Remotely delivered physiotherapy for musculoskeletal conditions is cost saving for the health system and patients: economic evaluation of the REFORM randomised trial

Alison J Hayes; Hannah G Withers; Joanne V Glinsky; Jackie Chu; Matthew D Jennings; Ian Starkey; Rachel Parmeter; Max Boulos; Jackson J Cruwys; Kitty Duong; Ian Jordan; David Wong; San Trang; Maggie Duong; Hueiming Liu; Tara E Lambert; Joshua R Zadro; Catherine Sherrington; Christopher Maher; Barbara R Lucas; Deborah Taylor; Manuela L Ferreira; Lisa A Harvey

doi:10.1016/j.jphys.2025.06.006

Remotely delivered physiotherapy for musculoskeletal conditions is cost saving for the health system and patients: economic evaluation of the REFORM randomised trial

J Physiother. 2025 Jun 26:S1836-9553(25)00058-X. doi: 10.1016/j.jphys.2025.06.006. Online ahead of print.

Authors

Alison J Hayes¹, Hannah G Withers², Joanne V Glinsky², Jackie Chu², Matthew D Jennings³, Ian Starkey⁴, Rachel Parmeter⁴, Max Boulos⁵, Jackson J Cruwys⁵, Kitty Duong⁵, Ian Jordan⁶, David Wong⁷, San Trang⁸, Maggie Duong⁸, Hueiming Liu⁹, Tara E Lambert¹⁰, Joshua R Zadro¹¹, Catherine Sherrington¹¹, Christopher Maher¹², Barbara R Lucas¹⁰, Deborah Taylor¹⁰, Manuela L Ferreira¹³, Lisa A Harvey¹⁴

Affiliations

¹ School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
² John Walsh Centre for Rehabilitation Research, Kolling Institute, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
³ Allied Health, Liverpool Hospital, South Western Sydney Local Health District, Sydney, Australia.
⁴ Physiotherapy Department, Blacktown and Mt Druitt Hospitals, Sydney, Australia.
⁵ Physiotherapy Department, Campden and Campbelltown Hospital, Sydney, Australia.
⁶ Physiotherapy Department, Hornsby Ku-ring-gai Hospital, Sydney, Australia.
⁷ Physiotherapy Department, Liverpool Hospital, Sydney, Australia.
⁸ Physiotherapy Department, Bankstown-Lidcombe Hospital, Sydney, Australia.
⁹ The George Institute for Global Health, Faulty of Medicine and Health, University of Sydney, Sydney, Australia.
¹⁰ Physiotherapy Department, Royal North Shore Hospital, Sydney, Australia.
¹¹ Institute for Musculoskeletal Health, The University of Sydney, Sydney, Australia.
¹² School of Public Health, The University of Sydney, Sydney, Australia.
¹³ Sydney Musculoskeletal Health, School of Health Sciences, The University of Sydney, Sydney, Australia.
¹⁴ John Walsh Centre for Rehabilitation Research, Kolling Institute, Faculty of Medicine and Health, University of Sydney, Sydney, Australia. Electronic address: lisa.harvey@sydney.edu.au.

PMID: 40579312
DOI: 10.1016/j.jphys.2025.06.006

Abstract

Questions: Is remotely delivered physiotherapy cost saving when compared with usual face-to-face physiotherapy as typically provided in a public hospital outpatient setting? Is remotely delivered physiotherapy cost-effective?

Design: Economic evaluation embedded within a randomised controlled, non-inferiority trial using a health system plus patient perspective.

Participants: Patients with musculoskeletal conditions presenting to Sydney public hospitals for physiotherapy treatment.

Intervention: REFORM was a randomised controlled trial comparing remotely delivered physiotherapy with usual care provided in an outpatient setting. Remotely delivered physiotherapy involved one face-to-face physiotherapy session in conjunction with text messages, phone calls and an individualised exercise program delivered through an 'App'.

Outcome measures: The economic evaluation included the Patient Specific Functional Scale at 6 weeks in the cost-minimisation and cost-effectiveness analyses, and quality-adjusted life years (QALYs) at 26 weeks in the cost-utility analysis. Health system and patient resource use were derived from patient self-report.

Results: Costs per participant over 6 weeks were AUD $742 for remotely delivered physiotherapy and $910 for face-to-face physiotherapy, with a mean cost difference of -$168 (95% CI -$339 to $1). There was a 98% probability of remotely delivered physiotherapy being cost saving within the non-inferiority margin of the Patient Specific Functional Scale, and an 88% probability of being dominant to face-to-face physiotherapy (less costly and more effective). There was a 51% probability of being cost-effective at a nominal $50,000/QALY threshold.

Conclusion: Moving people with musculoskeletal conditions to a remote model of physiotherapy care is potentially cost saving for health systems and patients, without compromising health outcomes when compared with currently provided public hospital care.

Trial registration: ACTRN12619000065190.

Keywords: Cost-effectiveness; Economic evaluation; Musculoskeletal conditions; Rehabilitation; Telehealth.