Remote Monitoring Enhanced Outpatient Physical Therapy: A Mixed-Methods Implementation Study

BACKGROUND AND PURPOSE: Remote therapeutic monitoring uses technology to track physical activity and exercise. This study evaluates the implementation outcomes and effects of remote therapeutic monitoring on steps and exercise over 6 months. METHODS: Mixed-methods were used in this hybrid type 2 effectiveness implementation report in outpatients with Parkinson's disease, multiple sclerosis, stroke, concussion, post-COVID-fatigue, or musculoskeletal pain. Participants wore activity trackers synced to a mobile application. Clinicians evaluated activity, tailored goals, and performed clinical measures as part of their physical therapy. Effects were measured using daily steps and weekly aerobic exercise minutes. Implementation outcomes synthesized data from medical records, surveys, exit interviews, and meeting notes. RESULTS: Forty-two patient participants (mean age 56 ± 16 years; 55% female) enrolled in this study; 81% (n = 34) completed 6 months of monitoring. Fidelity to participant tracker use and clinician goal setting were high. Daily steps increased from 4892 ± 3694 to 5958 ± 4385, and weekly exercise from 44 ± 66 to 83 ± 85 minutes. Mixed effects models showed significant but decelerating improvements (steps: β = 87.5, P = 0.002; β2 = -2.4, P = 0.01; exercise: β = 3.6, P = 0.002; β2 = -0.1, P = 0.006). Participant interviews showed motivation and accountability drove engagement, while health and technology issues were barriers. DISCUSSION AND CONCLUSIONS: This first study of remote therapeutic monitoring of steps and exercise in physical therapy suggests therapist-supported monitoring is implementable and may enhance long-term physical activity and exercise participation.