions to this population.

Objective: To identify program elements that affect engagement with, and effective delivery of, a lifestyle medicine program for patients with chronic musculoskeletal pain and metabolic comorbidities. It was hypothesized that patients with more social disadvantage engage with proportionately greater group (vs. individual) and telehealth (vs. in-person) programming.

Design: Mixed methods study.

Setting: Lifestyle medicine program within a tertiary care academic center.

Participants: Adults with chronic musculoskeletal pain and obesity-related metabolic comorbidities who presented to a musculoskeletal-oriented lifestyle medicine program.

Interventions: Not applicable.

Main outcome measures: Logistic regression tested whether patients' level of social disadvantage (operationalized as national Area Deprivation Index [ADI] percentile) is associated with their proportion of program engagement via group (compared to individual) and telehealth (compared to in-person) visits. Semistructured interviews among a subgroup of 38 patients explored other program elements that patients perceived to affect equitable and effective program implementation.

Results: Among 205 patients (median [interquartile range] age 60 [50-67] years, 169 [82%] female, 145 [71%] White race), worse social disadvantage was associated with an increased proportion of engagement via group (compared to individual) visits (odds ratio [OR], 1.13 per 10-unit increase in national ADI percentile [95% confidence interval (CI), 1.07-1.20], p < .001) and via telehealth (compared to in-person) visits (OR, 1.13 [1.07-1.20], p < .001). Patient-perceived keys for effective participation included the program's holistic, interprofessional, goal-oriented approach and genuine kindness and care by knowledgeable program clinicians. Some patients requested long-term periodic program check-ins to facilitate maintenance of lifestyle changes. Improved insurance coverage, clinic expansion to multiple sites, and after-hours programming would improve access for some patients.

Conclusions: Group visits (using shared medical appointments) and telehealth visits improve equitable access to lifestyle medicine interventions.