Predicting pain outcomes after digital care in chronic spinal pain: the roles of disability, work impairment, and occupation in a secondary analysis of a prospective clinical study

OBJECTIVE: To evaluate whether baseline disability, work impairment, and job occupation predicted post-pain levels of a digital care program (DCP) for chronic spinal pain. DESIGN: Ad hoc analysis of a real-world clinical registry of patients undergoing a DCP. SETTING: DCP delivered remotely across the United States. SUBJECTS: Adults with chronic spinal pain (N = 13 330) enrolled in a DCP through employer-sponsored health plans. METHODS: Predictors included baseline disability (Oswestry Disability Index or Neck Disability Index), work impairment (Work Productivity and Activity Impairment questionnaire-WPAI), and occupation (job type group). Primary outcome was the last pain score reported during the intervention (11-point Numeric Pain Rating Scale). Structural equation modeling was used, adjusted for demographic and clinical covariates. Moderation analysis assessed whether effects varied by pain location (neck vs low back). RESULTS: Baseline disability and occupation significantly predicted post-treatment pain. Greater disability was associated with higher last pain scores (β = 0.30, SE 0.02, P