The Effect of Mobile Care Delivery on Clinically Meaningful Outcomes, Satisfaction, and Engagement Among Physical Therapy Patients: Observational Retrospective Study (Preprint)

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.