Imagine this. Before you take the plunge and have surgery on that achy knee, the doctor refers you to physical therapy. Instead of physically traveling to a physical therapy clinic, the clinic comes to you.
Your insurance company sends you a device that attaches to your knee and monitors your knee movement. The information collected from the device is sent to a physical therapist, who reviews the data and meets with you virtually on a regular basis.
This may sound futuristic, but it is happening now.
The Covid-19 pandemic has accelerated the use of digital and virtual platforms in healthcare. Digital musculoskeletal care is one area that has seen a growth in the number of available platforms and investor dollars.
Treating musculoskeletal pain is expensive
In 2016, healthcare spending in the United States was estimated to be $3.1 trillion. Spending on neck and back pain topped the list at $134.5 billion. Treatment of other musculoskeletal pain had the second-highest amount spent at $129.8 billion.
Private and public insurance companies paid most of these costs. As a result, they started to look into other ways to treat musculoskeletal pain. The main concern was finding ways to avoid surgery, given the high cost.
Physical therapy can often be a lower-cost alternative to surgery. However, barriers such as the lack of physical therapy clinics in remote locations, and the availability of physical therapists in more populated areas exist.
Recently, insurance companies and investors have started to turn their attention to the digital monitoring of musculoskeletal care.
What is digital musculoskeletal care?
In digital monitoring for musculoskeletal care, patients are often overseen by a physical therapist, trainer, or health coach remotely. Visits take place over a video chat. Some digital musculoskeletal companies also provide patients with a wearable device that helps to monitor the patient’s movements.
While digital musculoskeletal monitoring companies seek to meet the need for widespread care, investors have poured money into digital musculoskeletal care companies.
Companies such as Hinge health and SWORD health lead the way with investor funding after both companies reached valuation in the billion-dollar range in 2021. 1,2
Other notable companies in the digital musculoskeletal care space include Kaia Health, RecoveryOne, SpineZone, DarioMove, and Sprite Health.
While all of these companies connect patients with a physical therapist, each uses a unique platform, and use of technology to deliver care.
Companies such as Hinge Health and SWORD provide patients with a wearable device that allows the physical therapist to track and analyze a patient’s movements.
Other companies such as Kaia Health and RecoveryOne utilize video motion capture technology to analyze a patient’s movement.
How effective is digital musculoskeletal care?
A systematic review published in 2020 examined the effectiveness of digital musculoskeletal care. Included studies compared digital care to either no treatment, traditional face-to-face in-clinic care, non-digital self-management interventions (eg leaflets), and noninteractive digital self-management ( eg web page).
Measured outcomes included pain and functional disability. Nine out of the 19 studies showed digital musculoskeletal care significantly improved reported pain, while 10 out of 16 studies showed digital musculoskeletal care significantly improved functional disability. Another study in 2020 tracked 10,000 participants enrolled in a digital care program over 12 weeks. The study participants were either being treated for low back or knee pain. Over 78% of the study participants reported a decrease in their pain that was clinically meaningful. The study authors also cited a significant decrease in reported anxiety and depression.
Is digital musculoskeletal care for everyone?
No formal studies have looked at the determinants of who can benefit from digital musculoskeletal care versus traditional care. The 2020 study did note that participants with a higher BMI (body mass index) were less likely to complete the 12-week digital care program.
Other factors which may determine whether digital musculoskeletal care is appropriate and effective may include internet access, comfort with technology, and patient safety while performing interventions at home.
A report by the Pew Research Center in 2021 outlined how Americans access technology in rural versus urban and suburban areas. The use of broadband internet, computers, and devices such as a tablet or smartphones has increased among rural adults over the past decade.
However, those living in rural areas still utilize technology at lower rates than those living in more populated areas. By some estimates, 42 million Americans do not have access to broadband internet. For digital healthcare to be available in rural areas, improvements need to be made in technology infrastructure to make broadband internet access more available.
Many questions persist regarding patient safety while undergoing digital musculoskeletal care. Therapy sessions are conducted by a physical therapist, and many platforms have pathways for reporting adverse reactions. These safeguards can be helpful for most high-functioning patients.
However, remote patient monitoring may not be appropriate for more complex patients. Patients who are impulsive, at risk for falls, or need to have their vitals closely monitored during therapy sessions may not be candidates for digital care.
The cost of care is the most important
Overall, digital healthcare aims to change the healthcare and medical system.
Digital healthcare can decrease barriers for some participants. Improved therapist availability, and not having to travel to a brick and mortar clinic can be appealing for some patients. Factors such as a willingness to engage in technology, comfort with technology, and internet access may determine whether you or a loved one can benefit from digital musculoskeletal care.
However, health and safety needs during therapy sessions should be addressed before participating in digital musculoskeletal care.
Modalities such as physical therapy, either on an in-person or remote basis tend to cost less than surgery. If the overall goal is to decrease healthcare costs, then both forms of physical therapy need to be seen as a solution. Whether to pursue in-person care or musculoskeletal care should be up to you, the consumer.
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