Background Musculoskeletal care is now delivered via mobile apps as a health care benefit. Although preliminary evidence shows that the clinical outcomes of mobile musculoskeletal care are comparable with those of in-person care, no research has examined the features of app-based care that secure these outcomes. Objective Drawing on the literature around in-person physical therapy, this study examines how patient-provider relationships and program engagement in app-based physical therapy affect clinically meaningful improvements in pain, function, and patient satisfaction. It then evaluates the effects of patient-provider relationships forged through in-app messages or video visits and timely, direct access to care on patients’ engagement in their recovery. Methods We conducted an observational, retrospective study of 814 pre- and postsurveyed participants enrolled in a mobile app physical therapy program where physical therapists prescribed workouts, education, and therapeutic activities after a video evaluation from February 2019 to December 2020. We estimated generalized linear models with logit functions to evaluate the effect of program engagement on clinical outcomes, minimal clinically important differences (MCIDs) in pain (ΔVisual Analogue Scale ≤−1.5) and function (ΔPatient Specific Functional Scale ≥1.3), and the effects of patient-provider relationships and clinical outcomes on patient satisfaction—participant reported likelihood to recommend the program (Net Promoter Scores of 9-10). We estimated Poisson generalized linear models to evaluate the effects of stronger patient-provider relationships and timely access to physical therapy within 24 hours on engagement including the number of weekly workouts and weeks in the program. Results The odds that participants (N=814) had a pain MCID increased by 13% (odds ratio [OR] 1.13, 95% CI 1.04-1.23; P=.003) with each weekly workout and the odds of a function MCID by 4% (OR 1.04, 95% CI 1.00-1.08; P=.03) with each week in the program. Participants with MCIDs in function and large changes in pain (Δ Visual Analogue Scale ≤−3.5) were 1.85 (95% CI 1.17-2.93; P=.01) and 2.84 times (95% CI 1.68-4.78; P<.001) more satisfied, respectively. Those with video follow-up visits were 2 to 3 times (P=.01) more satisfied. Each physical therapist’s message increased weekly workouts by 11% (OR 1.11, 95% CI 1.07-1.16; P<.001). Video follow-up visits increased weekly workouts by at least 16% (OR 1.16, 95% CI 1.04-1.29; P=.01) and weeks in the program at least 8% (OR 1.08, 95% CI 1.01-1.14; P=.02). Access was associated with a 14% increase (OR 1.14, 95% CI 1.05-1.24; P=.003) in weekly workouts. Conclusions Similar to in-person care, program engagement positively affects clinical outcomes, and strong patient-provider relationships positively affect satisfaction. In app-based physical therapy, clinical outcomes positively affect patient satisfaction. Timely access to care and strong patient-provider relationships, particularly those forged through video visits, affect engagement.

No abstract

No abstract

BACKGROUND Digital physical therapy (DPT) programs deliver physical therapy (PT) via a mobile app to privately-insured employees as an employer-sponsored healthcare benefit. Although evidence shows that some DPT clinical outcomes are comparable to in-person care, no research examines how DPT delivers these outcomes. We evaluated a DPT program that delivered care through an app including initial video PT evaluations, follow-up video visits and in-app chat. Participants also accessed prescribed workouts, education and therapeutic activities assigned by their physical therapists (PTs) in the app. OBJECTIVE This study examined the correlates of “good” outcomes in DPT, defined as minimal clinically important differences (MCIDs) in pain and function as well as patient satisfaction. It then examined the effects of the strength of the patient-provider relationship and timely access to care on participation in DPT. METHODS We conducted an observational retrospective study of 814 pre and post surveyed DPT participants, 18 years and older, enrolled in DPT from February 2019 through December 2020 using generalized linear models. Binary variables defined participants with MCIDs in pain and function as the clinical outcomes. “Satisfied” participants had Net Promoter Scores of 9-10 on a final survey question capturing participants’ likelihood to recommend the program. Program participation included workouts per week and number of weeks in the program. RESULTS Clinically meaningful outcomes in DPT are directly affected by program participation. The odds participants had MCIDs in pain increased by 13% (p<0.01) for each additional weekly workout completed and the odds they had MCIDs in function increased by a factor of 1.04 (p<0.05) with each additional week in the program. Participant’s satisfaction was greater for those with significant changes in pain and function and more virtual visits. Participants with MCIDs in function and large changes in pain were approximately 1.85 (p<0.01) and 2.84 (p<0.0001) times more satisfied, respectively. Those with virtual visits beyond their initial evaluation were approximately 2-3 times (p<0.01) more satisfied. Direct access to and virtual visits with PTs were associated with great participation. Each additional PT-initiated message per week increased weekly workouts by 11% (p<0.0001). Virtual follow-up visits increased weekly workouts and weeks in the program by factors between 1 and 2. Access to a PT within 24 hours was associated with a 14% increase in workouts per week. CONCLUSIONS Program participation (program length and frequency of exercise) are associated with clinical outcomes in a DPT program. Satisfaction is affected by both virtual face-to-face visits and clinically meaningful changes in pain and function. Participation in DPT, which drives outcomes, is secured by strong relationships between PTs and patients as well as timely access to a PT.

No abstract