Digital vs. in-person physical therapy and surgery rates

Study overview

Clinical guidelines recommend physical therapy-based conservative care for many MSK conditions, but evidence comparing downstream surgery rates after digital versus in-person physical therapy has been limited. This retrospective matched-cohort analysis compared 12-month surgical outcomes among adults with spine, knee, hip, or shoulder conditions.

Researchers used a HIPAA-deidentified US nationwide claims dataset and compared people who initiated Sword’s multimodal digital care program with a matched cohort who initiated in-person physical therapy. The study included 4,190 matched individuals and evaluated any MSK surgery and low-value MSK surgery over 12 months.

Key findings

Digital care was associated with lower surgery risk

The Sword summary reports a 58% lower relative risk of any MSK surgery among digital care participants compared with matched in-person physical therapy participants.

Low-value surgery risk was lower

The study reported an 82% lower relative risk of low-value surgeries for digital care participants versus the matched in-person physical therapy cohort.

Results were consistent across populations

Reduced surgery and low-value surgery rates were consistent across age groups and socioeconomic strata, including individuals living in more socially deprived areas.

Digital participants completed more therapy sessions

Digital participants completed more than twice as many therapy sessions on average compared with in-person care, and they reported clinically meaningful pain reduction and high satisfaction.

Why this study matters

This is a flagship study for Sword’s surgery and low-value care category. It moves beyond self-reported pain and function to evaluate downstream surgical utilization using claims data.

The study should be framed with precision. It is a retrospective matched-cohort analysis, not a randomized trial, so language should use “associated with” rather than “caused.” Its strength is showing that digital MSK care was associated with substantially lower 12-month surgery and low-value surgery rates compared with matched in-person physical therapy.

Read the full study