AI’s the limit

Technological advances such as the use of bioinformatics, machine learning and artificial intelligence to gather, analyse and interpret patient data have entered a golden era. 

While fears of some sci-fi dystopia abound, in reality physiotherapy is already using heath informatics technologies to identify problems, improve patient care and ensure physiotherapists use their skills where they are most needed.

Euan McComiskie the CSP’s health informatics lead says the CSP’s Physiotherapy Health Informatics Strategy (PHIS)¹ has been designed to showcase innovation and help physiotherapists understand how all aspects of health informatics can be used to improve and enhance their own practice and improve patient care.

He adds that the PHIS arose from an awareness of what physios were already doing at a local level.

‘The more we looked the more we realised the sheer volume of things going on out there,’ he explains.

‘We decided to see if we could make it easier for members to find out what was going on. The vision is that there will be a digital pathway for every single member – be it for the own personal practice, in a management role or on a wider operational level – even nationally. 

‘We can showcase successes so that it makes overcoming the next challenge a bit easier because we know the right people and know the problems, they had so we don’t make the same mistakes twice.’

The UK Digital Competency Framework for Allied Health Professionals,³ written by physio Christopher Tack and published by Health Education England is a UK-wide document, although there are now also digital capability frameworks for all of Ireland and one for NHS Wales. 

Euan says the frameworks have been designed to be a developmental and supportive tool that can enable all AHP staff to meet their digital potential. 

Physios can also use the NHS England Digital Skills Assessment Tool (DSAT)² an interactive online assessment tool that allows people to answer a set of questions to determine their current digital literacy levels and help identify areas of learning need. 

Once an individual has completed the self-assessment questionnaire, they will be directed to relevant learning resources to help them develop their skills in specific areas.

Spirometry innovation

Respiratory physiotherapist Helen Parrott is the director of clinical operations and evidence at NuvoAir, a digital health company which has worked with patients to develop software and self-monitoring tools to create remote monitoring and assessment services which support faster diagnosis and treatment for people with respiratory conditions. 

The NuvoAir service uses respiratory physiologists and home monitoring technology, including a handheld spirometer to assess lung function, and a specially designed sensor to track inhaler usage and technique. 

Patients follow their data on an app while NuvoAir provides referring NHS teams with access assessment reports, gaining longitudinal insights, and helping them to efficiently address care needs.

NuvoAir is collaborating with 17 NHS trusts to provide a remote respiratory assessment service designed to increase clinical capacity, reduce time to diagnosis, and support remote patient monitoring and management. 

Helen says that since 2018, NuvoAir has worked with over 40 NHS services, enabling NHS teams to remotely monitor respiratory patients offering assessments that help support treatment, diagnosis, or examining uncertain diagnoses.

Home assessment

‘Rather than bringing patients to a diagnostic hub or GP practice we carry out a virtual home assessment of lung health using phone, text and virtual coaching – we ask the patient to carry out spirometry four times per week, looking at symptoms and how much they use their inhalers,’ Helen says. 

A team of physiologists provide coaching on how to perform good quality spirometry offering the same experience a patient would expect to get in hospital. 

‘The benefit for patients is that they can have the assessment at home where they feel more comfortable, reducing the need to travel to the hospital or GP practice,’ Helen explains.

‘Our service helps clinicians to quickly confirm diagnoses, change treatments or refer to other services where needed.’
Patients can be referred from a GP or practice nurse or secondary care respiratory teams or specialist asthma services. 

‘Our clinical team supports patients to improve their digital capabilities. We help them get a better understanding of their own health and manage their health better. When they are unwell, they can get help faster, avoiding further deterioration or taking an unnecessary course of medication.

‘Over 40 clinical studies have demonstrated NuvoAir’s ability to produce high-quality data, obtain high patient satisfaction, and reduce both scheduled and emergency care.’

The digital physio

Finn Stevenson is the co-founder of Flok Health, a digital health company which uses physiotherapists, doctors, and AI to deliver bespoke back pain assessment and treatment programmes. But the 30-minute virtual appointments are delivered not by a human, but an AI engineered ‘digital physio’.

Finn, who studied medicine and musculoskeletal science, explains that the Flok treatment pathway starts with an appointment with its AI-powered digital doctor, who asks questions to triage each patient and assess the suitability of digital treatment.

‘If physiotherapy is likely to be effective for you, we’ll prescribe a series of weekly appointments with our digital physio,’ he says. ‘Each appointment is like a 30-minute video call, except our side of the call is created by our AI engine in real-time, just for you.’

Finn says patients can answer questions and the “digital physio” will respond live. ‘It’s a continuously generated personal video stream that looks and feels like a virtual appointment with a physiotherapist. It’s bespoke and real time, and there are no waiting lists.’

Flok’s system can generate more than a billion possible treatment combinations to create the most effective multidisciplinary regime for each patient.

The system contains two pieces of novel technology – a decision engine that uses feedback from patients to determine the best next steps, and a system for assembling and delivering custom video in real-time in what appears to be a continuous stream.

Finn says over 98.5 per cent of Flok’s patients have an entirely automated care pathway. ‘The other 1.5 per cent will have a call from one of our clinicians when the software has been unable to make a sufficiently confident decision unaided.’

Flok is regulated by the Care Quality Commission as a care provider and, as the software is a medical device, it is also regulated by the Medicines and Healthcare Products Regulatory Agency (MHRA).

‘We are tightly regulated as there are some severe conditions that could present as back problems,’ Finn says.

‘We also have a team of physiotherapists and doctors who are central to the design, development, and delivery of our service.’

Flok is carrying out trials with NHS commissioners and trusts providing community services. Patients can also pay or use medical insurance.

Finn feels AI physios could help slash NHS waiting times. ‘Back pain is very common, which makes it almost impossible for the NHS to deliver timely care at the required scale using traditional delivery models.’

Patients have been extremely enthusiastic and positive about interacting with an AI physio, Finn says, and he adds that an automated care pathway with several weekly appointments works out significantly cheaper than a single traditional MSK appointment.

So, should physios fear Flok? ‘Not at all,’ says Finn. ‘I see our role as being able to handle high volume routine care pathways and help cut NHS waiting lists and speed up patient access.

‘Physios are constrained by super long waiting lists and unmanageably high demand, and the population is getting older and heavier so there are more MSK problems – demand is not going away. We will free up physios to make the most of their expertise to be able to deal with more complex cases.

‘Flok has no waiting list, and the service is available 24 hours a day 365 days of the year – AI physios don’t get tired.’

Problem solvers

Euan McComiskie says the examples show how physiotherapy can use technology to drive better care. 

‘They demonstrate how the next generation of innovators have identified a problem and come up with a solution that improves patient care. It’s not come from the other direction – here is some shiny new bit of technology, how can we use it in practice, it’s arisen because physios have said ‘here is a problem with patient care how can we use digital technology to solve it?’  

He highlights the importance of patient collaboration. ‘Too often in the past we have ‘done’ health to people and that will have limited impact. These solutions have been developed by asking patients what they want; what do they need from people providing their care and the success is clear to see.’