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 < 0.001). Business-related occupations were non-significantly different from trade, transportation, and utilities, but showed higher last pain score than those in goods-producing (β=-0.18, SE 0.07, P = 0.015) and healthcare/education (β=-0.14, SE 0.04, P = 0.001) jobs. WPAI Overall and WPAI Activity were not significant predictors after adjustment. Predictor effects were consistent across spinal locations. Final model explained 21.3% of variance. Conclusions Baseline disability and occupation were predictors of outcomes post digital rehabilitation for chronic spinal pain, while work impairment was non-significant. Integrating these factors into routine screening may enhance predictive accuracy, patient communication, and facilitate personalized care pathways. These results encourage confirmatory studies to reinforce these findings. Trial registration ClinicalTrials.gov, NCT05417685. Registered on June 14, 2022; https://clinicaltrials.gov/study/NCT05417685.