Examining the Feasibility and Effectiveness of an mHealth Solution Designed to Enhance Clinical Outcomes Among Patients Attending Physical Therapy for Musculoskeletal Pain

Musculoskeletal (MSK) pain is a major burden on the US population, representing the leading cause of disability and non-cancer reason for opioids prescriptions, as well as the top health care spending category in the country. Physical therapy (PT) has been shown to be effective in reducing pain and disability among patients with MSK

pain. PT has also been shown to help reduce health care spending related to MSK pain by reducing the utilization of major cost drivers, such as imaging and surgery. However, the effects of PT are closely tied to patients’ engagement with PT care, especially how often they complete prescribed home exercises. Unfortunately, these

rates are often low, which means patients are not experiencing the full benefit of PT and are likely going on to receive more invasive procedures or use opioids following a “non-response” to PT. In 2021, new procedural codes were announced by the Centers for Medicare and Medicaid Services that facilitate the use of Remote

Therapeutic Monitoring (RTM) by physical therapists. RTM is a point of care mobile health (mHealth) solution that includes the integration of a mobile application into the PT episode of care. Through the use of a digital RTM platform, RTM allows physical therapists to assign exercises to patients in a mobile application, track their

adherence to home exercise programs, and to track patient progress through the use of patient-reported surveys administered through the mobile application. While RTM stands to improve patients’ experiences with PT and the effectiveness of PT, little to no research has been conducted on the effectiveness of RTM-enhanced PT nor

has research been conducted examining the feasibility of implementing RTM in health care systems. As such, there is an urgent need for research examining the use of RTM among patients with MSK pain. To address this gap, we propose a phased project (R21/R33) that will examine the feasibility, effectiveness, and implementation

of RTM at a large US academic health care system. During the R21 phase of the project, we will examine the feasibility of implementing RTM among a pilot group of physical therapists that provide care for patients with MSK pain (R21 Aim 1). We will also elicit feedback from these physical therapists and their patients receiving

RTM to refine our approach to delivering RTM (R21 Aim 2). Informed by our experiences during the R21 project phase, the R33 project phase will include full-scale implementation of RTM among all MSK physical therapists at our institution. During this project phase we will utilize routinely collected patient-reported data (i.e., PROMIS)

to examine the clinical effectiveness of RTM-enhanced PT compared to standard PT (R33 Aim 1), the influence of RTM-enhanced PT on cost and downstream health care utilization (e.g., imaging, opioids) (R33 Aim 2), and key implementation outcomes based on the RE-AIM framework. This study will represent one of the first studies

of RTM-enhanced PT and is likely to have major implications for the use of RTM services in the US. Our team plans to leverage the experience and data we obtain during this project to inform the development of a multi- center clinical trial examining the clinical and cost-effectiveness of RTM outside of our institution.