Digital Versus In-Person Physical Therapy in Adults With Musculoskeletal Conditions: Retrospective Matched-Cohort Analysis of Surgery and Low-Value Surgical Rates
Study Overview
This retrospective, matched-cohort analysis examined 12-month surgical outcomes among commercially insured adults with spine, knee, hip, or shoulder conditions. Using a nationwide, HIPAA-deidentified claims dataset, researchers compared individuals who initiated Sword Health’s digital care program (DCP) with a matched cohort who initiated in-person physical therapy.
The digital care program combined exercise therapy, education, and cognitive behavioral therapy, delivered remotely with real-time biofeedback and ongoing oversight from licensed physical therapists. Both groups were closely matched on age, sex, pain site, acuity, prior healthcare utilization, comorbidities, and social deprivation index to ensure fair comparison.
Key findings
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58% lower risk of surgery Participants in the digital MSK program had a 58% lower relative risk of undergoing any MSK surgery within 12 months compared to those receiving in-person physical therapy (5.5% vs 13.2%; RR 0.42). This translates to one surgery prevented for every 13 participants treated digitally.
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82% reduction in low-value surgeries Surgeries classified as low-value based on Choosing Wisely–aligned definitions were 82% less frequent in the digital care group (0.6% vs 3.5%; RR 0.17). No low-value shoulder surgeries occurred among digital participants.
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Consistent impact across pain sites Lower surgical rates were observed across spine, knee, hip, and shoulder conditions, with the largest relative reductions seen in knee and hip surgeries.
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Equitable outcomes 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.
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High engagement and clinical improvement Digital participants completed more than twice as many therapy sessions on average compared to in-person care. They also experienced clinically meaningful pain reduction, with 64% achieving meaningful relief and an average satisfaction score of 8.7 out of 10.
