Background: Chronic lower back pain (CLBP) is a global health issue leading to significant disability and socioeconomic burden. Traditional treatments, including exercise and cognitive behavioral therapy (CBT), are often limited by physical and temporal constraints. This study aimed to evaluate the efficacy of multidisciplinary digital therapeutics (MORA Cure LBP) compared to conventional treatments. Methods: This multicenter, randomized, controlled pilot study enrolled 46 participants. Participants were randomly assigned in a 1:1 ratio to either a MORA Cure LBP group or control group, which received conventional treatment. Results: At eight weeks, both groups demonstrated improvements compared to baseline. No statistically significant differences were observed between the MORA Cure LBP and control groups in reductions in usual pain intensity (MORA Cure LBP: 3.1 ± 1.9 vs. control: 3.0 ± 1.5, p = 0.809), worst pain intensity (MORA Cure LBP: 5.00 ± 2.18 vs. control: 4.27 ± 1.83, p = 0.247), and functional disability (ODI, MORA Cure LBP: 15.6 ± 9.6 vs. control: 15.6 ± 10.0, p > 0.999). Compliance was significantly higher in the MORA Cure LBP group during the first 4 weeks (MORA Cure LBP: 74.7% ± 27.4 vs. control: 53.1% ± 28.6, p < 0.001). Conclusions: Both multidisciplinary digital therapeutics (MORA Cure LBP) and conventional treatments were effective in reducing pain and functional disability in patients with CLBP, with no significant differences between the two groups. Digital therapeutics, particularly those that integrate CBT and exercise, offer promising alternatives to conventional therapies by improving accessibility and potentially enhancing patient engagement.

Woo H, et al. J Korean Med Sci. 2022 Aug;37(34):e262. https://doi.org/10.3346/jkms.2022.37.e262

Background/Objectives: Accurate postural assessment is essential for managing musculoskeletal disorders; however, routine screening is often limited by radiation exposure, cost, and accessibility constraints of radiography. Recent advances in artificial intelligence (AI) have enabled automated, marker-free analysis using two-dimensional photographs. This study evaluated the validity and reliability of MORA Vu, an AI-based posture estimation software, against radiographic parameters. Methods: A prospective pilot study was conducted with 72 participants, divided equally into the cervical and lower-limb alignment groups. Forward head posture (FHP) and digital hip–knee–ankle (DHKA) angles were measured using MORA Vu and compared with corresponding radiographic parameters. Three healthcare professionals independently conducted the AI-based assessments. Correlations were analyzed, and interrater reliability was assessed using the intraclass correlation coefficient (ICC). Results: FHP showed the strongest correlation with the craniovertebral angle (r = −0.712) and C2–7 sagittal vertical axis (r = 0.704). The DHKA angle strongly correlated with the radiographic hip–knee–ankle angle (r = 0.754). Interrater reliability demonstrated high agreement (ICC: 0.84 FHP, 0.90 DHKA). Conclusions: MORA Vu demonstrated strong validity and high reliability, supporting its potential as a noninvasive screening tool for postural assessment. Given its accessibility and radiation-free nature, it may serve as a viable alternative for routine postural evaluation.

Background: Patellofemoral pain (PFP) is a common musculoskeletal disorder characterized by persistent knee pain, often without any structural abnormalities. Conservative treatments, particularly exercise therapy, are widely recommended; however, adherence remains generally low, and full recovery is often not achieved. Psychological interventions can aid in symptom management; however, studies integrating cognitive behavioral therapy (CBT), which is known to be effective for chronic pain, with exercise therapy for patients with PFP are limited. This study examined the impact of MORA Cure (PFP), a multidisciplinary digital therapeutics (DTx) app that integrates exercise and CBT, in comparison with conventional treatments for PFP management. Objective: This study aimed to evaluate the efficacy and safety of an 8-week DTx intervention incorporating exercise and CBT compared with in-person exercise education in patients with PFP. Methods: A parallel-group randomized controlled trial was conducted with 35 patients diagnosed with PFP recruited from orthopedic outpatient clinics. Participants were randomly assigned to either the DTx group (n=18, 51%) or the control group (n=17, 49%). The DTx group received an 8-week intervention via the MORA Cure (PFP) app incorporating home-based exercises and weekly CBT modules with daily worksheets. The control group received conventional treatment, including disease education, a single in-person exercise education session conducted by a medical professional, and encouragement to continue self-exercising throughout the study period. The outcome measures included pain severity (usual and worst, assessed using the numeric pain rating scale), functional disability (Anterior Knee Pain Scale), knee extension strength (measured using an isokinetic dynamometer), health-related quality of life (EQ-5D), and mental health status (9-item Patient Health Questionnaire). Assessments were conducted from baseline at 4-week intervals for up to 12 weeks. Results: The DTx group showed significant reductions in usual pain at each time point (4 weeks: mean score 2.2, SD 1.5, and P=.006; 8 weeks: mean 2.3, SD 1.7, and P=.003; 12 weeks: mean 1.2, SD 1.8, and P=.008), whereas the control group exhibited no changes. The knee extension strength in the DTx group increased significantly at both 8 and 12 weeks (P<.001), with greater improvement than that in the control group at 8 weeks (P=.04). Both groups showed significant improvements in functional disability at 12 weeks (DTx: mean score 85.2, SD 12.7, and P=.006; control: mean 84.5, SD 13.0, and P=.01). Health-related quality of life (EQ-5D) also improved in the DTx group at 8 and 12 weeks, whereas the control group showed improvement only at 12 weeks. Conclusions: This multidisciplinary DTx intervention was associated with significant pain reduction, improved functional disability, and increased knee extension strength in patients with PFP. These findings underscore the promise of DTx in PFP management and their potential to enhance patient outcomes. Trial Registration: ClinicalTrials.gov NCT05614583; https://clinicaltrials.gov/study/NCT05614583

Background: Although early mobilization has been shown to improve clinical outcomes after intensive care unit (ICU)-acquired weakness, its implementation remains limited in routine clinical practice. This study aimed to evaluate the feasibility, safety, and preliminary clinical outcomes of a mobile application-based rehabilitation program in non-ambulatory patients during the early ward phase following ICU discharge. Methods: This prospective single-arm pilot trial included adult patients (≥19 years) who had received ICU care and demonstrated limited ambulatory function, defined as Functional Ambulatory Category (FAC) ≤3. Participants received an individualized, application-guided exercise program comprising two daily sessions over two weeks. Primary outcomes were programmatic feasibility, safety, and patient satisfaction. Rehabilitation compliance was quantified using application usage logs and categorized as high (≥50%) or low (<50%). Secondary functional outcomes, such as Medical Research Council Sum Score (MRC-SS), ICU Mobility Scale, FAC, muscle strength measures, health-related quality of life, and pain scores, were assessed at baseline, week 1, and week 2. Results: Of the 25 initially enrolled patients, 5 dropped out due to clinical status changes or transfers, yielding a retention rate of 80.0%. For the 20 analyzed patients (mean age 52.7 ± 13.9 years; 45% male), the overall mean rehabilitation compliance was 40.6%. No serious adverse events related to the intervention were reported, and overall patient satisfaction and application usability were high. Progressive increases in exercise intensity and training levels were observed throughout the intervention period. Significant improvements over time were found in MRC-SS, ICU Mobility Scale, FAC, grip strength, health-related quality of life, and pain scores (all p < 0.05). Although compliance-based recovery trajectories were confounded by small subgroup sizes and baseline clinical imbalance, exploratory analyses nonetheless identified statistically significant time × compliance interaction effects for MRC-SS and straight leg raise performance. Conclusions: This pilot study demonstrates that a mobile application-based rehabilitation program is a feasible and safe approach to implement in deconditioned patients after ICU discharge. These preliminary functional recovery trajectories provide encouraging signals, suggesting that this digital platform may serve as a potential adjunct to conventional care. Rigorous, randomized controlled trials are required to confirm its definitive clinical efficacy and scalability.

Objectives To evaluate whether an 8-week smartphone-based multidisciplinary digital therapeutic (DTx) combining exercise and cognitive–behavioural therapy reduced usual knee pain at 8 weeks compared with education and exercise instruction in chronic patellofemoral pain (PFP). Methods This multicentre, parallel-group randomised controlled trial included 216 participants with chronic PFP, defined as anterior or retropatellar pain lasting at least 3 months with activity-related provocation, recruited from orthopaedic outpatient clinics at 10 hospitals in the Republic of Korea. Participants were randomly assigned to the DTx group (MORA Cure PFP) or a control group receiving PFP-related education, one-time exercise instruction, printed materials and self-monitoring exercise diaries. The DTx intervention included personalised home-based exercises, weekly cognitive–behavioural sessions and self-reflective daily worksheets. Outcomes were assessed at baseline, 4, 8 and 12 weeks. The primary endpoint was usual pain at 8 weeks, measured using a 0–100 mm visual analogue scale (VAS). Secondary outcomes included worst pain, knee function (Anterior Knee Pain Scale; AKPS), health-related quality of life assessed using the 5-level EQ-5D version (EQ-5D-5L) and the EQ visual analogue scale (EQ VAS), and psychological distress (Patient Health Questionnaire-9 and Pain Catastrophizing Scale (PCS)). Longitudinal changes were analysed using linear mixed-effects models. Results For the primary endpoint, usual pain at week 8 favoured the DTx group (between-group mean difference −12.5 mm, 95% CI −17.1 to −7.8). Secondary outcomes at week 8 also favoured the DTx group, including worst pain (−10.7 mm, 95% CI −15.9 to −5.4), knee function (AKPS, 5.2 points, 95% CI 2.7 to 7.7), health-related quality of life (EQ VAS 10.7 points, 95% CI 7.1 to 14.4) and pain catastrophising (PCS, −1.8 points, 95% CI −3.3 to −0.3). Exercise adherence exceeded 80%, with no device-related or intervention-related serious adverse events reported. Conclusion An 8-week smartphone-based multidisciplinary DTx programme reduced usual pain at 8 weeks compared with education and exercise instruction in patients with chronic PFP, with improvements in pain, knee function, health-related quality of life and psychological outcomes. These findings support the potential role of an integrated DTx package for delivering exercise and cognitive–behavioural support in PFP care. Trial registration number NCT06260865.