Manage My Pain [26], the app used for this study, is a digital health solution that comprises 3 components: (1) an app for patients to track their pain, function, and medication; respond to questionnaires; and view insights on their conditions; (2) reports that summarize the information collected in the app to be used during clinical visits to facilitate communication between patients and clinicians; and (3) a monitoring portal used by clinics to remotely assess patient progress, assign questionnaires, and highlight clinically relevant trends and patterns using advanced analytics [25]. MMP was first launched in 2011 as the first pain management app on the Android platform. In 2015, ManagingLife partnered with the multidisciplinary team to evolve the solution to meet clinical needs and successfully integrate it into the clinical workflow of an outpatient clinic of an academic hospital [27]. Several papers have applied machine learning techniques to analyze the engagement patterns of users within MMP and develop prediction models from its data set of over 50,000 users [28-30].

MMP is used by both patients and clinics to measure and monitor pain, function, and medication use. Patients can record their experiences by using the MMP app on their mobile device (compatible with Android and iOS devices) or accessing a web-based platform. When prompted by an in-app push notification triggered at 8 PM daily, patients record daily reflections in the app, where they indicate the meaningful activities they were able to accomplish. The daily reflection concept is based on acceptance and commitment therapy principles that have demonstrated an ability to improve clinical outcomes relevant to pain management [27]. Patients also record their pain episodes, including descriptions such as severity, locations, associated symptoms, characteristics, duration, environment, and aggravating or alleviating factors (Figure 1).

Screenshots of the screens used by Manage My Pain to collect patient-reported outcomes.

Each section of the app can be customized by the patient so that it is representative of their situation. MMP is designed to capture both daily reflections and pain episodes in less than 60 seconds [25]. As patients enter information into the app, charts and graphs are presented to the patient to highlight patterns and trends that increase self-awareness of their condition and provide insight into triggers and interventions. With consent, this information can also be viewed by their clinical team through MMP’s remote monitoring portal. For clinics, pain and function trends are summarized across a predefined time period and can be viewed digitally or output into a clinician-friendly concise report. These self-reported outcomes are used to improve communication with a patient during a clinical visit and assess progress more objectively between clinical visits. Moreover, MMP allows clinics to assign validated questionnaires on pain and related domains for patients to complete at home in advance of their clinical visit. Responses to these questionnaires, along with their corresponding scores and interpretations, are also available through the MMP portal and can be summarized in the clinician-facing report (Figure 2). Emails are sent to the patients by MMP at predefined intervals to encourage engagement with the app and prompt patients to complete the questionnaires by the specified due date.

Sample clinician-facing report produced by Manage My Pain that contains scored responses to validated measures as well as a summary of the daily tracking.

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