Peterson Health Technology Institute evaluates digital musculoskeletal programs

June 14, 2024

The Peterson Health Technology Institute, which published a report on digital diabetes programs earlier this year, published a much more positive assessment of musculoskeletal digital  programs last week. This report focused on routine musculoskeletal disorders, and excluded patients with other musculoskeletal conditions, significant trauma, autoimmune disease, cancer and infections. Their economic models were based on treatment of low back pain.

Researchers evaluated literature published in peer reviewed journals and invited vendors to submit additional information. They divided digital programs into purely digital app-based programs, physical therapist (PT) guided digital programs, and digital augmentation of ongoing in-person physical therapy.

• They found that purely digital programs, which provide self-directed exercise therapy, improved pain but not function, so was not an appropriate substitute for in-person PT. They drew no conclusion about impact on cost.    

• Physical therapist guided programs that used sensors or monitors fared much better. These programs improved both pain and function and decreased total spending. The researchers calculated that if 25% of in-person PT users with low back pain shifted to these digital programs, it could save $1.9 million per million commercially insured lives. This sounds like large savings as presented, but this is only about $0.16 pmpm.

• The remote therapeutic monitoring augmentation of in-person physical therapy might increase efficacy of PT, but it increases costs. They concluded that this might be high value if restricted to members with higher acuity conditions.

The Peterson researchers note that all of the studies have moderate or high risks of bias, but conclude that “findings are consistent enough to assess clinical effectiveness and economic impact of the solutions.”  The peer-review literature was almost entirely industry sponsored, though, and publication bias could mean that studies with negative findings would not be presented to journals and therefore would not be available for this evaluation. They note that venture capitalists have invested over $4.2 billion in musculoskeletal digital companies since 2010.

Implications for employers:

• PT guided digital programs can increase access to effective therapy and can decrease time away from work.

• The positive Peterson Health Technology Institute study will likely increase adoption of PT-guided programs, but discourage use of app-only digital programs

• Employers should expect programs to delight members with musculoskeletal disease and decrease time away from work but be cautious about savings projections. All digital PT vendors treat conditions beyond lower back pain, so the value of these services may not be similar with real-world use.

Thanks for reading.  You can find previous posts in the Employer Coverage archive

Please subscribe, “like” and suggest this newsletter to friends and colleagues. Thanks!

Illustration by Dall-E

Monday: American Heart Association projects increase in cardiovascular disease and cost