Virtual physiotherapy can mean an exercise programme delivered through an app, regular care from a physical therapist, or monitoring between clinic appointments. Those models use similar screens for different jobs. A service that replaces some in-person care has a different clinical and financial comparison from one added to existing visits.
The Peterson Health Technology Institute’s assessment of US virtual musculoskeletal care provides a useful framework for separating them. Its 2024 evaluation, subsequently corrected in version 1.3, should be read as a dated evidence assessment rather than a live ranking of today’s products. Assessment and update history
Compare the service behind the exercise
Musculoskeletal, or MSK, care concerns muscles, bones, joints and related tissues. Within that broad area, PHTI groups virtual services by how technology and professional support are combined.
| Model in the assessment | Role of the virtual service | Relationship with clinic care |
|---|---|---|
| App-based exercise therapy | Delivers a structured exercise programme | Generally intended as an alternative to in-person care |
| Physical therapist-guided care | Combines digital exercises with therapist involvement | Generally intended as an alternative to in-person care |
| Remote therapeutic monitoring added to physiotherapy | Supports practice and monitoring between appointments | Supplements an existing course of in-person care |
The comparison concerns delivery models, not whether an app contains a camera, a sensor or an AI feature. Those features do not, on their own, establish the level of professional involvement. PHTI intervention definitions
For someone assessing a service, “therapist-supported” still leaves practical questions. Does the therapist assess the person, set the programme, review progress and change it? What happens between scheduled contacts? An exercise demonstration and an individual clinical assessment should not be treated as interchangeable simply because both appear on a phone.
Read the comparator before the conclusion
PHTI reported improvements in pain and function for the evaluated virtual approaches compared with usual care, which generally did not include physical therapy. Its assessment also identified therapist-guided services as a potentially effective alternative to in-person therapy. Those are different comparisons. Summary of findings
A result against care without physiotherapy does not establish superiority over a full course of clinic physiotherapy. Likewise, evidence for a structured programme cannot automatically support a different exercise library with less contact or a different patient population.
A 2025 review by authors affiliated with virtual-care provider ViewFi Health also highlights the difficulty of comparing varied digital programmes, alongside trial-design challenges and sponsor bias. Its abstract supports that methodological caution; it does not supply a head-to-head ranking of current services. Review abstract and affiliations
Replacing a visit and adding monitoring change the budget differently
In PHTI’s economic analysis, therapist-guided virtual care could reduce spending by providing an alternative to clinic care. Monitoring added between clinic visits introduces another service and cost. Its financial case therefore depends on what the additional support achieves, rather than on assuming the original visits disappear. Prices, payer arrangements and the population included affect the modelled result. Economic analysis
This distinction helps separate a programme’s evidence from its payment method. A reimbursable activity is not itself proof of improved function, and an improvement in function does not establish savings under every contract.
Access includes the ability to use the programme
US federal telehealth guidance asks providers to consider digital literacy, readable instructions, device access and alternatives for people who cannot use the technology. Being able to join a video call is one part of access; following and communicating about a programme is another. HHS practical guidance
The useful comparison consequently follows the whole course of care: assessment, professional contact, home practice, review and onward care. It also keeps the condition in view. Therapist-supported stroke rehabilitation is a separate evidence question; its findings cannot be imported into general joint and muscle care.