This Week in Musculoskeletal Science: Weather, Wallets, Workflows & Wellness

This week’s collection of research takes a wide-angle look at how various external factors—ranging from climate and cost to clinical decision-making and psychological readiness—influence physical therapy outcomes across the globe. These five studies offer timely insights for clinicians, policymakers, and healthcare innovators working to modernize musculoskeletal care in a way that is more human-centered, equitable, and effective.

Monday: When the Weather Decides If Patients Show Up

In a Taiwanese study by Wu et al. (2022), researchers explored how weather conditions impact the use of physical therapy in patients with osteoarthritis. Using over a decade of insurance and climate data, they found that higher temperatures were associated with increased physical therapy utilization, while colder conditions dampened visit frequency. Humidity and temperature fluctuations had dual effects—supporting access in warm weather, hindering it in cold.

This study reminds us that environmental conditions influence healthcare behavior. When planning for equitable access to care, physical therapy providers and health systems must consider seasonal strategies such as telehealth, flexible scheduling, and location-specific outreach.

Tuesday: Paying More, Moving Less—How Copayments Skew First-Line Care

Jin et al. (2024) analyzed how insurance copayments influence whether and when patients with newly diagnosed low back pain access physical therapy versus opioid prescriptions. Higher physical therapy copayments were strongly linked to delayed initiation and reduced frequency of physical therapy services, and those patients were more likely to start opioid treatment earlier.

Conversely, higher opioid copayments drove patients toward physical therapy, indicating that out-of-pocket cost is a major lever influencing clinical decisions. In a time when the healthcare industry is working to combat opioid misuse, this study makes a strong case for insurance reforms that remove financial barriers to conservative, guideline-recommended care.

Wednesday: Not All Physical Therapy Is Equal—Treatment Type Drives Outcomes

Farrokhi et al. (2024) examined outcomes for patients receiving different types of physical therapy interventions for low back pain in a military health system. Active treatments (like exercise) were associated with lower rates of opioid prescriptions, spinal injections, and hospital visits, while passive interventions (like traction and hot packs) were linked to higher overall healthcare utilization.

Manual therapy showed promise when combined with active care, but mechanical traction stood out as the least effective approach, associated with a 220% increase in specialty referrals. These findings support the longstanding principle that engagement-based therapy—not passive treatment—is the cornerstone of successful musculoskeletal care.

Thursday: The Mind Behind the Pain—Why Screening for Yellow Flags Matters

Despite clear evidence linking psychological distress to poor musculoskeletal outcomes, screening remains rare in orthopedic settings. Lentz et al. (2016) developed a brief, high-accuracy tool to help physical therapists identify “yellow flags”—psychological risk factors such as fear-avoidance, depression, and low resilience. The 17-item tool—and its shorter 10- and 7-item versions—predicted elevated pain and disability risk across body regions, with over 75–85% classification accuracy.

This tool enables more precise and personalized care, helping physical therapists tailor interventions to patients' cognitive-emotional profiles and prevent chronic pain trajectories before they start.

Friday: Can Prehabilitation Improve Total Knee Outcomes? Maybe.

Prehabilitation—targeted preoperative interventions—holds promise for improving surgical outcomes, particularly for patients at risk of poor recovery after total knee arthroplasty. But Karimijashni et al. (2025) found inconsistent and low-quality evidence in their systematic review. While exercise-based interventions had mixed results, non-exercise therapies (education, weight loss, psychological support) showed minimal impact.

This review calls for more standardized, evidence-based protocols that clearly define risk, select modifiable factors, and track long-term outcomes. As surgery volumes increase and patient complexity grows, refining prehabilitation approaches will be critical to better outcomes and lower postoperative costs.

Conclusion: Rehabilitation Is an Ecosystem, Not an Encounter

From climate and cost to clinician behavior and psychological readiness, this week’s research underscores that effective physical therapy doesn’t happen in isolation. It is influenced by a constellation of environmental, economic, and emotional factors. As we move toward value-based care and whole-person health, these insights point toward a more integrated, responsive model of musculoskeletal rehabilitation—one that adapts not only to evidence, but also to context.

Follow along each week as we bring you summaries and perspectives on the most impactful studies in physical therapy and musculoskeletal science.