Psychological mediators in chronic spinal pain after fully remote digital rehabilitation: a real-world, large-sample study.

No comparison group. Every participant received the same remote program, so the study cannot show the program reduces pain or that it works better than anything else. The paper never reports how much pain changed between baseline and discharge, so the size of the overall improvement is not visible anywhere in it. In the unadjusted analysis two of the three psychological factors were not linked to pain at all. The effects appeared mainly once baseline levels were entered into the model, so the result depends on that adjustment choice. The study cannot show cause and effect. It is an observational registry, and the authors themselves state that unmeasured factors may still explain the link between psychological change and pain. All outcomes are self-reported, and participants were people with employer-sponsored access who were mostly employed (91.0%), mostly educated beyond high school (64.4%) and mostly non-Hispanic White (69.7%), so they may not match a general clinic caseload. Measurement points varied widely. For example, 7,257 patients had 9-session data while only 726 had 30-session data, and 7,561 last-time-point observations stood in for the full 14,818 people in the trajectory model. Analyses were not adjusted for how many sessions people completed, so someone who did much of the program is not distinguished from someone who did little of it. Only three psychological factors were measured. Others that could matter, such as self-efficacy, motivation and readiness to change, were not included. The study cannot say which part of the program (exercise, education, cognitive behavioral therapy or therapist contact) changed the psychological scores.

The study was supported by Sword Health Inc, the company that makes the digital care program and the motion-tracking device used in it, and the paper states that the funder was involved in the study design, conduct and reporting. A second funder is named as Componente 5: Agendas Mobilizadoras para a Inovação Empresarial. No individual author disclosures appear in the text supplied.

Do not take this as evidence that a remote digital program reduces pain. Everyone in the study received the same program, there was no comparison group, and the paper never reports how much pain changed from the start to the end. It shows only that people whose psychological scores improved most also reported the least pain, which is an association and not a cause.