Chronic back pain is one of the world’s most underrated and underestimated health issues. It is the leading cause of disability and work absenteeism globally, creating significant clinical and economic challenges for individuals, health systems, and our communities. 

Despite its myriad causes and dynamic impact, the most successful interventions are a paradox: According to an international working group focused on reducing the growing burden of low back pain, clinical guidelines emphasize that many cases of low back pain require minimal or no formal treatment. 

Yet access to this care offered through traditional clinical solutions remains unequal to the sheer number of people needing help. Generally, only about 20% of patients who even see their physician receive a referral for conservative musculoskeletal (MSK) support as a first-line solution, contributing to low access rates. In fact, for every American who will experience an MSK condition this year, only three in five -– or 60% -– will actually receive care. Data also shows that there are financial benefits of getting patients with lower back pain early access to physical therapy. Early referral to guideline adherent physical therapy is associated with significantly lower utilization for all outcomes and 60% less total lower back pain-related costs.

Amid these limited solutions, digital health tools are emerging as promising alternatives for managing chronic back pain programs, and there is reason to be optimistic. However, despite the potential, lagging payment reform and tired myths heavily influence care delivery and adoption. 

Barriers to successful MSK care adoption

Healthcare reimbursement models strongly influence MSK clinical decisions and care delivery. Physical therapists and other MSK providers operating under fee-for-service structures are financially incentivized to keep patients returning for in-person visits, making it difficult to adopt alternative care models like digital MSK solutions that could benefit patients, their workloads, and healthcare organizations. But value-based care is helping change that. Providers in value-based organizations have more flexibility to offer this innovative care delivery. Encouragingly, new billing codes now allow fee-for-service providers to incorporate digital care, signaling a shift toward broader adoption. 

Even accounting for appropriate pay, digital transformation among clinicians has historically been slow. Some clinicians believe that traditional, in-person care is superior, reinforced by confirmation bias. Others are concerned about the impact of AI on clinical standards, patient relationships, workloads, and meaningful outcomes. 

Another persistent hurdle is the ongoing myth that certain patient populations won’t equitably benefit from digital MSK solutions. For instance, some believe that older adults won’t engage with digital tools, despite data showing otherwise. Many older adult consumers are already collecting their own passive health data from smartwatches, health apps, and other ways. One study found that 85% of 65- to 74-year-olds surveyed and 74% in the 75+ age group have used more than one digital health device. 

Similarly, there are concerns about adoption of digital care among patients in rural areas. However, brick-and-mortar locations are not necessarily more accessible. Data suggests that rural residents may need to travel two to three times farther than urban residents to see hospitals and specialists.

So where are the priorities to scale up MSK solutions to meet the urgent, widespread need among patients?

Envisioning a new standard of care

In an ideal setting, accessing high-quality digital MSK care often starts with a hospital, primary care, or urgent care provider to identify if a patient is a candidate for low-acuity care. These physicians would evaluate and triage the patient directly into conservative MSK care as a first-line solution due to its availability, accessibility, and affordability — avoiding unnecessary imaging, specialist referrals, or injections. The MSK provider would then assess the patient and develop a custom program accordingly.  

This could include visits to an in-person provider, and if deemed appropriate, ongoing treatment would be supported with the help of a digital MSK tool. Modern MSK tools feature educational resources, leverage AI to better support patient mobility and improvement, and help track patient outcomes. In this structure, a patient still benefits from a dedicated clinician’s expertise and attention while also receiving more robust support when following prescribed exercises at home. 

Over time, the clinician can remotely monitor as well as meet with the patient live or virtually through the episode of care, remaining flexible to the patient’s needs and improving outcomes without having to rely on higher interventions, from injections to medications or surgeries. This can be an appropriate option for the more than 13 million Americans who don’t have access to reliable transportation and is more cost-effective, not only for insurers, but also for the 10% of those in the U.S. who are uninsured. 

Yet not all MSK solutions are equally affordable. In fact, some new all-digital solutions on the market are even more expensive than traditional, in-person forms of care. In contrast, MSK solutions that enable an organization’s existing clinical team (versus outsourcing these services) are often more economical. When 75% of Americans find healthcare to be unaffordable and avoid care, we must do better to ensure equitable access. 

However, digital MSK care isn’t a silver bullet. For some patients, regardless of receiving early care, they will still seek downstream services because their condition doesn’t improve. This conservative approach ensures that hospitals are allocating the highest-acuity resources, from medication to surgical interventions to those that are truly in need. 

It’s time to rethink digital MSK care adoption

For millions of people in the U.S. and globally, chronic back pain is a significant concern. While high-acuity options must remain for those that need stronger interventions, millions more could be benefiting from access to low-acuity or minimal interventions. Patients deserve better than long wait lists, expensive care, or seeking surgery to address their pain. 

Digital care can often be a driving force for keeping people both pain-free and engaged in the workforce. For the 40% who never receive care, digital solutions have the potential to shift the care pathway by bringing conservative interventions, like physical therapy and MSK solutions, earlier into the patient journey. Through payment reform, moving beyond outdated myths, and enabling clinicians to help more patients through digital care instead of replacing their expertise with AI, we have an opportunity to address clinical and economic challenges at scale.

Photo by flickr user Michael Dorausch

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