PAIN+ CPN

OBJECTIVE: Remote physiologic monitoring (RPM) and remote therapeutic monitoring (RTM) are growing digital health applications. The use of RPM, focusing on objective physiologic data, has been supported by evidence for managing chronic conditions. RTM, which collects subjective patient-reported data, is newer, but offers great potential in musculoskeletal (MSK) rehabilitation and chronic pain management that has already been recognized clinically and by reimbursement frameworks. However, in comparison with RPM, there is limited evidence directly assessing whether RTM contributes to improved clinical outcomes. This review compares the quality of current evidence for improved clinical outcomes from RTM in MSK and pain-related conditions with RPM in chronic disease management.

METHODS: A systematic search of PubMed, Scopus, and the Cochrane Library was conducted through March 2025 using keywords related to remote monitoring, digital health, and MSK conditions. Only reviews and meta-analyses were included for RPM, while both primary and review studies were considered for RTM, restricted to MSK or pain-related outcomes. Three reviewers independently screened and read all articles to reduce risk of bias.

RESULTS: 22 studies met inclusion criteria (9 RPM, 13 RTM). RPM reviews consistently demonstrated clinical benefits, including reduced blood pressure, HbA1c, and hospitalizations. Across RTM studies, feasibility, patient satisfaction, and engagement were consistently high, although studies were heterogeneous, with some yielding improved pain and activity levels, while others found no difference relative to usual care.

CONCLUSION: RTM consistently demonstrates strong feasibility and patient engagement in MSK rehabilitation and chronic pain management, though evidence for clinical superiority compared to standard care remains limited. Future studies should emphasize larger randomized trials with standardized functional outcomes, therapy adherence, and integration into rehabilitation and pain management workflows.

Rehab Clinician (OT/PT) rater

The decision not to conduct a qualitative assessment of the included studies due to the heterogeneity of the study designs is not justified, given that specific risk-of-bias assessment tools are available for each design. Mixing case series, RCTs, and systematic reviews is also questionable, and the lack of a quantitative summary greatly diminishes the relevance of the data provided.

Rehab Clinician (OT/PT) rater

Although this study demonstrates the potential efficacy of the Remote Therapeutic Monitoring (RTM) framework in managing musculoskeletal pain, it simultaneously highlights the current insufficiency of robust evidence. As noted in the article, the primary gap in existing research is the lack of high-quality studies directly comparing RTM with traditional follow-up methods. Furthermore, a point not addressed in this study is the extent to which cultural differences might influence the outcomes of digital health applications. In this regard, it is my contention that future research should also investigate the impact of cultural variables on the effectiveness and implementation of these monitoring systems.

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