The story of our first #champion patient – remote recovery after ACL reconstruction

From an idea formulated in a research paper and all the way to a product, you have to follow a long road and dive deep into the unknown.
The process of creating a design for a wearable product that can be successfully used by patients after an orthopedic incident is one of the hardest tasks;
Even harder than you might imagine right now when you are reading.
Orthopedic physiotherapy is a very “customized” experience, so does the product needs to be.

In order for re.flex to become reality, we dedicated our time in understanding the needs of all the parties that are involved in the orthopaedic episodes (patients, physiotherapists, owners and insurers) and in improving their experience, so that in the end to make it possible possible to bring into the lights a transparent reimbursement process.

This is a large plan and we started with the most important part of all: telerehabilitation for the patient point of view.

We have put a lot of effort in creating a product that can be easily used by patients of almost all ages and which can offer a pleasant experience during the exercise sessions, this being one of our primary goals.
Later on, we focused on working with our product in clinics and in our patients’ homes.

The first “baby steps”

We’ve tested re.flex for one year in a controlled environment, in order to understand how different types of patients interact with the system and also to identify what makes them feel motivated to complete their recovery.

These tests were conducted in a busy physiotherapy clinic, under the guidance of our own physiotherapist, Alex Ivan, who worked for 5 years in a public hospital and who has an extensive experience in designing recovery protocols.

Alex is highly passionate about technology and with great communication skills towards his patients. Alongside another physiotherapist who recently joined our team, Calin, and with the help of Centrokinetic’s specialists, they have monitored the activity developed by the participants in our first testing stage;

The Centrokinetic team is located in Bucharest and thus, it was very simple to collaborate in this project, not only due to close geographic proximity, but also because they wanted to be part of our mission to innovate the industry.
During the pilot tests, approximately 100 patients had their recovery monitored by our product.

We’ve built the first user requirements documents and saw how the different types of patients managed to find their own reasons and motivation to use the device.
Some liked the idea of having the degrees shown on their screen during the exercises, while others were happy to see that they got a good grade when they performed a repetition in a correct way.

First time with remote patients

Our clinic stage ended in success, with our team understanding to great details all the steps that are needed in the physiotherapy recovery process.
Besides this, we also gained in-depth knowledge on the issues the patients had in understanding their prescribed exercises and decided to enter the next stage.

This stage revolved around the idea of remote recovery exercises concluded by patients at home. The patients included in our second stage still participated at their physiotherapy appointments, in which the doctors monitored their physical recovery evolution, but the recovery exercises were concluded outside the clinic, with the assistance of Centrokinetic and with our orthopedic advisor, dr. Bogdan Andrei.
In order to make sure that this stage will run smoothly, we had to plan every single detail, so that our patients will be able to actually carry out their prescribed exercises; it was equally important for us to obtain accurate data on their recovery, as well as monitor their outcomes both on short and long term.

Another reason that motivated them to keep practicing was determined by the 3D visualization option and the “shadow” feature included in the app, which shows how the patient’s leg must be positioned and where it needs to be located at the end of the exercise (including the rhythm at which the patient must deliver the respective exercise). The 3D visualization method is very helpful in this sense, as the patients feeling pain during their exercises can’t usually receive an “instant reassurance” on the fact that they are actually doing what they are supposed to.remote patient monitoring for physiotherapy
During our study, we have also discovered that one of the main reasons for which orthopedic rehabilitation programs fail when performed at home, with no real supervision, is that patients are not sure that the prescribed exercises are completely necessary. For example, a set of exercises written down on paper or videos of persons delivering the same types of exercises fail to provide a real measure on how a patient is actually working.

Our study reflected that there are two main types of patients – those who are sufficiently motivated to conduct their exercises as needed, and those who gave up their recovery, which is a common practice amongst persons who have suffered a type of injury and seem to be recovered and thus, they lose their interest in performing “additional” exercises included in the recovery plan.
As a general rule, most of the patients included in our study were actually very interested in learning the features of our product and they tried to achieve as many goals as possible and obtain a high rank. Even though at the moment in which the study was running our engagement features were not completed, the results we had were above the expectations of our most pessimistic colleague, Andrei Vig, our iOS developer.

We’ve discovered our first re.flex champion

We have also learnt that the patients included in our second stage of the re.flex tests generally live far away from the clinics that provide the necessary equipment or specialized medical staff or, if they have a nearby clinic, it is usually a small one, which does not offer the necessary conditions for a proper physiotherapy rehabilitation program.

This was the case of one of our patients, Carmen.J., a 49 years old woman, who suffered a knee injury and had to travel to Bucharest for surgery, at Dr. Bogdan Andrei. Following the surgery, she has been prescribed with three months physiotherapy rehabilitation program.
As she did not live in Bucharest and in her home city there was no clinic specialized in this field, C.J. returned home and started the program by using the re.flex sensors.

With determination, and with the advice of the physiotherapy team working at Centrokinetic, C.J. completed in a correct manner her rehabilitation program, being one of the patients who had the most impressive results with the help of our product. She regained her full flexion in week 5 and her Oxford Knee Score after 12 weeks of treatment was 46.

“I wouldn’t have been able to achieve these results without re.flex. This device helped me in so many ways. I was motivated to train even in the days when I was tired because I knew that my therapist will know if I didn’t do the session. It’s a good feeling to see your leg moving on the screen and I was always looking to get high grades”, Carmen told us.

As she is definitely one of the persons who qualifies in the first category of patients mentioned above (determined to complete the recovery), C.J. would have easily completed her program in a clinic, provided that there were any suitable options in this sense at the moment when she suffered her injury.

Enable data collection in your clinic

As most of the patients who have to follow a physiotherapy rehabilitation program are prescribed with a longer exercise session outside the clinic (besides a shorter period of time – after the surgery or injury, when they are closely monitored by a physiotherapist in a clinic), using the smart assistant can be an appealing idea for both the patient and his or her physician, as both parties can gain a fast insight on the manner in which the prescribed program is evolving.

Due to this, numerous patients have expressed their interest in purchasing our sensors, but in our business model, we believe that we only facilitate certain physiotherapy rehabilitation mechanisms and our product will always need the supervision of a specialist in the field (a physiotherapist, a clinician) and thus, the re.flex product can’t be purchased individually by persons who need musculoskeletal rehabilitation (we have received on our website plenty of inquiries from patients) and the only safe way to use the sensors is by requesting them from our affiliated orthopedic physiotherapy clinics.

For 2019 we’ve booked few pilot tests with clinics and hospitals in 7 countries on 3 continents. There are only few places available for a specific profile of clinics. Interested to learn more?
Send us an email at

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