Fritsch CG, Ferreira PH, Prior JL, et al. Effects of using text message interventions for the management of musculoskeletal pain: a systematic review. Pain. 2020 Nov;161(11):2462-2475. doi: 10.1097/j.pain.0000000000001958. (Systematic review)

Musculoskeletal pain is the greatest cause of disability worldwide. Owing to its increasing prevalence and burden, the importance of affordable treatments has been highlighted. Text message interventions are accessible, low cost, and effective in promoting healthy behaviour and managing chronic diseases. However, little is known about their role in musculoskeletal pain. This systematic review was conducted to appraise the literature on the effects of text messages (as an intervention or a component of an intervention) compared with any control on pain and function in people with musculoskeletal pain (PROSPERO: CRD42018117371). MEDLINE, EMBASE, CINAHL, Cochrane, and PEDro databases were searched from inception to April 2020. Keywords relating to musculoskeletal pain, text messages, and randomised controlled trials were combined. Methodological quality was assessed using the PEDro score. Of the 12,022 studies identified, 11 were included, with a mean PEDro score of 5.4/10 points (SD 1.3). Pooled analyses were not performed because of heterogeneity of interventions and clinical characteristics. When text messages were added to and compared with usual care, some positive effects were found only on treatment adherence. Although small and inconsistent, some positive effects were reported for pain intensity, function, care-seeking behaviour, adherence, and quality of life when text messages were added to multicomponent interventions. Moreover, text message and telephone counselling interventions had similar effects on function. Overall included studies were of limited methodological quality and heterogeneous. However, our results indicate potential benefits of text messages in the treatment of musculoskeletal pain, which need to be confirmed in future trials.

Discipline Area Score
Psychologist 5 / 7
Rehab Clinician (OT/PT) 5 / 7
Physician 4 / 7
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Comments from MORE raters

Physician rater

Interesting topic. The MA/SR is limited by the quality of available manuscripts; therefore, the conclusion and significance were both limited in scope.

Physician rater

This systematic review of published randomised studies examined the effect of text messaging on outcomes for patients with musculoskeletal pain. The few studies that were able to be included in the systematic review were generally of poor quality and had considerable heterogeneity making combination of results unreliable. Apart from a small effect on treatment adherence, there was no consistent effect on any outcomes for this patient group. While it is a cheap intervention, the lack of any definite or consistent benefits makes it questionable whether it is worth the effort to implement this intervention.

Psychologist rater

As the authors point out, evidence is not high quality and the heterogeneity of studies obviated the use of meta analysis. Nevertheless, the "doc in a box" potential of encouragement through texting is intriguing at a time when access to services can be limited.

Rehab Clinician (OT/PT) rater

More and probably better studies will be done in the future. Healthcare management will be increasingly digitalized in the future.

Rehab Clinician (OT/PT) rater

The systematic review was limited by the quality/heterogeneity of studies reported, however, text follow up is worthy of additional investigation and along with telehealth a potentially effective tool.
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