Title: Digital application was superior to physicaltherapy for orthopedic knee injuries assessed by PROMIS measures

Abstract

Physical therapy is often the initial treatment for conservative care of musculoskeletal disorders in the United States. Efficacy of a physical therapy exercise program delivered via a digital application (Limber Health app) compared to standard physical therapy has not been thoroughly assessed. We hypothesize that Digital Home-Exercise Therapy Application (DETA) will be superior to the standard of care (Physical Therapy (PT)) after 8 weeks with respect to improvement in PROMIS® pain and function Computerized Assessment Test (CAT) measures. We use a multi-center, prospective; single-blind randomized clinical trial comparing PT (standard of care) to DETA. A total of 60 patients prescribed PT were randomly assigned in a 1:1 parallel block randomization compared to PT prescription. The PT groups were assigned to therapy twice a week for 8 weeks. The DETA group was assigned to 15-25 minute videos 3 times a week for 8 weeks that were tailored based on the patient’s disability and health status. The DETA’s algorithm adjusted the intensity of program progression based on changes in PROMIS® scores. The primary outcome was PROMIS® pain and function CAT. Thirty patients completed the 8 week intervention (17 control, 13 treatment) at the time of submission. Independent t-tests revealed absolute changes in PROMIS Physical Function were significantly greater in the DETA group compared with control, indicating a greater improvement in function; a large effect size was noted (p<.05, Hedge’s g = 0.77). Reductions in Pain Interference were not significant between the groups, but a medium-to-large effect size was noted in favor of the Limber app (p>.05, Hedge’s g = .60). Changes in Physical Function and Pain Interference surpassed MCID in the Limber group, but not in the control group. An 8-week DETA program was superior to the standard of care of PT; a digital therapeutic exercise application could have similar outcomes with respect to pain and function compared to traditional PT. This study describes an innovative approach to risk stratify patients to appropriate exercise based on their disability.