The state of digitalization in physiotherapy. What does the future hold?

Digitalization in physical therapy is starting to get many shapes and forms in all of the countries. The increasing number of Corona cases in recent weeks brought up more Romanian doctors requesting a convenient way when it comes to referring patients to physical therapy.
There are different types of digital solutions supporting this, but their differences need to be properly assessed. In 2020, an orthopedic doctor has the following options.

Apps with video exercises

There are many apps with video exercises. Most of them are covering the fitness training, but in the last couple of years an increase of applications for physical therapy was recorded.
In most cases, the home-exercise plan prescribed by the doctor is just an incentive that the clinics are offering for existing customers. Because the level of monitorization offered by the video apps is basic and the data collected are not entirely relevant to assess the progress of the rehabilitation, charging this service is close to impossible. This is a real business challenge for clinic owners and hospital managers.

One-on-one video sessions

The most time-consuming method of all, the one-on-one video session, offers a little more guarantees for patients than the app with video exercises because you can talk with the therapist directly. But the problems are on both ends. The physiotherapist needs to be able to separate from the clinical hours and have a premium internet connection. Patients most probably won’t agree with the hours, while switching to a more powerful internet connection is not convenient at all. Just like in the example above, certain services can’t be scaled without involving the HR department.
In 2020, the most successful clinic owners and hospital managers are looking for ways to profit from technology and better use the actual human resources, rather than experimenting with a solution that can’t be easily scaled.

Digital physiotherapy using wearable sensors

The innovation in technology opened a new way for orthopedic doctors and physiotherapists to treat their patients. Using digital solutions which include wearable technology, patients have a convenient way to access care. The level of assistance provided by the wearable solution is superior to other types of digital solutions mentioned above. For example, re.flex monitors 13 different parameters which help a clinician remotely assess the patient’s progress.
The data recorded during the physical therapy sessions is making the progress more transparent and patients are showing an increase of adherence.
Another key aspect when assessing the potential of a digital solution is its capability of integrating it into different areas of the patient’s pathway, creating positive and predictable outcomes. For example, doctors recommending re.flex are using the device before the surgery, for strengthening, after the surgery for rehabilitation and restoring normal function and later for prevention, in order to maintaing the results.

Challenges of the digitalization in Romania and the plans for a better future

Last week re.flex CEO and Co-Founder Camil Moldoveanu was invited in a webinar moderated by Elena Ovreviu, PhD in medical devices and Proffesor at the Politehnica University of Bucharest.
The other two guests were the President of eHealth department in the Romanian Ministry of Health, Dr. Stefan Busnatu and the owner of Centrokinetic and advisor in re.flex, Dr. Andrei Bogdan.

The main topic covered the digitalization from 3 different perspectives. The medical device industry, hospitals or clinics, and state authorities. In order for a digitalization program to be successfully implemented, these 3 pillars have to work together.
We will take all of them to digest.

State authorities

Dr. Stefan Busnatu was chosen to lead the Romanian Ministry of Health efforts to develop a framework for digitizing certain aspects of healthcare delivery and therefore increase the quality of the treatments.
The newly created department needs to develop a strategy which is set to be implemented in 2021-2027, together with other state authorities involved in public health.

“Our focus is to get a real system, which is aligned with the possibilities we have. Digitization in health is not a priority only in Romania, but worldwide. It is not only about the evolution of Covid19 cases, but also about the evolution of medical technology. I think that in 10-20 years, medicine will be completely changed for the better, thanks to technology “, said Dr. Stefan Busnatu.

Clinics and Hospital

Dr. Andrei Bogdan was the first doctor to prescribe digitally assisted physiotherapy with re.flex, when the team released the first version of the product.
He is the owner of Centrokinetic, a leading physiotherapy clinic located in Bucharest with 10000 new patients every year and a reputable orthopedic surgeon specialized in knee conditions.

“In Romania, an orthopedic patient can only access two weeks of physical therapy from the public reimbursement policy. But the easiest protocol in our clinic is 6 weeks, for minor injuries. For patients recovering after surgery for example, the protocol is 12-18 weeks of physical therapy. There is simply not enough reimbursement to treat these patients.  We’ve noticed that the large majority of patients are suffering from job-related musculoskeletal conditions. We try to do everything to help them get on their feet, but it is hard for them to maintain the results they achieve in the clinic. This is why they come back, and this is good for the clinic, but not for the country. In Romania we don’t have a nationwide program to help people in this matter”, said Dr. Andrei Bogdan.


Medtech companies

Camil Moldoveanu talked about the different challenges that a medtech company has to overcome in order to deliver the relevant studies for the medical community and how difficult it was for re.flex to convince the orthopedic doctors in Romania to use the solution.
“At first we only had Dr. Andrei Bogdan using the solution because nobody was comfortable with the risk involved when introducing a new solution. But now we are working with many doctors and we are happy with the progress.
The main obstacle was the clinical studies that had to be done and the awareness over the solution. Finding the right University partners and building the evidence together is of the essence for any medtech startup”

“re.flex has released two main products. The first one includes the post-operative protocols, covering a wide range of knee&hip surgeries while the other is targeting patients with gonarthrosis.
The product for gonarthrosis makes the patient be less dependent on human interactions, focusing more on the drivers which creates positive adherence and outcomes.
In Germany, we started to validate the knee OA protocol with Tubingen University. After we finish, all German patients will use the same protocol with around 100 exercises. ”, said Camil Moldoveanu.

During the webinar, Camil announced a new partnership between re.flex and one of the largest private insurance companies. However, the name was not publicly released yet.

re.flex is on a mission to digitize the physical therapy treatment. Want to learn more? Say the first hello at 
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