Adding an online psychologically informed pain management program to routine musculoskeletal care in Australia: a feasibility study

Introduction: Best practice guidelines recommend access to psychological support within routine musculoskeletal care, but this remains limited. This mixed methods study aimed to explore the feasibility and acceptability of adding an online psychologically informed pain management program to usual care provided by musculoskeletal clinicians.

Methods: Australian-based musculoskeletal clinicians recruited patients with persistent musculoskeletal pain. Clinicians screened, recruited and invited patients to complete an online, psychologically informed pain management program provided by an Australian digital psychology clinic. Feasibility was determined via calculating patient recruitment rate, retention in the study and adherence to the online psychologically informed pain management program. Perspectives of clinicians and patients were explored through semi-structured interviews, which were audio-recorded, and transcribed verbatim. Qualitative analyses used a reflexive thematic approach with themes then mapped to the Theoretical Domains Framework.

Results: N = 168 patients were screened, n = 60 patients recruited n = 40 completed an application and n = 29 enrolled in a psychologically informed pain management program. Thematic analysis from clinicians and patients identified a range of skills, attitudes and beliefs regarding the addition of psychological care and identified individual, systemic and practice-level barriers and enablers to engagement.

Conclusions: Lending support to initial feasibility and acceptability, musculoskeletal clinicians could screen and recruit patients into the study. Subsequently, 66% of these patients applied, 48% enrolled and 36% completed an online psychologically informed pain management program. Qualitative results suggest the need for targeted clinician education, streamlined referral processes, and supportive practice environments to enhance digital psychology adoption.