# Combined Use of Digital and Analog Physical Therapy in Patients With Musculoskeletal Disorders and Indicators of Chronicity: German Claims Data Analysis

## TL;DR

This study analyzed German health data to understand how digital and traditional physical therapy are used together for musculoskeletal disorders, finding that chronicity is a key factor.

## Contribution

The study provides real-world evidence on the combined use of digital and analog physical therapy in a national healthcare system.

## Key findings

- 36.3% of patients used both digital and analog physical therapy simultaneously.
- Chronicity and higher age were significant predictors of combined therapy use.
- Female patients were more likely to receive concomitant physical therapy.

## Abstract

Musculoskeletal disorders are highly prevalent worldwide and contribute significantly to the overall burden of disease. Regular physical therapy with trained physiotherapists is recommended in the guidelines. Recently, digital physical therapy offered by digital health interventions was shown to be effective. However, the evidence on its real-world usage in health care systems is limited.

Based on claims data, this study examined the current usage of digital health applications (DiGAs) for musculoskeletal disorders in the German health care system. Patients with standalone digital physical therapy were compared to those with a combination of analog and digital physical therapy. In addition, predictors for concomitant use were identified.

This retrospective cohort study analyzed claims data from Germany’s largest statutory health insurance. Patients who used DiGA for musculoskeletal disorders at least once were included. Sociodemographic and medical characteristics of patients receiving standalone and concomitant physical therapy were compared. Statistical analyses comprised univariate analyses and binomial logistic regression.

Of the 6090 individuals, 58.2% (3543/6090) were prescribed physical therapy within 6 months before or after DiGA prescription. In this population, 36.3% (2210/6090) used DiGA and analog physical therapy at the same time. Concomitant physical therapy was significantly more likely in patients with chronicity risk (odds ratio [OR] 1.49, 95% CI 1.31‐1.69; P<.001) or established chronicity (OR 2.76, 95% CI 2.22‐3.47; P<.001), female gender (OR 1.48, 95% CI 1.33‐1.66; P<.001), and higher age (OR 1.02, 95% CI 1.02‐1.02; P<.001).

The findings highlight the diverse utilization patterns of DiGAs among patients with musculoskeletal disorders. Chronicity emerged as an important predictor for combined digital and analog physical therapy. These findings support considerations on integrating digital health interventions into current guidelines.