A few weeks ago, we discussed the current state of affairs regarding the opioid epidemic. At that time, we shared some grim numbers along with some hopeful steps being taken to tackle it. This time, we're addressing the connection between musculoskeletal disorders and opioids.

Musculoskeletal pain and opioids: the hows and whys

Musculoskeletal disorders (or MSDs) are injuries or disorders that affect the human body’s movement or musculoskeletal system, causing recurring pain, stiffness or swelling. The most commonly affected areas of the body are the back, neck, shoulders, hip, and knees. When we talk about chronic low back pain or chronic shoulder pain, we’re usually talking about an MSD. Many MSDs are work-related or at least worsened by work. Opioids have long been a standard, go-to option to treat MSDs. But given the current circumstances, doctors are becoming increasingly cautious when prescribing them. Even the Center for Disease Control and Prevention has issued guidelines to help Health professionals decide whether or not chronic pain patients might require opioid treatment. Given opioids’ high addiction rates, keeping people from beginning to take them unless absolutely mandatory may prevent many future deaths. This sounds like a good strategy since their very real toll on populations has been unraveling before our eyes for years now. However, the most baffling piece of information regarding opioids and its use to treat chronic pain is that opioids are not even a recommended approach to hand these affections. In fact, specialists recently came to the conclusion that “NSAIDs and opioids reduce pain in the short-term, but the effect size is modest, and the potential for adverse effects need careful consideration.”. What this study does recommend as the best way to address back and joint pain is a combination of physical therapy and behavioral intervention.

Sorting what's wrong with conventional physical therapy

Being the favored solution to treat MSDs, it may come as odd that under 10% of people engage in physical therapy when their doctors prescribe it. But it’s fairly easy to understand why: the hassle to get to a physical therapy center, most likely at inconvenient times, and the time spent in the waiting room make most people opt out. To solve the inconvenience associated with physical therapy, we at SWORD Health have developed a new approach to it: the Digital Therapist. By bringing physical therapy to the patients’ home, we have eliminated the hassle factor that causes people to reject physical therapy. By allowing for real-time remote monitoring, assessment, and communication via a human clinical team comprised of doctors and physical therapists, we make understanding the patients’ evolution and troubleshooting seamless and immediate. But, most importantly, by delivering a therapy solution that is clinically proven to be even more effective than conventional physical therapy, we are ensuring patients reduce pain by 74%, enabling people to have a better quality of life while keeping opioids at bay.

If you would like more information on how we can help you reduce your workforce’s burden with MSDs, reach out to our Strategic Business Development team.

Monica is a P.E. teacher and an all-around fan of sports. She’s the kind of person that can’t just stand still: she fidgets around all the time, like a runner at the starting line waiting for the whistle to be blown. Given her connection to sports, Monica had already had physical therapy a few times. She is a knowledgeable user of physical therapy, for good and for bad. When she hurt her shoulder on a car accident and had to undergo surgery, she knew what she was up to.  

From disbelief to relief

After surgery, Monica was in a lot of pain and she had to hold her arm still. “The physical therapy center was a few miles away from home, and I would never step into the bus or the subway with my arm hurting like that.” Then her doctor told her about SWORD Digital Therapist. “At first I found it odd: I was used to conventional physical therapy, so I thought an approach like this could never work. But then I tried it and I figured it was really cool.” Monica says that the most significant difference for her is the fact she is continuously monitored, “the evolution is completely different.” Furthermore, she quickly understood that the exercises she had to perform brought some relief to her pain. “Sometimes I couldn’t sleep because of the pain, so I got up at ungodly hours and started exercising (...) The best part of my day was the therapy; it actually relieved my pain”.  

Laughing her way through recovery

Monica has just finished her physical therapy program. The first thing she asks about when we visit her for this interview is the physical therapists that accompanied her during her recovery with the Digital Therapist: “How are they doing? I have to invite them over for dinner”. Her relationship with the physical therapists that monitored her recovery was unique. Monica took the Digital Therapist with her on vacations and sent over pictures of her having therapy by the pool. At a certain point, one of her prescribed exercises required her to lift weights. She once used a bottle of wine as a weight and sent a picture to her mildly astonished but utterly amused physical therapists. Life is slowly going back to normal, Monica has just rejoined her indoor football team, and she went back to walking her huge, lively dogs. She’s catching up with her life. Her initial expectations for the Digital Therapist were quite low: “I thought I was just going to play with a tablet.” Her opinion about it has changed a lot in the past few weeks: “This is unlike anything I have ever tried. And believe me, I should know, I have tried everything."

Over the past years, our entire team has been working relentlessly to get to the findings we are now very proud to share with you: patients recovering with our Digital Therapist at home under remote supervision of our clinical teams recover faster and better than patients resorting to conventional physical therapy. Not only that, the benefits of our combined human+machine physical therapy solution are longer lasting than those presented in traditional physical therapy. Forbes explained the motivation behind our research very sagely: An AI physical therapist guides patients through a number of exercises, using the trackers to give feedback in real time (...). The exercises are set by a remote team of human clinicians, who’ll check in periodically, and they’re covered by a number of insurance companies worldwide. (...) But pretty much everyone is doing something “AI” these days, so the real test of its effectiveness is the patient data. It’s looking good. The fact is, when it comes to the Digital Therapist, clinical validation is not a mere formality. That is why our teams are continuously assessing its effectiveness and why we always have ongoing studies to objectively discern what benefits we are bringing to patients.

The Digital Therapist is faster and overall more effective

In the first study, published in Nature Scientific Reports journal, we compared two groups of patients that had undergone knee surgery during their eight-week recovery. The first group used the Digital Therapist to perform physical therapy at home, and the second group used conventional physical therapy. Results showed the group using SWORD’s Digital Therapist improved twice as much than the conventional physical therapy group in the test that objectively measured their recovery (Timed Up and Go test). The same results surfaced for the subjective, patient-reported quality of life assessment regarding the existence of symptoms or pain and the ability to perform activities of daily living.

SWORD’s Digital Therapist shows longer lasting benefits

The second study was published in the Journal of Medical Internet Research, the leading Health Informatics journal, and aimed at proving the Digital Therapist's medium and long-term superiority. The article demonstrates that the benefits shown in the group using SWORD's Digital Therapist were maintained three and six months after surgery, without additional treatment beyond the 8-week program. The results apply to objective performance measures and also to subjective scales of pain, quality of life and ability to perform daily activities. This article proves that the Digital Therapist is a reliable long-term solution since its benefits do not fade over time.

The future of physical therapy

"These findings prove SWORD Health's innovative approach is the future of physical therapy," said our CEO, Virgílio Bento. "We are not just dramatically reducing costs for physical therapy. We are proving to be a better, faster, and tremendously more convenient approach to physical therapy that enables patients to recover at home." Bento also points out that "Demand for physical therapy is rising around the world yet, for the vast majority of people, the therapy they need, in terms of quality and intensity, is out of reach." Our Chief Medical Officer, Fernando Correia, is "very pleased to finally prove that patients can access effective treatment without leaving their own houses, with sustained benefits over time. Ours is a life-changing approach to physical therapy, and we are looking forward to making it accessible to more and more patients all over the world."

This article was featured in The Next Web

It’s been more than 20 years since Garry Kasparov lost his famous chess match against IBM’s Deep Blue, which heralded much anxious commentary about how humanity was soon to be subjugated by the superior processing power of supercomputers. Two decades later and our cultural understanding of AI can feel like it’s still stuck in the nineties. Videos of increasingly agile robots from Boston Dynamics steal headlines about the AI-apocalypse, while AI’s application in other industries can be all but ignored by the mainstream. However, amid all the worry about AI taking jobs, there’s little informed debate and nowhere is this more true than in healthcare. As far as the public perception of AI and health, we have struggled to move beyond the idea of robot doctors. The reality of AI’s likely influence in health is more nuanced and, I’d argue, more exciting. The healthcare sector is already a key battleground in the coming AI revolution, with the AI health market expected to reach $6.6 billion by 2021. Jeff Bezos, Warren Buffett and Jamie Dimon have entered the market with much media attention, but can AI deliver the cost savings they seek while maintaining equal or better patient outcomes?

AI in Healthcare: Strengths and Limitations

It’s worth remembering that AI is a collection of different technologies, which together represent a real opportunity to improve efficiency in administrative and clinical healthcare practices. Take Moorfields Eye Hospital in London, the hospital has teamed up with Google DeepMind to greatly increase the detail at which they’re able to analyze retinal scans, opening up the potential for earlier diagnosis and cures of otherwise debilitating conditions. Meanwhile companies like BenevolentAI are using AI technology very differently, to rapidly accelerate the process of drug discovery. At the other end of the scale, AI-driven chatbot technology is being used by Babylon Health to ease the burden on the UK’s National Health Service by offering basic diagnoses and appointment scheduling through smartphone apps. But Babylon is a case in point of AI’s weaknesses as well as its strengths: the app got into trouble recently after finding that some users have been ‘overplaying’ their symptoms in order to get appointments faster. This cuts to a key weakness of AI in healthcare: while it’s great for analysis and research, healthcare still needs a human touch. How can we reconcile these two conflicting directions?

Lessons from Chess

The key is in finding the right balance, and, as unlikely as it sounds, there are lessons from chess. After Garry Kasparov’s infamous defeat against IBM’s Deep Blue, he went on to consider the possibilities offered by playing chess in partnership with computers rather than against them. Rather than admitting defeat, he invented a new form of the game, called Advanced Chess, where a human and AI work together. The brute force analysis of the computer system together with the more strategic thinking of the human player has taken the game to heights of skill never seen before, and it’s now an active sport around the world. We need a similar approach in healthcare. It’s overly simplistic to see AI technologies and human medical professionals as opposed to each other in a battle over jobs. What matters most is patient outcomes, and a combination of strong AI-led analysis with a human context has the potential to deliver massive improvements. While machine learning scanning technology is able to detect microscopic lesions or tumors on scans better than the human eye, this on its own is not enough. Healthcare is a multidisciplinary practice, requiring social, behavioral, and contextual information from the patient in order for the physician to make an informed decision about possible treatment.

The one-to-many relationship

What does the future look like? I believe it starts with rethinking how we view the doctor-patient relationship. This relationship, at the foundation of modern medical practice, has traditionally been thought of as one-to-one, and this has to change. Our populations are aging around the world, putting pressure on healthcare budgets to deliver a quality standard of care. The one-to-one doctor-patient relationship is no longer sustainable. Instead we should look to AI, machine learning, and modern communications technology to distribute physicians’ time more efficiently. Clinical teams can be augmented with AI technologies to automate more repetitive or non-critical tasks, such as supervising exercises, or analyzing test results. Rather than leading to job losses, this would free up more time for doctors and therapists to focus on delivering the unique value they have to offer. Our healthcare future is bright, and it doesn’t involve robot doctors. Instead, we’ll see more patients assigned to a single doctor or physician, and technology will enable that one-to-many relationship to happen without significantly impeding on quality of care.

Antonio runs a busy life. When we called him for a 6 pm interview, he asked if we could make it quick because he had to leave for work. António is a waste collector, and heavy jobs like his don’t comply with nine-to-five schedules. Antonio spends his nights hopping on and off a garbage truck, so things looked quite dim when he had to undergo knee surgery. Antonio relies on his knees to perform his job quickly and effectively, up and down from the truck again and again for eight hours in a row. On top of that, Antonio lives 30 miles away from the physical therapy center he was supposed to attend. “The insurance company would cover the costs, but I would still have to go back and forth, I’d easily spend three hours a day for one therapy session.” Antonio didn't want to waste his precious time, so he decided to use it more wisely. As he puts it himself "I could take the time it would take me to have just one session in a traditional therapy facility and have three physical therapy sessions with the Digital Therapist.

"It was way better than traditional physical therapy"

Antonio is the ultimate SWORD Health champion: he had sessions on Christmas Eve, Christmas Day, and New Year’s Eve. We talked to Antonio almost one year after he started treatment and he is assertive: “It was way better than traditional physical therapy. Even now, almost a year after I finished treatment, I am pretty sure it wouldn’t have gone better. I could have therapy more times, at home, I didn’t have to move around.” Antonio is not a tech-savvy guy, but when we warily wondered about how easy it was for him to adapt to this tech-driven approach to physical therapy, he laughed and quickly said “I had no problem at all, it was easy to use. (...) I didn’t feel the need for more support from the physical therapists. The device was built to replicate their presence, and they could adjust the sessions whenever they needed.” Thrilled as we were to learn that, we wanted to know if the recovery process ever got lonely. Antonio’s quick answer is reassuring: “I felt [my physical therapists'] guidance throughout the entire process, they were and still are available," even almost one year after the treatment came to an end. It must really be the case because running, the hobby Antonio had dropped after knee surgery, is slowly being picked up under their guidance: “They advised me not to rush it, so I’m taking it slow, but I’m back on the running track.”

Think of the stock photo version of a physical therapist. The kind smile, the reassuring eyes, the trustworthy expression - that’s Sara. Sara left her family, her hometown, and 10 years of work behind her to join our team because “I had been working within the pattern for many years and I realized that was not enough for me. SWORD is bold and I needed boldness in my life”. Sara can’t stand still: she recruits and trains our Physical Therapy teams in the field and launches SWORD Therapy’s clinical operation within partner institutions. Nonetheless, she still manages to fit patient sessions into her tight schedule because “my patients are my people”. Having Sara with us is a product of sheer chance. When she was working at a physical therapy center, one of her patients wanted to complement the traditional Physical Therapy he was having with SWORD Therapy. Sara wanted to be there for her patient’s first session and when the session started she couldn’t believe what she was seeing: “I couldn’t mask my awe. I was there as a spectator, but I couldn’t help but say “This is it. This is exactly what needs to be done, this makes complete sense”. I stayed in touch with the team and they eventually reached out with an invitation to join SWORD Health.”

I wanted to make a bigger dent in people’s lives

There never was a shadow of a doubt: “I had been [at my former job] for ten years, I had made the changes I thought were fit, my mission there had been accomplished. I work with a sense of mission, of purpose, and with SWORD I could make a bigger dent in people’s lives”. The size of that dent is Sara’s measure for success, or as she puts it, “I care about this company’s success not out of a desire for pride or wealth but because that’s how I know we’ve reached millions of patients. That’s all I care about”. Sara isn’t only determined, she is also very rigorous. From the recruitment process (“We ditch a lot of excellent physical therapists because they don’t have the human fit we are looking for”) to patient enrollment (“Patients don’t get days off. They must have therapy on bank holidays, on weekends, on vacations - it’s for their own good. But because they are doing it at home, there always has to be someone on the other side of the line in case they need us”), Sara holds everyone involved in the recovery process in a loving but tight grip.

We have moved past the leap of faith phase, now we have hard clinical evidence

Another example of Sara’s dedication is the gallery of people she has converted to SWORD’S innovative way of doing physical therapy, be them doctors, patients or fellow physical therapists. Her conversion methods adapt to her audience: with physicians and physical therapists, she uses hard evidence and patient reports (“They are always a little wary but as we start recovering the first, second, third patient, they start believing in what we do and become involved”). With patients, the process is a little harder: “You can have a protocol for everything but people and some people think they’ll never be able to do this. In the first session, people always say “I’m never going to be able to memorize all of this”. And I tell them “The thing is you don’t have to. The Digital Therapist guides you through every step you take, all you have to memorize is how to turn it on.” We’re treating people here, it’s hard enough as it is for them, they are not supposed to have to learn a new skill to be treated.” Think about the stock photo version of a physical therapist again. Now tell us if this isn’t exactly the answer you’d hope to get for the question “What’s the best part of your job?”: “I love it when they call me months after they finished therapy and tell me “Sara, I’m doing fine! How are you?””

The growing awareness of the toll opioid consumption is taking on the US population had a substantial boost last week with accusations of failure to address the public health problem coming from within the FDA. The head of the agency's opioid advisory committee stated it had failed to learn its lessons and keeps approving strong opioid painkillers, thus putting the interests of big pharma ahead of public health. In the meantime, concern comes from every side of public life: from the Senate, who sent a letter to the FDA’s commissioner showing atonement towards the fact they keep approving new medication, to Walgreen's board of investors, who required the company to show how it's monitoring and managing risks related to the opioid crisis. The world is starting to acknowledge how big a problem we have between our hands.

Terrifying Numbers

The most recent CDC report stated that 18% of the general population reports illicit drug use or prescription drug misuse somewhere in the past year. Add to this a baffling recent update from the National Safety Council showing that people are now more likely to die from a drug overdose than in a car accident. With 4.3% of the general population being prescribed opioids and a 33% addiction rate associated with them, this easily ends up translating into 130 people dying from overdoses in the US every day. Furthermore, if we assume that the most regular users of prescribed opioids are people with arthritis and back pain (63% of prescribed opioids users report the first and 59% report the latter) and add to that the recent studies showing that physical therapy combined with behavioral intervention can substitute opioid intake in many cases, it becomes very apparent that physical therapy plays a very relevant role in tackling the opioid epidemic.

Finding new solutions is crucial

Expert entities including the American College of Physicians are advocating for exercise programs and patient education as a first-line treatment option for chronic muscle and joint pain. At SWORD Health, we have conducted clinical studies that demonstrated our novel digital therapy intervention can reduce pain levels by 33% in just four weeks, all the while keeping people away from prescription opioids. We know that addressing this problem requires a multifold approach that comprises local, immediate action as much as systematic prevention. By creating cost-effective digital physical therapy at home and combining it with behavioral intervention and patient education, we are helping people stay away from opioids in the very first place. If you need more information about SWORD Health or need help in making this change happen in your workforce or your population, our team is here to help. About SWORD Health: SWORD Health is a tech-enabled provider of physical therapy pairing its AI-powered digital therapists with human clinical teams to recover patients faster and better. SWORD Health’s digital therapist cuts Healthcare system’s operational costs by half while providing patients with more convenient and effective physical therapy at home.

Jose leads a painting unit in a factory that builds buses. He’s responsible for painting thousands of buses a year, and he lives up to that responsibility with a humble smile. The only time a smack of anguish taints this interview comes when he talks about the 130 people he leads: “Many people, many families depend on me,” he says, “and this is why I had to come back to work as soon as possible." Jose is a chipper, lively 58-years-old guy who had to undergo two hip replacement surgeries in one year. So when one of our physical therapists approached him before his first surgery to explain what SWORD Health’s digital therapist is about, he quickly overcame any doubts he might have: “I had already had traditional physical therapy before. I had to rush out of the office, deal with the traffic and find a parking space. [When I finally started therapy] the therapist would come over, tell me which exercises to perform and then leave to check on another patient. I didn’t even know if I was doing the exercises correctly.”

Physical therapy made easy

SWORD Health was a no-brainer for Jose: “I could leave work at 7 or 7:30 pm” and still make it in time to have therapy at home. Persistent as he is, he continuously tried to beat his records and, even if he had evening arrangements: “I would leave at 10:45 pm so that I wouldn’t miss a session”. It came to the point that he started bickering with the digital therapist, “but she always ended up being right.” So when the time came for the second hip surgery, “I called Sarah [his physical therapist] and said: “I need my left leg to recover as well as the right leg did.” It was an amazing recovery; even my doctor said I should get a gold medal for hip surgery recoveries.” It must really be the case because the medical board that evaluated Jose’s ability to go back to work was astonished as well. Jose had medical permission to go back to work one and a half month after surgery, an absolute achievement. Jose knows his perseverance played a crucial role in his recovery: “I felt a huge responsibility towards myself and you guys. Compliance is essential. (...) It’s one thing to do the exercises; to do them correctly is an entirely different thing. This [feedback] is why I found your product so interesting. There is no doubt it was really helpful to work with SWORD Health.” Jose started working at age 13, and he comes from a generation that didn’t get as much formal education as the younger people working with him. Someone a little less kind-hearted would probably belittle the relevance of formal education in favor of their personal journey, but Jose sees it as an advantage: “I always tell my team to learn from our experience but also to integrate whatever knowledge they have acquired to make our work better.” This love of progress is part of the reason why he felt so compelled to work with us: “I’m used to working with innovative projects and people, so I fully embraced [SWORD].” Lucky us.

For SWORD Health, 2018 was the year to dare, to double down on our promise of bringing innovation into the world of physical therapy. So at the dawn of 2019, it’s time to wrap up all the things that happened in the past year and to launch some challenges at the year to come.

SWORD Therapy empowers more patients

In 2018, our innovative therapy reached more people and more markets. And the numbers reflect that scale: That is triple-digit growth in three different categories: minutes spent in therapy, saved trips to rehabilitation centers and the overall number of patients treated. Giving patients the ability to recover at home is crucial to keep their motivation high, and it saves them time and effort. This is why these numbers reflect much more than anecdotes around how many trips around the world we saved or how many songs fit into the minutes of therapy we delivered this year. This is patient empowerment happening before us and that is the fulfillment of our core goal.

Our Digital Therapy is the new gold standard of physical therapy

Besides patients’ validation, we also topped the year with four studies that demonstrated the clinical effectiveness of our digital therapist. This includes a landmark article in Nature Scientific Report proving our combined Digital Therapist and clinical team approach has better outcomes for patients than a physical therapist working one-to-one with patients. The endorsement of the scientific community strengthened our belief in the difference we are making. This was also the year we closed a seed investment round of $4,6 million that was led by a mix of American and European investors, and we are thrilled to have them with us for the years to come.

New Year’s Wishes

We made the best out of 2018, but we are doubling down on that bet again. We leave with the takeaway message from our CEO, Virgílio Bento: “2018 was the year we went from hope, to promise, to reality. For the first time ever, we enabled patients from all over the world to recover in the comfort of their home with our Digital Therapists. In 2019, we’ll continue to deliver on our mission to define the next 50 years of the physical therapy world, only now we’ll leave an even bigger global footprint.”