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Review of 189 trials favors shockwave for frozen shoulder pain; CMS finalizes 2027 pay cut and remote monitoring limits
A BMJ network meta-analysis of 189 randomized trials found moderate-certainty evidence that extracorporeal shockwave therapy probably reduces short-term adhesive capsulitis pain compared with usual care. The Centers for Medicare & Medicaid Services (CMS) finalized the 2027 physician fee schedule, cutting the conversion factor and limiting remote therapeutic monitoring. Other studies addressed hybrid digital care for low back pain, the timing of physical therapy around lumbar stenosis surgery and supervised scoliosis exercise.
Read this week's roundup and its sources: https://physicianintheloop.org/specialties/physical-therapy/2026-11-01/
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The voices on this episode are generated by AI, and so is the script, from the week's specialty roundup at Physician in the Loop. Every fact in the roundup links to its source.
The week's innovation news in physical therapy for physical therapists, every Sunday in a few minutes: new technology, AI tools, devices, FDA decisions and new ways of delivering care. From the Specialties pages of Physician in the Loop, where every story links to its sources: physicianintheloop.org/specialties/physical-therapy/. Read by AI voices.
Voice 1: This is Physician in the Loop, the weekly physical therapy briefing, for November 1st to November 7th, 2026.
Voice 1: A new network meta-analysis in BMJ pooled 189 randomized trials with nearly 13,000 participants and 59 different treatments for frozen shoulder, and found moderate-certainty evidence that extracorporeal shockwave therapy probably eases short-term pain more than usual care.
Voice 2: How big was that pain difference, and did anything stand out for improving motion?
Voice 1: On a zero to ten pain scale, shockwave therapy lowered pain by about two points compared with usual care. Separately, manipulation under anesthesia combined with a steroid injection into the joint probably added about 33 degrees of short-term shoulder flexion.
Voice 2: Did the review say anything about how safe these treatments are?
Voice 1: The authors said adverse events weren’t widely reported across the trials, and that absence shouldn’t be read as evidence that the treatments are safe.
Voice 2: CMS finalized its 2027 physician fee schedule this week, cutting the conversion factor for clinicians outside qualifying alternative payment models to $32.63, about a 2% decrease.
Voice 1: What about clinicians who are in those qualifying models?
Voice 2: Their conversion factor is higher, at $32.95, which is also about a 2% decrease from this year.
Voice 1: Did anything change for remote therapeutic monitoring?
Voice 2: CMS limited remote therapeutic monitoring to established patients and now requires a separately reportable initiating visit. It also delayed, until January 1st, 2029, a rule that would require remote monitoring to be performed only by clinical staff employed by the practice.
Voice 1: A network meta-analysis in npj Digital Medicine pooled 56 reports from 46 studies and 6,717 participants, 80% of them with chronic low back pain, to test hybrid digital and in-person exercise programs.
Voice 2: How much did combining digital and in-person exercise reduce disability compared with doing nothing?
Voice 1: Compared with no intervention, combined digital and in-person exercise reduced short-term disability by about 16 points, and digital exercise paired with physiotherapy cut it by about 13 points.
Voice 2: Did it help with pain itself, or just disability?
Voice 1: The combined approach also lowered pain intensity by about two points, and the authors reported no serious adverse events.
Voice 2: A registry-based study followed nearly 8,000 patients who had surgery for lumbar spinal stenosis, comparing different physical therapy pathways around the operation.
Voice 1: How did the pathways compare at one year?
Voice 2: Patients who had physical therapy only before surgery had higher odds of reaching meaningful, acceptable outcomes at one year than those treated both before and after. Patients who had physical therapy only after surgery had higher pain intensity and worse gait function.
Voice 1: Did the authors draw a conclusion from that?
Voice 2: They said presurgery physical therapy may be worth considering, and that additional postsurgery physical therapy may not be warranted for everyone.
Voice 1: A randomized trial compared supervised Schroth-based exercise against self-directed exercise in braced adolescents with idiopathic scoliosis.
Voice 2: Did the supervised program slow the curve more?
Voice 1: At 24 months, supervised exercise reduced the major Cobb angle by about 3 more degrees than self-directed exercise, but that difference didn’t reach the study’s threshold for a clinically important difference.
Voice 2: Did it make a difference for quality of life?
Voice 1: The authors said radiological status didn’t differ significantly between groups, and there was no sustained, clinically meaningful quality of life benefit.
Voice 2: CMS finalized a separate rule this week, its 2027 home health payment rule, which it estimates will raise aggregate Medicare payments to home health agencies by about 2%, or $415 million, according to Home Health Care News.
Voice 1: Does the rule do anything besides raise the overall number?
Voice 2: It includes a temporary 3% downward adjustment to the national standardized payment rate, recalibrates the case-mix weights, updates functional impairment levels, and changes the Home Health Quality Reporting Program.
Voice 1: Sources and corrections are at physicianintheloop.org, where you can sign up for the free email briefing. This briefing was read by AI voices.