Research Shows Direct Access Musculoskeletal Care Decreases Pain, Improves Job Function

Research Summary

The purpose of this study was to investigate if pain, physical function, and ability to perform job improved with direct access telehealth physical therapy, in a cohort of patients with musculoskeletal (MSK) pain. Secondarily, we sought to build on previous research that suggests upstream MSK care can prevent unnecessary and aggressive orthopedic interventions which drive up cost for self-funded employers.

This retrospective study was conducted with one of Aware Health's current customers as a means for evaluating the program prior to mass adoption and roll out. The full report can be found in the International Journal of Physical Therapy. 

Key Takeaways:

• 45% of total eligible members used the Aware Health Platform over the course of the study, a higher engagement rate than the industry norm of 5% 
• Program participants’ MSK claims were less than half that of non-participants, demonstrating the powerful cost-savings of fast, upstream care
• Across the 89 participants, there was statistically significant differences in function and pain as well as ability to perform their jobs 
• Study participants were highly satisfied with the quality of care they received and rated the virtual care experience as effective  
• MSK costs amongst Aware users were less than half the cost of non-users based on a claims analysis (59% less), suggesting less out of pocket costs to the employer and employees with Aware

Musculoskeletal Care Landscape: Direct Access MSK vs. Traditional PT

Before diving into the research, let’s back up to understand more about musculoskeletal pain. Whether it’s chronic back pain from sitting at a desk all day, an ankle sprain after a trip, or anything in between, half of employees go to work with musculoskeletal pain. 

Direct access to physical therapy, in other words, seeing a physical therapist first, diverts many of these barriers, giving employees the ability to directly seek diagnosis and treatment without a physician's referral or prescription. Most employees today are not eligible for direct access to musculoskeletal care or experience access barriers, and therefore, the majority of MSK conditions are managed by primary care physicians. 

Most PCPs lack specialized training in diagnosing and managing MSK conditions, leading to unnecessary referral to musculoskeletal specialists and surgeons, premature surgical intervention, and increased utilization of medications and diagnostic imaging.

These unnecessary steps increase downstream healthcare utilization and costs. It’s the reason why musculoskeletal is consistently ranked as a top 5 claims category for self funded employers (Sunlife). When physical therapists serve as a primary access point for MSK conditions, many of the downstream healthcare costs and unnecessary treatment pathways can be avoided, such as medication use, referrals for imaging and surgical intervention.  

Unfortunately, existing beliefs about how physical therapy should be administered makes many skeptical about its effectiveness despite evidence that contradicts these beliefs. Notions like “physical therapists must be hands on” often prevent people from seeking care in a virtual environment. While in-person treatment is needed in some cases, the majority of patients could be seen virtually. Research like this seeks to understand these preconceived beliefs and to explore feasibility of the direct access approach. 

Research Design

A single cohort retrospective design was implemented to offer direct access physical therapy to members of the Staywell Health Plan. There was a one month enrollment period where 199 members elected to join. Of the 199 who elected to join, 89 used the Aware Health Solution for care (45% utilization rate).  

Pain, function and ability to perform the participant’s job were measured before starting treatment and then after treatment. Secondary clinical outcomes included total number of visits, patient adherence, satisfaction and beliefs about the effectiveness of the interventions.

Each user participated in a 60-minute live video session led by a board certified orthopedic clinical specialist (OCS) physical therapist. Aware Health’s proprietary algorithm was used to identify any red flags (i.e. symptoms arising from non-neuromusculoskeletal origin). Anyone who showed red flag signs was eligible to participate but also referred to a medical provider via their health insurance plan. 

The subject participated in a physical examination via video call, which consisted of range of motion measurements and functional movement screening. Following evaluation, the physical therapist prescribed prerecorded, evidenced-based exercises. The physical therapist also provided the participant with education regarding diagnosis, prognosis, intervention and pain science as appropriate based on exam findings. 

Follow up visits were scheduled based on the participant’s needs.

Results of the Study

Participants experienced meaningful decreases in pain and improvements in function and ability to perform their jobs after participating in Aware Health’s MSK program. 

Participants were asked to rate their pain, function, and ability to perform their job before receiving treatment (pretest) and after receiving treatment (posttest) using rating scales. We saw significant improvements to the mean scores with pain reduction, function improvement and ability to perform their job. 

Of the 89 cases reported on in this study, no participants required or reported subsequent in-person physical therapy, medication or prescriptions, or surgery. Even more strikingly, MSK costs amongst users was less than half the cost of non-users based on a claims analysis. 

To note, it is possible that individuals would improve over time, without care. However, given approximately 75% of users were experiencing chronic pain on entry, spontaneous recovery is less likely to be an explanation of results versus if most of the users were experiencing acute pain.

Research Significance 

We see two significant insights that could change the way we care for MSK conditions: 

1. End User Acceptance: Telehealth direct access physical therapy may be as effective as traditional in person care without sacrificing employee satisfaction. We believe this will lead to a rise in telehealth offerings. 
2. Direct access telehealth, focusing on patient education, has the potential to minimize unnecessary diagnostic tests and aggressive treatment methods, which minimizes MSK claims costs for self-funded employers. We anticipate self-funded plans to consider adding MSK solutions to their overall plan strategy where MSK is a high claims category. 

If you would like an introduction to Aware Health's approach to virtual musculoskeletal care, please request a demo.