Digital musculoskeletal care reduced spending versus in-person therapy
A remote digital musculoskeletal program was linked to lower total and musculoskeletal-related health care spending than starting in-person physical therapy in matched insurance claims.
*Retrospective matched cohort (claims) study; Level 2b (OCEBM).

Citation

Pereira AP, Seet AM, Janela D, et al. Economic Impact of Digital Musculoskeletal Care Versus In-person Physical Therapy: A US Claims Analysis of Health Care Utilization and Outcomes. Archives of Physical Medicine and Rehabilitation. 2026;107:665–675. doi:10.1016/j.apmr.2025.09.010

Background

Exercise-based physical therapy is recommended as first-line care for many muscle and joint problems, but access and follow-through can be difficult, which may lead to more imaging or surgery. This study compared real-world costs and service use after starting a digital, home-based program versus in-person physical therapy.

Patients

United States adults (18 years or older) with commercial insurance and a muscle/joint-related index event (March–October 2023) and at least 12 months of claims before and after (matched groups: 2,183 vs 2,183). Excluded: claims suggesting pregnancy/perinatal status, cognitive impairment, or ongoing cancer treatment.

Intervention

Employer-offered remote digital program with guided exercises, education, and behavior-change support, monitored asynchronously by a physical therapist, using a motion-tracking device for exercise feedback.

Control

Initiation of in-person physical therapy, identified by evaluation billing claims.

Outcome

(Primary) Total health care spending and muscle/joint-related spending per person per year; spending components (surgery, imaging, office visits). Intervention group also reported symptom and productivity changes.

Follow-up Period

12 months before vs 12 months after the index event.

Results

Outcome (post-index) Savings with digital care (USD per person-year) 95% confidence interval
Muscle/joint-related spending (primary) $2,025.7 $1,362.0 to $2,689.4
Total health care spending (primary) $2,369.5 $1,305.4 to $3,433.7
Surgery spending (driver) $1,910.5 $1,271.7 to $2,549.2
Imaging spending (driver) $47.6 $29.4 to $65.8
Medical office visit spending (driver) $54.2 $13.7 to $94.8
The digital group had many more rehabilitation sessions but similar rehabilitation spending. The paper reports fewer surgeries overall in the digital group (counts), and productivity-related savings at program end of $518.1 per participant (self-reported; no control data).

Limitations

Observational design with likely self-selection (motivation/technology comfort), so unmeasured differences may explain some savings. Billing data can be miscoded or incomplete. Clinical outcomes were not available for the in-person group, limiting value-for-money conclusions. Results may not generalize beyond commercially insured, employer-based populations.

Funding

Sword Health; European recovery/resilience project “Responsible AI.” Sponsor-employment and equity conflicts.

Clinical Application

For commercially insured adults with common muscle/joint pain, consider digital-first physical therapy programs to reduce downstream imaging and surgery while supporting home-based rehabilitation.