Poster Presentation Sydney Spinal Symposium 2025

Implementation and Effectiveness of an Online Pain Education Program for Chronic Musculoskeletal Pain in the Brazilian Public Health System: A Hybrid Type III Randomized Controlled Trial (#9)

Bruno T Saragiotto 1 2 , Marina P Baroni 1 3 , Felipe JJ Reis 4 , Christiane Daniel 3 , Joshua Pate 2 , Livia Fernandes 5 , Luiz Hespanhol 6 , Gisela Miyamoto 7
  1. Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, Sao Paulo, SP, Brazil
  2. University of Technology Sydney, Sydney, NSW, Australia
  3. Department of Physical Therapy, Universidade Estadual do Centro-Oeste , Guarapuava, Brazil
  4. Instituto Federal do Rio de Janeiro, Rio de Janeiro, Brazil
  5. University of Otago, Wellington, New Zealand
  6. Department of Physical Therapy, Speech Therapy, and Occupational Therapy, University of Sao Paulo , Sao Paulo, Brazil
  7. Department of Health Sciences, Faculty of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil

Background

Clinical guidelines recommend pain education as a first-line non-pharmacological intervention, but access to structured pain education programs remains limited. Digital health interventions have the potential to bridge this gap by delivering scalable, evidence-based pain education. This study aimed to evaluate the implementation and effectiveness of three different online pain education delivery modalities in the Brazilian Unified Health System (SUS) for individuals with CMP.

Methods

This was a Hybrid Type III effectiveness-implementation randomised controlled trial (RCT) with economic evaluation. A total of 311 adults with CMP were recruited from primary healthcare units in Guarapuava, Brazil. Eligibility criteria included age ≥18 years, having CMP, access to the Internet, and either undergoing or having a referral for physiotherapy. Participants were randomly allocated into three groups: a) synchronous online pain education (videoconferencing), b) asynchronous video-based education, and c) interactive e-book.

Implementation outcomes included acceptability, appropriateness, feasibility, adoption, fidelity, penetration, and sustainability. Effectiveness outcomes assessed pain intensity, function, sleep, quality of life, self-efficacy, and adverse events at baseline, post-intervention (10 weeks), 6 and 12 months. A cost-effectiveness analysis (incremental cost-effectiveness ratio, ICER) was performed from both the healthcare and societal perspectives, considering direct healthcare costs and productivity losses.

Results

The study sample included 311 participants (age: 39.2 ± 10.6 years). Both intervention groups showed significant improvements in clinical outcomes, but no differences were found between modalities. For implementation, synchronous and asynchronous groups demonstrated greater acceptability, feasibility, and sustainability, while the e-book group showed lower engagement and higher dropout. Economic analysis indicated that asynchronous was the most cost-effective option (lowest cost per unit of improvement in pain and self-efficacy).

Conclusions

While no modality outperformed others in clinical outcomes, implementation success varied, favouring synchronous and asynchronous video-based formats. Economic evaluation suggests that asynchronous video-based education is the most cost-effective model for integration into public health systems.