Strategies to Increase Patients' Adherence to Digital Therapeutics for Musculoskeletal Diseases: A Narrative Review

Abstract

Digital therapeutics (DTx) are a promising intervention for musculoskeletal diseases. However, real-world adherence remains low despite their established clinical efficacy and safety. This study analyzed the factors influencing patient adherence to DTx from four perspectives-DTx-related characteristics, patient-related factors, medical professional-related factors, and health system-related factors-and proposed an actionable strategic framework for each stakeholder group. A comprehensive literature search of PubMed and Google Scholar (January 2014 to December 2024) identified 45 eligible references on adherence to DTx for musculoskeletal diseases, including systematic reviews, randomized controlled trials, case-control studies, and other relevant publications. Key DTx features that affect adherence include demonstrated efficacy and safety, personalization, user-friendly interface design, gamification, reward systems, feedback mechanisms, and technical reliability. Patient-related factors included demographic characteristics, disease type and severity, and digital health literacy. Factors related to medical professionals included their perception of and preference for DTx as well as patient education and training efforts. Health system-related factors included regulatory frameworks, infrastructure, and accessibility. Based on these findings, we developed a strategic framework illustrating how developers, patients, physicians, and health system-level stakeholders can collaborate to improve adherence. These insights may serve as a valuable resource for promoting the adoption and widespread implementation of DTx.