Most digital psychological interventions for chronic pain fail to measure all 4 dimensions of the quadruple aim of value-based health care: a scoping review

ABSTRACT: Psychological treatments are increasingly being developed and delivered using platforms such as mobile applications, online modules, virtual reality, and artificial intelligence chatbots. This scoping review aimed to examine how digital psychological interventions deliver outcomes that are valuable not only for patients but also for clinicians and the broader health system. Peer-reviewed studies evaluating digital psychological interventions for adults with chronic primary pain and chronic primary or secondary musculoskeletal pain were included. Seven databases were searched: PubMed, Embase, CINAHL, Web of Science, Scopus, PsycInfo, and Cochrane. Screening was conducted independently by 2 reviewers, with a third reviewer providing consensus in cases of conflict. After screening, 108 articles met the eligibility criteria, reporting on 81 distinct interventions. Outcomes were mapped to the quadruple aim of health care to assess for improvements in population health, patient experiences, clinician experiences, and cost-efficiency. All interventions demonstrated improved health outcomes for people living with pain, with most also assessing patient experiences (n = 65, 80.2%). Few measured clinician experiences (n = 22, 27.2%) or cost-effectiveness (n = 8, 9.9%). Only 2 interventions reported outcomes that addressed all 4 quadrants of the quadruple aim of health care. At the time of review, a third of the interventions (n = 27, 33.3%) were available for use in real-world settings. Overall, current evaluations demonstrated positive impact on population health, patient experience, and access to psychological care. However, limited understanding remains on how clinicians are supported to refer and implement these treatments, as well as the costs of integrating them into routine care.