What the studies show, where each one stops, and what we do not claim.

The honest frame

Five things we claim. Five things we do not.

The eight studies

Each one, with its limit stated

01 · Monitoring plus in-person PT

In-person PT with remote therapeutic monitoring was associated with better functional outcomes than in-person PT alone.

DesignRetrospective case-control study of patients with musculoskeletal conditions in outpatient PT, with and without RTM. Finding72% of PT-plus-RTM patients reached the functional-status benchmark at discharge versus 63% of controls (P = .004). More RTM patients attended more than two visits a week (36% versus 24%). Controlling for other variables, RTM participation predicted reaching the benchmark (adjusted odds ratio 1.53, 95% CI 1.04 to 2.22). LimitRetrospective and observational: patients who opt into monitoring may differ from those who do not, and the study cannot separate the monitoring from the engagement it selects for. One provider network; not joint-replacement specific. What it supportsThe claim that monitoring alongside in-person care is associated with better outcomes, not that any particular product causes them.

Marshall T, Goldman A, Lyles R, Grundstein MJ. Retrospective case-control study on the effect of in-person physical therapy with remote therapeutic monitoring on functional outcomes and plan of care adherence amongst individuals with musculoskeletal conditions. Archives of Rehabilitation Research and Clinical Translation, 2025. PubMed 40980535

02 · Real-world RTM in outpatient PT

The first published implementation study of remote therapeutic monitoring in physical therapy: monitoring was implementable, and activity rose over six months.

DesignMixed-methods implementation study in outpatient physical therapy: 42 patients monitored for steps and exercise, with clinician goal-setting and interviews. Finding81% of participants completed six months of monitoring. Daily steps rose from about 4,900 to about 6,000 and weekly exercise from 44 to 83 minutes, with improvements that decelerated over time. Motivation and accountability drove engagement; health and technology problems were the barriers. LimitSmall, single program, no control group, and the monitored measures were steps and exercise minutes rather than joint range of motion. Published in a neurologic physical therapy journal, so the population is not orthopedic post-operative patients. What it supportsThat therapist-supported monitoring can be run in real outpatient practice and sustain engagement for months. The full paper also reports billing fidelity: the 20-minute management code was billed in roughly 53% of monitored months even for tracked patients (this figure is in the full text, not the abstract). That is where our calculator's 55% default comes from; the pilot replaces it with your own number.

Hohl et al. Remote monitoring enhanced outpatient physical therapy: a mixed-methods implementation study. Journal of Neurologic Physical Therapy, 2026. PubMed 42489634

03 · Digital tools and self-care

Digital health tools improve self-care monitoring by a moderate amount and barely move behavior or medication adherence.

DesignMeta-analysis of 55 randomized trials, 5,889 patients with chronic diseases. FindingBehavior and medication adherence moved very little (standardized mean difference 0.06 across 17 trials). The one clear monitoring signal is narrower than it looks: standardized mean difference 0.49 is heart failure only, from 5 studies and 364 participants, at low certainty. In diabetes the same review found little to no clear improvement across every self-care domain it pooled, at low to very low certainty. LimitChronic-disease populations, not orthopedic recovery, and heterogeneous interventions pooled together. What it supportsWhy JointCoach sells the monitoring half and not the behavior half: the instrument makes the clinician's view better; it does not by itself make patients do their exercises. Read strictly, this paper is stronger on the second half than the first — the near-null adherence result is pooled across 17 trials, while the positive monitoring result is one low-certainty subgroup. It is good evidence for what we do not claim, and weak evidence for what we do.

Longhini J, et al. Effectiveness of digital health interventions to improve self-care in patients with chronic diseases: a systematic review and meta-analysis. Journal of Medical Internet Research, 2026. PubMed 42263266

04 · Standardized measurement

Physical therapists use standardized outcome measures almost universally, but fewer than half believe they are administered in a standardized way across the profession.

DesignCross-sectional survey of 514 U.S. physical therapists. FindingNearly all used outcome measures, with performance-based tests used more than self-report surveys (97% versus 83%). 89% said performance-based tests help them make clinical decisions, against 61% for self-report surveys. Fewer than half agreed outcome measures are administered in a standardized way throughout the profession. LimitSelf-reported survey; respondents may not represent all clinicians. What it supportsThe comparability gap, and the reason to compute a joint angle the same way on every phone and every session. It says nothing about whether JointCoach's angle is more accurate, or more consistent, than a goniometer; that has not been measured.

Kristal A, Gaunaurd IA, Morgan SJ, et al. Use of standardized outcome measures among physical therapists in the United States: a cross-sectional survey. PLoS One, 2025. PubMed 40834029

05 · The employed PT as owner

In a randomized trial, physical therapists' diagnoses agreed with senior physicians' at high levels, with no adverse events.

DesignRandomized controlled trial, 102 patients, single site. FindingAgreement between PT and senior-physician diagnoses ranged from kappa 0.72 to 0.96, with no adverse events reported. LimitOne site, diagnostic agreement rather than treatment outcomes, and a setting that may not resemble a U.S. orthopedic practice. What it supportsThat putting the practice's own PT on record as the owner of a monitored episode is reasonable, which is exactly what the CY2027 proposed rule requires. It does not show that PT-owned monitoring improves recovery.

Zeybeker et al. Archives of Physiotherapy, 2026. DOI 10.33393/aop.2026.3586

06 · Home-exercise adherence

Nonadherence to home exercise in rehabilitation is estimated to reach as high as 50%, and connected technology is proposed as a way to measure and support it.

DesignViewpoint article summarizing the adherence literature and the case for connected-health measurement. FindingEstimates of nonadherence as high as 50%, with a potentially detrimental effect on outcomes; the authors argue adherence cannot be judged, or improved, without a robust measurement tool. LimitA viewpoint, not a trial; the 50% figure is an estimate drawn from earlier studies. A companion systematic review of adherence interventions found insufficient evidence to endorse any one of them in practice. What it supportsThe problem statement, and the measurement half of the answer. Not that any tool fixes adherence.

Argent R, Daly A, Caulfield B. Patient involvement with home-based exercise programs: can connected health interventions influence adherence? JMIR mHealth and uHealth, 2018. PubMed 29496655 · Peek K, et al. Interventions to aid patient adherence to physiotherapist prescribed self-management strategies: a systematic review. Physiotherapy, 2016. PubMed 26821954

07 · No magic bullet: physical therapy versus injection

A course of physical therapy was cost-effective compared with glucocorticoid injection for knee osteoarthritis, with more quality-adjusted life and no surgeries in the therapy group.

DesignSecondary economic analysis of a randomized trial: 156 adults with knee osteoarthritis at two U.S. military hospitals, randomized 1:1 to physical therapy (8 visits over 4 weeks) or glucocorticoid injection, followed one year; health economists blinded to outcomes. FindingPhysical therapy gained 0.076 more quality-adjusted life-years at one year (95% CI 0.02 to 0.126). Unadjusted knee-related costs were nearly identical between the groups. The incremental cost-effectiveness ratio, for knee-related costs and for all medical costs, fell far below the conventional per-QALY threshold, with a 99.2% probability of cost-effectiveness for knee-related costs. Most injection patients needed more than one injection (mean 2.6); 14 later went to physical therapy; four had knee surgery, all in the injection group and none in the therapy group. LimitA closed single-payer military system with no copays, so out-of-pocket costs were not captured; an unplanned secondary analysis; a one-year horizon; quality of life mapped from WOMAC scores rather than measured directly; total medical costs for any reason were higher with physical therapy. What it supportsThat physical therapy which is actually done, aligned with best practice and given time, works and pays for itself, and that the "one quick shot" rarely stays one. There is no magic bullet in musculoskeletal care; the variable is effort, adherence and time, which is the variable monitoring makes visible. It says nothing about JointCoach itself.

Rhon DI, Kim M, Asche CV, Allison SC, Allen CS, Deyle GD. Cost-effectiveness of physical therapy vs intra-articular glucocorticoid injection for knee osteoarthritis: a secondary analysis from a randomized clinical trial. JAMA Network Open, 2022. PubMed 35072722 · Parent trial: Deyle GD, et al. Physical therapy versus glucocorticoid injection for osteoarthritis of the knee. New England Journal of Medicine, 2020. PubMed 32268027

08 · When therapy starts

The longer physical therapy was delayed after a knee osteoarthritis diagnosis, the higher the risk of opioid use, and the relationship was graded.

DesignReal-world cohort of 67,245 American adults with incident knee osteoarthritis who were referred to physical therapy within a year, using commercial and Medicare Advantage claims from 1999 to 2018, split into opioid-naive (35,899) and opioid-experienced (31,346). FindingCompared with starting therapy within one month, each further delay carried more risk, in steps. Among people who had never used opioids, the adjusted relative risk of any opioid use rose 1.18, 1.49, 1.73 and 1.93 across delays of 1–3, 3–6, 6–9 and 9–12 months; for chronic opioid use it rose 1.25, 1.83, 2.29 and 2.50. Among people with prior opioid experience the same pattern held but more gently, reaching 1.54 and 1.65. Active, exercise-based therapy was associated with lower chronic opioid use in the opioid-naive group, but only under the stricter definition: the primary estimate was 0.86 with a confidence interval of 0.72 to 1.02, which crosses 1; the 0.77 (0.62 to 0.95) comes from a sensitivity analysis that required every visit to carry an active code. On dose, 6 to 12 visits was associated with lower chronic opioid use than 1 to 5; more than 12 visits was not, which the authors read as a marker of worse pain rather than a harm of therapy. LimitClaims data and observational: the diagnosis could not be validated against clinical criteria, people who wait for therapy differ from people who do not, and confounding by pain severity runs in exactly the direction of the finding. The authors adjusted for prior use and healthcare utilisation and report E-values for unmeasured confounding, but this is an association, not a demonstrated cause. What it supportsThe timing half of the same claim the trial above makes about the choice: physical therapy that is actually done, early, is where the value is. The graded step is the important part — 1.18 to 1.93 for any opioid use, 1.25 to 2.50 for chronic — a dose-response relationship of this shape is one of the classical reasons to take an observational finding seriously. It says nothing about JointCoach, which starts after the referral has already happened.

Kumar D, Neogi T, Peloquin C, Marinko L, Camarinos J, Aoyagi K, Felson DT, Dubreuil M. Delayed timing of physical therapy initiation increases the risk of future opioid use in individuals with knee osteoarthritis: a real-world cohort study. British Journal of Sports Medicine 2023;57:958–964. PubMed 36822841

Also cited on this site: video-based motion analysis is already used by roughly half of physical therapists, with established methodological standards (International Journal of Osteopathic Medicine, 2023); the CMS rules and rates are on the FAQ with their primary sources.

How people read their pain

Two trials on pain beliefs, each with its limit stated

Neither is about joint replacement, and neither tests JointCoach. They are here because fear of movement and beliefs about pain come up in every rehab program, and the headline numbers travel further than their limits do.

A · A physical therapist works on the fear

When physical therapists worked on how people understood and feared their back pain, alongside graded movement, disability fell more than with usual care, and most of the gain was still there three years later.

DesignRandomized trial of 492 adults with chronic, disabling low back pain in 20 Australian physiotherapy clinics: cognitive functional therapy, with or without movement-sensor biofeedback, against usual care. 312 people were followed to three years. FindingDisability on the Roland-Morris scale (0 to 24) improved 4.6 points more than with usual care at 13 weeks, with similar results at 52 weeks and lower societal cost. At three years disability was still 3.5 to 4.1 points better, while pain was only 1.0 to 1.5 points better on a 0 to 10 scale. LimitNot blinded, and the method’s developers co-authored the trial. Chronic low back pain, not joint replacement or knee arthritis. Pain moved much less than function. In a secondary analysis of 301 participants, the therapy did not reduce opioid dispensing. What it supportsThat what a person believes about their pain, and whether they are afraid to move, are things a physical therapist can work on in the room, with gains in function that last. It says nothing about JointCoach, which does not deliver this therapy.

Kent P, et al. Cognitive functional therapy with or without movement sensor biofeedback versus usual care for chronic, disabling low back pain (RESTORE): a randomised, controlled, three-arm, parallel group, phase 3, clinical trial. The Lancet, 2023. PubMed 37146623 · Three-year follow-up: Hancock M, et al. Lancet Rheumatology, 2025. PubMed 40780241 · Opioid dispensing: Thiveos L, et al. European Journal of Pain, 2026. PubMed 41979226

B · Reading pain as a signal, not damage

In one Boulder trial, two-thirds of people with chronic back pain were pain-free or nearly so after a therapy that teaches them to read their pain as a real but non-dangerous brain signal. No independent team has repeated it yet.

DesignRandomized trial of 151 adults with chronic back pain, mostly low to moderate (4.1 of 10 on average): pain reprocessing therapy (a physician visit plus eight hours of therapy), an open-label placebo injection, or usual care. FindingPain-free or nearly pain-free (0 or 1 of 10) after treatment: 33 of 50 (66%) with the therapy, 10 of 51 (20%) with placebo, 5 of 50 (10%) with usual care. At five years 113 of the 151 answered: 21 of 38 (55%) in the therapy group were pain-free or nearly, against 10 of 39 (26%) and 13 of 36 (36%). Counting everyone randomized to the therapy, 21 of 50 (42%) is the floor. Mind-or-brain explanations rose from 10% of the reasons people gave for their pain to 51% with the therapy, against 8% in the other arms; the shift tracked the drop in pain but explained only about 9% of its variance. LimitOne trial, not yet repeated by an independent team. The therapy was delivered by its developer or one other expert therapist, and several authors disclosed financial ties to pain-treatment businesses. The placebo arm got one injection while the therapy arm got hours of attention, and therapy cannot be blinded. Participants were mostly college-educated, active volunteers from one city with low-to-moderate pain. A quarter were missing at five years, and nobody measured the years in between. What it supportsThat how a person explains chronic back pain may be one route to relief, and that the idea deserves an independent trial. It does not support telling someone recovering from joint surgery that their pain is only a brain signal: new or worsening pain after surgery gets checked first. JointCoach does not deliver this therapy.

Ashar YK, et al. Effect of Pain Reprocessing Therapy vs Placebo and Usual Care for Patients With Chronic Back Pain: A Randomized Clinical Trial. JAMA Psychiatry, 2022. PubMed 34586357 · Five-year follow-up: JAMA Psychiatry, 2025. PubMed 40736996 · Pain attributions: JAMA Network Open, 2023. PubMed 37768666

What JointCoach does with this today is small. After a session, a pain rating of 4 or more brings up the warning signs first, then says that some pain during rehab exercise is expected and that how much is right is the physical therapist’s call. The message is shown on the phone and nothing is sent. The app does not deliver either therapy and does not ask how you explain your pain.

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