ReLiva is a chain of physiotherapy clinics with 9 locations in Mumbai region. It is focused on reinventing physiotherapy and intends to soon offer its clinical expertise online through digital applications. This blog puts across my perspectives as the founder of ReLiva and as an engineer on the importance and need for this reinvention and in the course, answering why tele-physiotherapy (aka digital physiotherapy or tele-rehab) is a good thing for patients and practitioners and why should it be adopted with great enthusiasm.
This started when we noticed that a large number of corporate employees could not benefit from our clinical services due to their work hours and time scarcity. It was these clients who provided the initial inspiration to evaluate developing an online physiotherapy service. Also, it was heart breaking, especially in case of pediatric patients, to see many clients not being able to continue their physiotherapy treatment because of cost of services, cost of travel and cost of time (of their caregiver) needed to keep coming to the clinic.
When we started looking into tele-physio/ tele-rehab we realized that there is a large body of recent research which confirms validity and effectiveness of telerehab/ tele-physiotherapy. In these research, no material differences was found in clinical outcomes (between telerehab and face to face) for diverse conditions –post total knee replacement, stroke, multiple sclerosis, low back pain, cardiac rehab, knee osteoarthritis, COPD and others.
Agostini et al in their review1 concluded that “a strong positive effect was found for patients following orthopaedic surgery, suggesting that the increased intensity provided by telerehabilitation is a promising option to be offered to patients”
Tousignant et al conducted randomized controlled trials on 48 TKR patients and have found Telerehab was found comparable to usual face to face care not only in terms of clinical effectiveness, but also in terms of patient and therapist satisfaction.
Their paper2 concluded that Home telerehabilitation is at least as effective as usual care, and has the potential to increase access to therapy in areas with high speed Internet services
Another paper3 published their study on 1) patient satisfaction and perception of inhome telerehabilitation and 2) physiotherapists’ satisfaction toward technology and concluded that “As patient satisfaction is important in maintaining motivation and treatment complianceand the satisfaction of healthcare professionals must be high in order for new treatments to become mainstream in clinics, the results show that in-home telerehabilitation seems to be a promising alternative to traditional face-to-face treatments.”
In fact a study4 conducted in Nigeria, demonstrated that a six-week course of structured telephone calls thrice-weekly to patients at their home, to monitor self-administered osteoarthritis-specific exercises for patients with knee OA (i.e., tele-physiotherapy) achieved comparable results to physiotherapy conducted in the clinic.
Varnfield et al conducted a randomized controlled trial5 of cardiac rehabilitation (CR) on post myocardial infarction (MI) patients and concluded “This smartphone-based home care CR programme improved post-MI CR uptake, adherence and completion. The home-based CR programme was as effective in improving physiological and psychological health outcomes as traditional CR. CAP-CR is a viable option towards optimising use of CR services”
These studies and many others supported our conviction on remote delivery of physiotherapy care. Moreover, drawing from experiences at our clinics, there was a strong case for superior compliance by patients if the access to physiotherapy was made lot more convenient. As with any medical therapy, compliance by the patient to the treatment is responsible for a significant portion of the clinical outcomes. If patient’s compliance to treatment is improved by increasing convenience, clinical outcomes are bound to improve.
The core of physiotherapy is in prescribing and delivering “exercise as medicine” and as long as one can depend on the patient to be compliant and follow instructions, remote physiotherapy care could be equally effective clinically while being convenient, accessible and cost effective. A digital physiotherapy service would thus address all the three sides of ‘Iron Triangle of Health Care’ i.e. access, quality and cost.
For historical commercial reasons physiotherapy is now lot more associated with passive elements like electrotherapy, manual therapy and massages instead of the active core that is prescriptive exercises. These commercial reasons obviously increase patient’s dependence on the therapist and visits to the clinic. This has kept physiotherapy an expensive and inconvenient intervention and limited its reach, at least in India.
Now, in a more health conscious and aware world which is connected through internet, time has come to start delivering physiotherapy care online at scale and ReLiva aims to be at its forefront.