PHTI validates virtual MSK solutions after taking diabetes tools to task

The startling revelation that many prominent diabetes care tools do not provide clinical benefits threw into sharp relief the need for proven versus purported clinical efficacy claims in digital healthcare. As the market matures, technology developers are finding that it is not enough to have a great idea — it must be a great idea that works. For technology developers in the musculoskeletal (MSK) care arena, there is good news on this front.

The independent evaluation organization Peterson Health Technology Institute (PHTI) has found that solutions targeting MSK disorders do, in fact, improve pain and function outcomes.

The organization’s findings, detailed in its latest report, bolster the outlook for the burgeoning digital MSK care market. A study published in January cites data showing that MSK disorders affect more than one in three people in the United States, representing approximately 127.4 million individuals. Research also indicates that MSK conditions are driving employers’ healthcare costs up.

With demand and costs rising, there is an urgent need to address MSK disorders and the accompanying pain and loss of productivity. However, most Americans want to avoid invasive procedures like surgery.

A survey commissioned by digital MSK care provider Hinge Health shows that 77 percent of 10,000 US adults are looking for nonsurgical options to treat their MSK pain. Thus, virtual care solutions have emerged as a popular option to address the rising need for cost-effective treatments for MSK disorders.

This has led to a flurry of technological development in the MSK arena, with digital health companies scrambling to create the most effective nonsurgical treatment option.

“We have a lot of companies that have figured out how to offer high-quality virtual PT [physical therapy] care that people can do anytime they want and from whatever location is convenient for them,” said Caroline Pearson, executive director of PHTI, in an interview with mHealthIntelligence. “There's a real opportunity to improve convenience and access for patients with digital augmentation or digital solutions.”

And it appears that these digital care solutions work.

For the analysis, PHTI researchers conducted a systematic literature review of evidence for eight virtual MSK solutions in three categories: app-based exercise therapy with limited physical therapist intervention, physical therapist-guided solutions as an alternative to in-person care, and solutions that supplement in-person PT with virtual care and are paid for as remote therapeutic monitoring (RTM). They screened more than 2,000 articles, of which 48 met the inclusion criteria.

Various companies, including DarioHealth, Hinge Health, Kaia Health, Limber Health, Omada Health, RecoveryOne, Sword Health, and Vori Health, sell the solutions in the evaluation. In addition, Hinge, Limber, Omada, Sword, and Vori submitted a combined 44 clinical references and evidence reviews for their solutions.

“We also have a team of clinical advisors that give us advice about standard current care and the digital enhancement of that care,” Pearson explained. “And we do direct research with patients to really understand their care journey and how these solutions fit into their needs.” For its latest evaluation, PHTI interviewed seven patients.

The report shows that the virtual MSK solutions deliver clinically meaningful improvements in pain and function compared to people receiving usual care, which includes physician visits and pain management but not PT.

“So, across the board, doing self-directed virtual physical therapy at home helps people heal more quickly than just usual care, including waiting for your body to heal itself naturally,” Pearson said. “And for our physical therapist-guided solutions, which have physical therapists working directly throughout the care process, those really performed as well as in-person PT in terms of improving pain and function for the patients.”

Clinical efficacy is not the only benefit of these solutions. According to the report, physical therapist-guided solutions help reduce average healthcare spending.

“Those solutions can reduce overall healthcare spending, not only by reducing the cost of administering physical therapy but also by getting more patients to start therapy early and adhere to their treatment, which helps avoid other unnecessary medical care like surgeries,” Pearson said.

The report states that if 25 percent of low back pain patients using in-person PT shifted to these MSK platforms for $995 per year, it would save an estimated $4.4 million per 1 million commercially insured individuals.

Further, the report notes that RTM-augmented PT solutions have limited but positive evidence indicating superior outcomes for pain and function compared to in-person PT alone. However, the overall cost savings associated with this category of solutions are unclear. Though the evidence shows that doing exercises between PT sessions is better than in-person PT alone, Pearson said there isn’t enough evidence to suggest that the cost savings are enough to offset the additional price of those RTM solutions.

The differences between the findings of this latest report and the diabetes tool evaluation are stark, though the methodology is the same. Pearson has a few thoughts as to why this might be the case.

For one, MSK solutions are an adequate substitute for in-person care, making the economic impact more favorable.

“There's just a real opportunity for them to lower overall healthcare costs versus the diabetes solutions, all of which were really layering on top of existing care delivery and thus adding cost to the system,” she said.

Another reason virtual MSK solutions fared better than digital diabetes tools is that the standard of care for MSK disorders is generally more effective than those for diabetes. Pearson noted that bringing hemoglobin A1C levels down is challenging regardless of in-person or virtual care approaches, whereas PT is effective through either approach.

“And that means that patients who have MSK disorders have real equal choices between whether they want to pursue in-person physical therapy or virtual therapy, and they get to decide what's going to be best for them,” she added.

According to Pearson, the report's findings have differing implications for healthcare payers, providers, and companies. Given the solutions' clinical and economic advantages, healthcare providers can confidently offer them to appropriate patients, she said.

Though the clinical benefits between virtual and in-person MSK care are equitable, access may not be, as coverage varies across health plans and benefits. Thus, Pearson stated that healthcare payers should consider moving them from the wellness benefit category to the traditional medical benefit category.

And finally, digital health companies must prove the clinical efficacy of their solutions to set themselves apart in a crowded and competitive market.

“We've proven that care can be delivered virtually, digitally, asynchronously, but now we need to really capture those results, and we need to capture those results relative to whatever usual care looks like… Solutions that are being integrated into usual care should demonstrate value relative to that usual care and how they're changing care,” Pearson said. “And clearly, from this report, the potential is there, and so we need to measure it, and we need to be accountable, and then use that data to drive both the purchasing of digital health solutions [and] the evolving innovation of those solutions.”