Development and evaluation of the Digital-My Arm Pain Programme (D-MAPP) for improving painful distal upper limb musculoskeletal disorders

Research question Is it possible to develop a robust evidence-based, digitally delivered care package to address the deficiencies in treatment and healthcare support for people with distal upper limb (DUL) musculoskeletal disorders (MSDs) in order to optimise recovery; improve long-term functional use and reduce pain?

Background DUL-MSDs are highly prevalent and commonly include: hand, wrist and thumb osteoarthritis (OA), carpal tunnel syndrome, tendinitis and epicondylitis. DUL-MSDs cause distressing levels of pain, swelling, loss of function and disability. The effects of living with a DUL-MSD are considerable in terms of personal, social and economic consequences.

Primary care consultations for upper limb disorders are high: a UK population survey reported 15% had consulted a GP within the previous year with upper limb pain. There are difficulties in the treatment and management of DUL-MSDs and a lack of national guidelines.

Current challenges in our NHS including increasing costs, overburdened musculoskeletal (MSK) services and an unwarranted variation in service provision, all call for innovative ways of delivering rehabilitation.

Supporting self-management and personalising treatments, including the use of digital technology are NHS priority areas.

Aim The overall aim of this research programme is to co-develop and evaluate a digital rehabilitation programme -Digital-My Arm Pain Programme (D-MAPP) to be prescribed by health professionals for improving DUL-MSDs.

Objectives To develop consensus between patients and key clinician stakeholders on the required components of D-MAPP; To explore potential barriers and facilitators to patient engagement; To iteratively co-design and refine D-MAPP with patients and clinical stakeholders, identifying key intervention attributes and specifications for optimising use; To identify the causal mechanisms underpinning D-MAPP, and develop a logic model of the intervention; To explore with patients and key clinical stakeholders the content and usability of D-MAPP and any barriers to usability, adoption and adherence; To examine the clinical and cost-effectiveness of D-MAPP to determine if it will provide clinical and cost-effective improvements in DUL regional pain and physical function and facilitate workability compared to usual care; To explore experience, perceptions, usability and adherence of the D-MAPP by people with DUL-MSDs; To assess the challenges of intervention implementation of D-MAPP with patients and key clinical stakeholders in primary and community care.

Methods/Timeline The programme is designed as a mixed methods study with multiple work packages culminating in a randomised controlled trial.

Workpackage 1: Modified Delphi study and exploratory qualitative research (Months 1-7) Workpackage 2: Experience Based Co-Design with case study and evaluation (Months 6-28) Workpackage 3: Randomised controlled trial with internal pilot and mixed methods evaluation (Months 24-71) Workpackage 4: Implementation (Months 1-12, 25-36, 61-72) Anticipated Impact and Dissemination We will produce a novel digital intervention (D-MAPP) for people with DUL-MSDs which has the potential to reduce pain control, improve physical function and, if relevant, enhance work participation.

The D-MAPP will also reduce burden on over-stretched GPs and musculoskeletal services and likely post-COVID changed working practices.

We will ensure that the D-MAPP is widely disseminated to GPs, other health professionals, charity-based organisations and patient groups, including through social media, publications and conference presentations.