Tamsin Starr looks at the digital advances improving outcomes and lowering the cost of care
The pandemic supercharged advances in healthcare tech. Being forced to deliver services remotely turned innovations into everyday tools and the physiotherapy workforce into tech entrepreneurs.
Digital transformation is at the heart of expanding ways patients can access services in both the NHS People Plan and the AHP Digital Framework. Experts such as physio Dr Andrew Kerr, therapy lead at the Sir Jules Thorn Centre for Co-Creation of Rehabilitation Technology at Strathclyde University, says therapists can continue to be at the forefront of change. ‘We have to embrace innovation,’ he says.
Physios are needed to prescribe and supervise the use of tech, to be the personal instructor showing patients how to use it, then reviewing and adapting programmes to move patients on. Though studies show physios have mixed views on adopting tech, Kerr believes fear should not block progress. ‘No tech, even artificial intelligence (AI), will ever improve on humans but as physios our resources are limited, and we can only do so much.
And he insists progress can be achieved in an inclusive way. ‘We always keep people who may be digitally excluded in mind,’ he says. So instead of million-pound robotics, Kerr has been inventing spring-loaded rehab devices for a fraction of the cost, which clamp onto the kitchen table. ‘We want to deploy tech in homes, care homes or leisure centres,’ he says.
The value of virtual consultations, the role of AI in physio and emerging tools for measuring patient outcomes and supporting self-management feature at this year’s Virtual Physio UK conference on 5-6 November.
Ahead of the conference, Frontline takes a look at what’s working in today’s tech and looks forward to the future of healthcare.
Fast forward physio
Wearable therapies, virtual reality rehab games and AI are taking healthcare in a new direction
The AI will see you now
AI has already led to significant advances in some areas of medicine. Possible uses include processing and triaging pelvic health service referrals by automatically interpreting text, triaging musculoskeletal referrals via statistical analysis of responses to questions, or automatically managing conditions such as breathlessness via a smart phone app.
The potential of AI to improve healthcare triage and decision-making by providing an automated, more efficient and standardised approach is hugely appealing, but critics question how safe, ethical, inclusive and holistic – you can hear the future of AI in physiotherapy debated at the CSP’s upcoming Virtual Physio UK conference.
You wear it well
Wearable tech now monitors more than your heart rate – remote sensors can detect whether a patient is doing their rehab exercises correctly. There are several products in development, including the Sana motion sensor-studded bandage that tracks knee rehab via an app that plays like a game, and Dr Kerr’s sit-to-stand trunk strap that helps patients adjust their balance and movement with feedback via a paired laptop.
Lower-limb rehab strap Re.flex is one of the first to market. Specialist physiotherapy lead Carys Hansed, who trialled it, says, ‘Reflex allows me to communicate daily with my patients, to see that they are doing what I want them to be doing, to modify and adapt their rehab programme in a timely and efficient way, and answer any questions.’
How do you stop patients dropping out of long-term rehab – or make repeating a movement hundreds or thousands of times interesting? Turn rehab into a computer game. Scoring rewards – and fun – prolong physical effort while mental challenges hone motor skills and promote neural plasticity, supporting the recovery of cognitive function.
Now rehab pioneers have moved on from using consumer games on motion consoles like Wii Fit to working with developers on rehab-specific games for virtual reality (VR) headsets and with industry on custom tech.
Salford’s Brain & Spinal Injury Centre (BASIC) has gone one step further by creating a VR suite for brain and spinal injury rehabilitation using systems like the Computer Assisted Rehabilitation Environment (CAREN).
Clients play balance and coordination games programmed by their physio on the CAREN’s moving platform, which responds to a virtual game environment on screens surrounding them.
The platform accommodates wheelchairs, though a harness allows clients to stand safely.
Rather than having to hear complicated instructions, the screen shows patients their movements – while they are sailing a boat with their hips and weight distribution, or kicking a football across a pitch – so they can adjust to achieve better scores.
Worked muscles light up on screen while sensors track range of motion – allowing the therapist to programme different routines to target different muscles. And the therapist can add mental arithmetic challenges to further stimulate cognitive function. They can even programme everyday scenarios so patients can practice crossing a busy street, climbing stairs or opening doors.
Results have been impressive. One patient in his 30s was in a wheelchair for two-and-a-half years after having a brain tumour then a stroke. He was told that walking safely on his own – even in his own home – would be impossible. But after 12 sessions on the CAREN he can walk with a quadstick within his own environment, and no longer uses his wheelchair to come into BASIC.
‘When he started his mood was low,’ says neuro-physiotherapist Sylvia Moss, manager of the Body Basic gym and VR suite. ‘By the end his confidence had grown, he felt safer as his balance improved – I was thrilled.’
Two stroke patients in their 70s, who had completed their NHS physio sessions, started their CAREN session in wheelchairs and finished up walking. Both achieved their rehab dream – one to be able to play golf and the other to say her prayers standing up.
‘Patients often say we’ve filled a gap – they’ve done their physio, been discharged and then feel abandoned, just left,’ says Sylvia. ‘Some are told they’ll never walk again and in two or three years, we’ve changed their lives.’
Pandemic tech boom
The profession turned to digital tools for remote consultations, prescribing and monitoring during the pandemic – with some inventing their own.
The pandemic forced a shift to remote delivery for many physios, and early studies show patients welcome the new option – a review of Near Me virtual consultations in Scotland recorded 91 per cent of patients as being either satisfied or very satisfied.
Exercises were prescribed via mobile phone apps, such as myrecovery that monitored progress via paired wearable fitness trackers, while some physios created their own desktop programmes.
Laura Pearson, clinical lead for Knowsley Community Pulmonary Rehabilitation Service, worked with the Innovation Agency and Rehab Guru to tailor an existing digital exercise prescription platform to meet the needs of chronic respiratory disease patients and clinicians.
‘All our community rehab centres closed during the pandemic and while home exercise plans were good, we were not sighted on how patients were progressing,’ Pearson says. ‘With the digital tool, we can tailor programmes to individual patient need, and the platform allows us to monitor patient outcomes and progression. We can review how many times a week the patient has completed their exercises, see their breathlessness score, pain levels and any written feedback they provide. Results improved.’
They will keep offering digital programmes post-pandemic, not least because it frees up physical classes for those needing more intensive support and one-to -one monitoring. ‘Expanding options makes rehab more widely available, supporting more patients and successful outcomes.’
There’s an app for that
Smartphone apps in the CSP app library – all designed and run by physios and clinicians – show just how far digital pioneers are pushing the platform.
We take a look at the top six.
- Living with Covid Recovery – developed with input from Barts Health NHS Trust and now used by 14 trusts, it tracks patients’ health and activity, producing a dashboard for their physios.
- GetUBetter – provides 24/7 self-management support for common MSK injuries and conditions using symptom checking, videos, exercises and outcome measures to drive recovery.
- Air MD: Professional Spirometry – this coaches patients on improving results from their AirNext spirometer and NuvoAir disposable turbine and sends reports to their physio.
- Mhealth – a group of apps that support patients to self-manage their conditions more effectively. There are condition-specific versions for asthma, COPD, diabetes and heart disease.
- Physitrack – this high-end app (pictured) manages all interactions with patients, allowing physios to send them exercise programmes, educational articles and videos, with outcome measures to chart progress.
- Phio – close to being adopted by NHS providers, this app uses AI to seem like a real physio to patient users. The ‘digital physio’ triages MSK issues, prescribing different levels of care according to symptoms.
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