The case for Remote Physiotherapy — Background
This study was done as a part of the Interaction Gestaltung 4 module at the Hochschule für Gestaltung, Schwäbisch Gmünd, Germany under the guidance of Prof. Jonathan Bölz and Paul Käppler, with inputs from my guide in India, Prof. Jayesh Pillai, IDC IIT Bombay.
Introduction
Internet Technologies have a come a long way since the early 2000s. We are able to communicate via text, voice, images and even video in real time. While its usage has been limited by the general mass to chat and send memes, listen to songs and broadcast every moment of their lives to friends and family, it has undeniably allowed for growth and refinement of the technology. This growth has led to rapid advances in areas such as Internet of Things and has enabled us to control our homes and devices remotely.
Healthcare is an extremely rigid domain to revolutionise with internet technologies. What could be done easily with communication cannot be easily and swiftly replicated with Healthcare, given complexities such as incorrect diagnosis, delayed treatment and privacy concerns that can occur with reliance on internet based technologies. Healthcare has always relied on realtime feedback for proper diagnosis and treatment.
Physiotherapy is that part of the treatment that helps restore mobility to body parts that were previously injured or harmed. This is the part of the treatment that comes after the major injury has been technically cured. It is long drawn, intensive process which takes a lot of commitment from both the therapist and the patients side to ensure complete recovery. Enabling this recovery process to happen remotely will be beneficial to both the patient and the therapist. This is where internet technologies will play a huge role, bringing personalised care to each individual for a more efficient road to recovery.
What is Physiotherapy?
Physiotherapy is treatment to restore, maintain, and make the most of a patient’s mobility, function, and well-being. This is generally the part of the treatment that happens post the injury in order to help the patient rehabilitate and recover quickly. In the case of a fracture, the fixing of the broken bones would result in the patient being referred to as cured, but the treatment process often leaves the patient with a long road to full body recovery. This is where physiotherapy is needed to restore full function to the patient’s recovering limb. The duration of the treatment generally lasts 6 to 8 weeks, but in some cases, might require a life long follow up.
Physiotherapists help people affected by injury, illness or disability through movement and exercise, manual therapy, education and advice. They maintain health for people of all ages, helping patients to manage pain and prevent disease. The goal at the end is to ensure the patient can lead a healthy life without being dependant on external factors, such as pills and chronic care.
Types of Physiotherapy
- Cardiopulmonary: focus on helping individuals with cardio or pulmonary conditions such as heart attacks, pulmonary fibrosis, etc.
- Orthopaedic: focus on musculoskeletal system, joints tendons, ligaments, bones.
- Geriatric: focus on unique movement needs of older adults and treatment for diseases like arthritis, osteoporosis, etc.
- Neurological: focus on neurological conditions or impairments such as CP, Alzheimer’s, etc.
- Paediatric: focus on unique needs of infants, toddlers, children and adolescents.
The main focus for all the varied types of physiotherapy is to ensure the patient gains flexibility, coordination, strength, and ultimately, muscle build up.
Musculoskeletal, or Orthopaedic physiotherapy is the most common form of physiotherapy practiced. Sports injuries and ageing are the main contributors to musculoskeletal injuries, which is followed up by physiotherapy. Given this, I decided to focus on musculoskeletal physiotherapy and the procedures with regards to it.
Primary Research
The Primary Research was conducted by scheduling an interview with Dr. Sebastian Schulz at the University of Ulm Hospital. He is a sports scientist and works at the Sports Rehabilitation Centre. A questionnaire was prepared to understand the role of a physiotherapist in the recovery stage, and to understand the way a physiotherapist deals with the various injuries patients have suffered.
It was made clear that physiotherapy does not only deal with aiding the recovery of the injured part. It is a holistic rehabilitation of the body to ensure full fitness, but with a focus on building strength of the injured organ. For this reason, Dr.Schulz was skeptical of the idea of rehabilitating at home. But he did concede, that it is not necessary for the patient to see the therapist everyday.
Some of the other insights gathered from Dr.Schulz are:
- Patients lose motivation to continue with the exercises once they start to feel better.
- This abrupt stoppage in the physiotherapy many a times leads to lack of muscle build up which prevent the injury from being completely cured.
- There is lack of motivation in the beginning as well, since the patient is unable to see any progress being made.
- Exercises given to patients to do at home are generally easy to follow. Doing them incorrectly might not affect the recovery immediately, but it does affect long term rehabilitation.
While at the University of Ulm Hospital, we got a chance to speak to many people from the staff and to some of the patients. The staff informed us that at the sports rehabilitation centre, there are a many people who come in everyday with fractures and other injuries, and tending to them and to the patients undergoing physiotherapy is very stressful.
The patients on the other hand, many of whom were children, told us they did believe that physiotherapy was helping them and that they were following the schedules given by their therapists. But some of them who had been in physiotherapy for a long time said, truthfully, that they were getting bored of repeating exercises and would rather play games. Most of the older patients were of the opinion that an application would be beneficial in at least ensuring that they don’t forget to do the exercises and how to do them.
Based on all this information, a competitive analysis was done to see what the current solutions being implemented in the market are.
Market Research
There are tons of apps on the AppStore and PlayStore that cater to enabling physiotherapy from one’s home. There are some things that remain common between all the applications:
- All the applications list down exercises to be for pain in various body parts.
- Apps like Pocket Anatomy and Muscle Premium provide an anatomical description of along with a video of what the muscles are doing and how doing particular exercises will help.
- Apps like TherX and Shoulder Decide provide a more detailed video on how to do the exercise.
- Apps like PT Pal Pro and BlueJay PT allow for doctors to send the patient a list of recommended exercises via email or text.
Apps like PT Pal Pro and BlueJay PT are affiliated to certain physiotherapists and allow for usage only if registered by the physiotherapist. And while these are the only two applications that allow for remote communication with a therapist, they offer no way to measure how the exercise is being done. PT Pal Pro does offer a service through which the user can record the exercise and send it to their therapist, but one of the inferences from the primary research was that the therapists and staff at Physiotherapy Rehabilitation centres have very little time on their hand as the number of patients inbound is high.
All the apps that listed down all the possible exercises to do, had highly detailed graphics relating to where a certain injury might’ve been caused that was appreciated by all, but the common question from all potential users was whether it was necessary. It unnecessarily added to clutter, overwhelmed the user with large amounts of information and caused confusion.
With this background, the next step was to understand where I, as a designer, could intervene and improve the lives of the stakeholders.
