Last month, Nature Digital Medicine—the world’s preeminent peer-reviewed journal on all aspects of digital medicine and health—published a groundbreaking paper revealing the results of a randomized controlled trial conducted by Sword Health in partnership with Emory University. The study demonstrated that Sword’s digital physical therapy (PT) program for low back pain (LBP) promotes the same levels of recovery as the highest-quality in-person PT—with no difference in primary outcomes (disability improvement) or secondary outcomes (pain, anxiety, depression, and overall productivity impairment) between the two groups.

While the two groups’ clinical outcomes were comparable, the dropout rate was double for the in-person group compared to the digital group—suggesting that digital care pathways are increasingly being accepted as the more accessible and engaging alternative to traditional healthcare models.

By proving that Sword’s digital PT program is just as effective as in-person care at managing LBP, while also 2x more engaging, this study unequivocally establishes Sword as the new gold standard of care for those living with LBP. This is significant news for the hundreds of millions of people suffering from LBP worldwide—and for their employers, who are losing money and worker productivity as a result of disability and the other issues LBP causes.

The Global Burden of Low Back Pain

To understand how impactful the findings of the Nature study are, it is first important to understand how prevalent, devastating, and costly LBP truly is. LBP is the leading cause of disability worldwide. It affected 619 million people globally in 2020, according to the World Health Organization (WHO). Due to an aging population, that number is expected to grow to 843 million by 2050. In other words, LBP is a massive problem that’s only getting bigger.

People who live with LBP often face a severely diminished quality of life, unable to work at full capacity and participate in the activities they love. These physical limitations can take a toll on mental health; adults with disabilities report experiencing mental distress almost five times as often as those without disabilities, according to the Centers for Disease Control and Prevention (CDC).

Furthermore—between the direct medical costs associated with LBP and the indirect costs of disability and reduced productivity—the financial strain of LBP can be disastrous for individuals, employers, and society at large. Back pain costs an estimated $250 billion annually and leads to 264 million lost work days (almost half of all lost work days) per year in the U.S. alone.

Rehabilitation Is Essential for Low Back Pain Sufferers

Fortunately, LBP is the condition for which the greatest number of people stand to benefit from rehabilitation. According to the WHO, “Rehabilitation is essential to reassure people and help them make sense of their pain, help them return to activities they enjoy and identify strategies to support recovery and improve function.” This is the case at all stages and for all types of LBP—whether acute or chronic, and whether specific (meaning the source of the pain can be identified) or non-specific (where the cause is unknown).

This goes to show that, while LBP is a huge problem globally, there is a clear path to relief for almost all who suffer from it—and that path is therapeutic exercise, in conjunction with education and behavioral interventions.

Barriers to Accessing In-Person Care

High-quality physical therapy (PT) based on therapeutic exercise is a very effective treatment for LBP. But it is only effective when patients can access it, afford it, and stick with it.

Unfortunately, in-clinic PT programs present some inherent limitations and scalability issues. For instance, patients and providers must be simultaneously available to meet one-on-one during regular business hours on a consistent basis. This can pose scheduling conflicts and require patients to miss work in order to receive care. Not to mention, the traditional PT system can entail long commutes to the clinic, long wait times to see a provider, and paying out of pocket or paying a copay for each visit.

The result? Many patients cannot access care in a timely fashion or at all. Of those who do begin a traditional PT program, 50% will drop out after just 4 sessions—which is nowhere near program completion. For chronic low back pain, PT typically starts with an 8-week program consisting of two or three sessions per week under the guidance of a physical therapist, followed by a long-term maintenance program that can be completed at home.

Digital Physical Therapy Breaks Down Barriers

In order to commit to a complete course of care, patients need convenient PT programs that fit their lifestyle and their budget. That’s where Sword’s digital PT program comes in.

Just like in-person PT, Sword’s program is primarily based on therapeutic exercise and is managed and monitored by a physical therapist. But unlike the traditional care model, digital PT allows patients to complete their sessions in their own homes and on their own time, without the therapist having to be present. This is made possible by a medical device that provides real-time feedback to the patient and relays biofeedback to the provider, as well as chat and video tools that enable providers and patients to form effective therapeutic relationships.

In other words, Sword’s digital PT program eliminates many of the accessibility concerns inherent to the traditional model—while also being more cost-effective. But the question has always been: Can digital and in-person PT programs yield comparable clinical outcomes when controlling for total treatment time?

Now, thanks to the Nature study, there is no question that Sword’s digital PT program is just as effective as the conventional PT model, in the same amount of treatment time. Not only that, but the study also suggests that LBP sufferers actually prefer Sword’s care model based on their greater engagement with it during the clinical trial.

For those suffering from LBP, this is excellent news. Digital musculoskeletal (MSK) solutions like Sword Health can reach people in rural areas and other provider deserts, as well as fit seamlessly into busy and/or unconventional schedules. Digital PT eliminates long waitlists to see providers, pricey copays, and cumbersome commutes. By reaching more people than ever, more conveniently than ever, digital PT is poised to free countless individuals from the physical, emotional, and financial toll of LBP.

Digital Physical Therapy Reduces Medical Spend

Employers, this news directly affects your bottom line. According to the CDC, about 40% of your employees live with back pain. That means that four in ten employees are not able to bring their best selves to work as they struggle with the physical and mental burden of being in pain.

The majority of employers (76%) say that MSK conditions, such as back pain, are the number one driver of their healthcare spend. Not only do employers pay for pain in the form of direct medical expenses—like the costly tests, imaging, and surgeries that are often prescribed for managing MSK pain, yet frequently fail to alleviate it— but there are also the indirect costs of sick/disability absences and reduced worker productivity to consider.

So, what is the best way to significantly reduce LBP within your employee population—and therefore significantly lower costs associated with it? Encourage your people to seek the least costly, least invasive, and most effective treatment available: Sword’s digital PT program. By incorporating Sword into your health benefits package, you can give your employees access to the most accessible, least costly PT model on the market. And you can do it with confidence knowing that it is just as effective as in-person PT.

To learn more about how the Nature study was designed and conducted, read this “Behind the Paper” profile written by Sword’s clinical team.