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Virtual Musculoskeletal (MSK) Solutions

Assessment Released

Last Updated

June 12, 2024


Musculoskeletal (MSK) Care

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PHTI conducted an evaluation of virtual musculoskeletal (MSK) care solutions for adults with conditions ranging from low back to knee, hip, shoulder, and neck pain.

Area overview

More than one in three Americans experience musculoskeletal (MSK) problems related to their muscles, bones, joints, or connective tissues, which may result from acute injuries, repetitive motion or strain, or osteoarthritis.

Virtual musculoskeletal (MSK) solutions aim to expand access to care—particularly virtual physical therapy (PT)—that can improve pain and functional status for people with a range of MSK disorders. By making care more available and convenient, these solutions aim to improve patient outcomes and avoid unnecessary treatment. The solutions in this report are assessed in three categories:  

  • App-based exercise therapy solutions 
  • Physical therapist-guided solutions 
  • Remote therapeutic monitoring (RTM)-augmented PT solutions 

App-based exercise therapy and physical therapist-guided solutions generally aim to replace in-person care, whereas RTM-augmented PT solutions are meant to supplement in-person care by improving adherence to care plans between in-person PT visits. PHTI assessed clinical outcomes of patients using these virtual MSK solutions, including improvements in pain, function, and adherence, as well as their economic impact compared with in-person PT. 

Read the Executive Summary

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Virtual Musculoskeletal Solutions

Released June 5, 2024

Report contributors and reviewers provided important expertise and insight throughout our process. Those who directly contributed to the report have no relevant conflicts of interest to disclose.

Summary of findings

Based on PHTI’s review of clinical evidence, the virtual MSK solutions assessed in this report deliver clinically-meaningful improvements in pain and function compared to usual care (which generally includes physician visits and pain management but not PT) for people with a range of MSK disorders. Across the three categories of solutions evaluated, physical therapist-guided solutions can be an effective alternative to in-person PT and have the potential to reduce healthcare spending. At the right price, app-based exercise therapy solutions may be valuable solutions to provide broad-based virtual care for patients with lower acuity. RTM-augmented PT solutions have high clinical efficacy but increase costs, making them most appropriate for more serious MSK disorders. Virtual solutions can close access gaps, particularly among older and rural populations or individuals who cannot easily get to in-person PT clinics.


Guidance & considerations for stakeholders


  • Negotiate for competitive prices 
  • Shift to value-based payment arrangements that build on the economic benefits of these solutions 
  • Begin integrating virtual MSK care into medical, rather than wellness benefit 


  • Virtual MSK solutions should be integrated into medical benefits, not wellness programs, to realize the full potential for savings in MSK care 
  • Solutions should partner with payers and providers to improve patient triage and build evidence for moderate and high complexity MSK care 


  • Encourage more PT-first MSK care 
  • Make patients aware of the range of therapy options to identify what works best for them 

Why assess virtual musculoskeletal solutions?

Additional resources

November 2023

Assessment Area Brief

Assessment area brief for PHTI’s assessment of virtually-enabled musculoskeletal (MSK) care tools.

November 2023

Virtually-Enabled Musculoskeletal (MSK) Care Methodology Overview (Presentation with Audio)

A review of PHTI protocol for systematic literature review of clinical impact.

October 2023

Systematic literature review of virtual physical therapy among patients with musculoskeletal disorders

International prospective register of system reviews (PROSPERO), National Institute for Health and Care Research


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