**Abstract**

This chapter will introduce the clinician to the quickly expanding field of musculoskeletal-focused digital apps (MDA), with an eye towards helping the clinician select and recommend MDAs for optimal patient care. MDAs are increasingly being used for physical therapy and rehabilitation, telehealth, pain management, behavioral health, and remote patient monitoring. The COVID-19 pandemic has vastly accelerated the adoption of telehealth and digital health apps by patients and clinicians, and the digital health field will only continue to expand as developers increasingly harness artificial intelligence (AI) and machine learning (ML) capabilities, coupled with precision medicine capabilities that integrate personal health data tracking and genomics insights. Here we begin with an overview of several types of MDA, before discussing the epidemiology of musculoskeletal conditions and injuries, clinical considerations in selecting a digital health solution, payor reimbursement for digital apps, and regulatory oversight of digital health apps.

**Keywords:** digital health, telemedicine, physical therapy, musculoskeletal, artificial intelligence

### **1. Introduction**

Digital health is a rapidly growing field. As of early 2019, there were over 318,000 mobile health applications in different app stores--and that number itself doubled since 2015 as consumers increasingly used mobile apps to manage their health [1]. Popular mobile health apps include AI-powered health symptom checkers, clinical records management apps, remote patient monitoring tools, patient self-monitoring tools, rehabilitation programs, and apps for medical condition education and management. In fact, healthcare applications constitute the most popular smartphone activity. Currently, 90% of physicians use smartphone applications for medical records, communication with their teams and for clinical content like UptoDate [2]. Over 75% of the largest health systems now offer mobile applications focused on patient engagement [3]. The global mobile health market is growing and is expected to reach \$111 billion by 2025 with fitness constituting \$50B in the US health market. The current COVID-19 Pandemic will accelerate the adoption and will further increase the adoption and growth [4].

An American Medical Association survey found that physicians' use of technology to provide televisits or virtual visits doubled from 2016 to February 2020, with nearly 30% of doctors adopting digital health technology [5]. And since the start of



#### *Evaluating the Clinical and Cost Effectiveness of Musculoskeletal Digital Health Solutions DOI: http://dx.doi.org/10.5772/intechopen.94841*

the COVID-19 pandemic, physician use of telemedicine has increased exponentially as digital technologies have become increasingly adopted by both physicians and consumers. Physical therapist and physiotherapist adoption of musculoskeletal-focused digital apps (MDA) has likewise expanded exponentially [6]. Consumer adoption of telehealth increased from 11% of care visits in 2019 to 46% in May 2020, as providers scaled the offerings and are seeing 50 to 175 times the number of patients via telehealth compared to before. In 2019, the annual revenue of US telehealth vendors was \$3 Billion with a big focus on the virtual urgent care segment. With new Centers for Medicare and Medicaid Services (CMS) policies being implemented during the crisis to expand the use of virtual care, up to \$250 Billion of current US healthcare spend could potentially be virtualized [7]. Primary care and behavioral health have led in the number of virtual visits. The services/clinical models that have the greatest potential for virtual care include on demand virtual urgent care, office visits, home health services and home medication administration services [8].

In particular, the number of mobile medical apps for musculoskeletal conditions and injury management is increasing exponentially as organizational health and wellness initiatives increasingly focus on pain management and holistic care. **Table 1** provides an overview of features present in several MDAs on the market as of August 2020. The general purpose of these different musculoskeletal apps is to provide therapy on a large sale for patients with musculoskeletal disorders. The MDAs surveyed in this table have physical or mental exercise programs, and some have behavioral interventions such as mindfulness practice. Most apps also have learning modules to teach organizations and individuals how to stay safe and protect themselves from further issues.

The MDAs surveyed differ in their targeted goals and their approach to achieving their goals. For example, Kaia Health concentrates on using multiple approaches to minimize pain, whereas Movement RX focuses on strengthening the mind-body connection to reduce pain. Wellness Coaches places emphasis on a very personalized and face to face therapy program. And while many apps do not have physical hardware, SimpleTherapy and Hinge Health use sensors that can be placed over joints to track progress and pain.

Moreover, most of the surveyed MDAs can be effectively used to improve population health, injury prevention and rehabilitation in large organizations and companies. The MDAs focus on individual health and progress, while also addressing how to prevent organizational ergonomic issues and manage musculoskeletal injury recovery.
