Professional-facing digital health technology for the care of patients with chronic pain : scoping review

Background: Chronic pain is a highly prevalent condition, estimated to affect as many as 30% of people worldwide. The need for more innovative solutions for chronic pain management is clear, and digital health technology (DHT) may be the best way to address this challenge. Much of the digital health research focusing on chronic pain focuses on patient-facing solutions; however, DHT for health care professionals (HCPs) is equally important to support evidence-based practice, which, in turn, improves patient outcomes. Despite this, no review has investigated the availability of professional-facing DHT for chronic pain management. Objective: This scoping review aims to identify the available professional-facing DHTs for chronic pain management. Specifically, the objectives were to investigate the components of the DHTs as well as development methods, user features, outcomes, and HCP perspectives on DHTs for chronic pain care. Methods: Databases, including MEDLINE, Embase, CINAHL, PsycINFO, and Inspec, were searched using comprehensive search strategies. Two independent reviewers screened titles and abstracts for inclusion of studies in the review and conducted full-text screening. Any conflicts in each stage of the screening process were first resolved through discussion and then through a third independent reviewer. Data extraction and quality assessment were completed using the Template for Intervention Description and Replication (TiDIER) checklist and Quality Assessment for Diverse Studies. Qualitative analysis involved inductive content analysis of user features and thematic synthesis of HCP perspectives. Results: In total, 52 studies were included in the review, reporting on 44 professional-facing DHTs. The included DHTs were intended for remote patient monitoring, clinical decision support, assessment and diagnosis, education of HCPs, or a combination. The most common target population for DHT use was multidisciplinary care teams; the most common setting for implementation was primary care. Approximately half (26/44, 59%) of the professional-facing DHTs had a connected patient-facing system. Inductive content analysis of the user features produced 4 themes: guiding initial consultation, supporting chronic pain management, facilitating ongoing patient management, and supporting routine clinical duties. The thematic synthesis of HCP perspectives produced the following 4 themes, reflecting factors affecting the use of DHTs in chronic pain care: additional value, integration into clinical workflow, ease of navigation, and trust in the DHTs. Most (43/52, 83%) of the included studies did not adequately report appropriate stakeholder involvement in a proper co-design of DHTs; only 7% (3/44) of the DHTs were reported to have been developed with guidance from a system development framework. Conclusions: There are various DHTs available for HCPs to use in the management of chronic pain. The included studies neither reported adequate stakeholder involvement in the DHT development nor any specific frameworks to guide rigorous co-design. Therefore, future research should focus on developing professional-facing DHTs with active involvement of stakeholders in the design process.