Musculoskeletal Clinicians’ Perspectives on Integrated Digital Personalized Feedback Interventions to Address Risky Alcohol use and PTSD after Musculoskeletal Injury

Risky alcohol use and post-traumatic stress disorder (PTSD) commonly co-occur with musculoskeletal injury–related pain, forming a recovery-delaying cycle. Web/app-based digital Personalized Feedback Interventions (dPFIs) show promise as a first-step adjunct for addressing this comorbidity. We conducted an exploratory cross-sectional survey of 138 musculoskeletal clinicians assessing (1) screening/referral practices for risky alcohol use and PTSD, and (2) interest in a dPFI for alcohol/PTSD treatment engagement, integrated with pain-coping skills. Clinicians indicated that risky alcohol use and PTSD impose multiple recovery challenges. Screening was largely interview-driven (alcohol: 40.4%; PTSD: 55.8%) with low use of validated questionnaires (~ 6% for both). Notably, 6.5% and 9.4% never discussed risky alcohol use and PTSD respectively, and 50.7% reported no on-site PTSD services. Referrals were fragmented: for risky alcohol use, 39.9% referred to primary care, exceeding specialty options; for PTSD, on-site treatment was most common (22.5%) yet half reported no on-site service. Adoption readiness was high: 89.1% expressed interest in an integrated web/app-based dPFI for alcohol and PTSD, 78.3% believed patients would benefit, and referral likelihood was strong (90.6% for each condition/comorbidity). Rates of app-favoring exceeded medication-assisted-treatment-favoring (37.2% vs. 13.9%). Findings support the development and implementation of accessible, scalable integrated dPFIs for PTSD, risky alcohol use, and pain in orthopedic settings.