The seven 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.
FindingSelf-care monitoring improved (standardized mean difference 0.49). Behavior and medication adherence moved very little (standardized mean difference 0.06 across 17 trials).
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.
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.
Finding97% reported using standardized outcome measures and 89% said performance-based tests drive their clinical decisions; only 48% agreed those measures are administered in a standardized way throughout the profession.
LimitSelf-reported survey; respondents may not represent all clinicians.
What it supportsThe comparability gap: a joint angle computed the same way on every phone and every session is the number clinicians already trust, made comparable. It says nothing about whether JointCoach's angle is more accurate than a goniometer.
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 ยท 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 ($2,131 versus $2,113). The incremental cost-effectiveness ratio was $8,103 per QALY for knee-related costs and $28,271 for all medical costs, both far below the $100,000 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
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.