Following surgery, the body undergoes a period of healing. Postoperative physical therapy is the first-choice strategy for faster and better recovery, helping the patient return to work and perform everyday activities as they would before the surgery. The rehabilitation process usually entails an intensive exercise program that extends for weeks and can include both in-clinic and at-home sessions. Committing to the process and maintaining adherence are the most fundamental aspects of physical therapy — and the hardest to accomplish, too.

The many barriers to rehabilitation adherence

Non-adherence to physical therapy programs is the result of the many obstacles that patients encounter or perceive along the way. Barriers such as transportation problems — especially in those cases where patients can’t drive, thus becoming a “burden” for family or friends —, childcare needs, work schedules, and financial constraints are common reasons to fail appointments. Other barriers, however, could be as limiting, especially when talking about at-home physical therapy sessions. Poor self-efficacy, that is, when the patient lacks confidence in their ability to perform a given task, can determine whether the treatment is effective or not. Left on their own, without qualified supervision or feedback, they no longer feel confident they are on the right path.

How SWORD’s Digital Therapist brings barriers down

To tackle this problem, different strategies and approaches have been proposed, and our Digital Therapist brings some into play:

Freeing patients from appointment scheduling

Perhaps the first advantage that comes to mind when talking digital is convenience. Because the Digital Therapist supervises the therapy session from the comfort of the patient's home, barriers such as fitting an appointment into their busy days or lacking transportation to a clinic are no longer an issue.

Giving structure to at-home rehabilitation

Improving self-efficacy is a top priority when it comes to increasing rehabilitation adherence. By giving patients access to demo videos on how to perform each exercise along with real-time feedback on their performance, they become more confident in their ability to go through with the prescribed program. That’s exactly what the Digital Therapist gives them: structure, supervision, and positive reinforcement.

Allowing patients to track their progress

Another way to improve confidence and self-efficacy is to increase patient empowerment by giving them a sense of control over their own rehabilitation process. With the Digital Therapist, patients have access to a summary of their performance in each session. Alongside the guidance from their human physical therapist, this allows patients to track their progress and understand not only what they still have to improve but also how far they have come.

Improving patient engagement through gamification strategies

By turning the physical therapy program into a game — with specific goals to achieve and rewards to earn — the Digital Therapist gives patients a sense of purpose and accomplishment during the rehabilitation process. This gamified therapy taps into the innate human needs for achievement and reward, compelling patients to improve their performance and attain more powerful results. More motivation to improve means higher patient engagement and, consequently increased compliance. And that is an important step forward to success.

The Digital Therapist’s most powerful asset: the human touch

SWORD’s rehabilitation programs go beyond the digital approach. We believe in human+machine collaboration. Every patient is assigned a Physical Therapist, who is always available to provide support and encouragement when needed. Knowing that their Physical Therapist is there to help them throughout the rehabilitation process can make a difference in the patient’s progress. In fact, they are most likely to adhere to the prescribed program if they perceive a positive relationship with their therapist. This positive relationship also fosters open and transparent communication, which is important to address patients' fears and anxieties about pain and self-efficacy, building up their trust in the process. And to make sure patients not only get better but stay better, communication is focused on continuous patient education and behavioral change, so they can achieve long-standing results, not just temporary.

How sedentary is the U.S. population? According to the U.S. National Health and Nutrition Examination Survey, Americans spend “the majority of their waking time in sedentary behaviors." Sedentary behavior is a matter of public health. Not only does it have a negative impact on overall health, it has also been associated with a proneness to suffer from musculoskeletal disorders – also known as MSDs, a set of diseases that includes chronic back and joint pain, and affects 1 in every 2 adults in the U.S.

Exercise, a central player in preventing and treating MSDs

The correlation between exercise and health is obvious. We know how relevant a role physical activity plays in preventing heart diseases and fostering mental health, for instance. Indeed, exercise is seen as "an economic and safe way to prevent and treat diseases" when compared with the cost of opioids and other drugs on families and society. Yet, what people sometimes overlook is that exercise can help prevent and treat musculoskeletal disorders, too. The 2018 Physical Activity Guidelines Advisory Committee of the Office of Disease Prevention and Health Promotion published a scientific report that showed “a relationship between greater amounts of physical activity with decreased pain and improved physical function in adults with osteoarthritis of the knee and hip." What is more, an active lifestyle also led to reports of “overall improvement in their quality of life.” As for low back pain, a recent systematic review stated that exercise, along with patient education, is the only clinically proven way to prevent it. The study goes as far as saying "exercise alone may reduce the risk of an episode of LBP [low back pain] and sick leave due to LBP, at least for the short-term." People with medical conditions, however, should be cautious when engaging in physical activity. MSD patients should follow an exercise program customized to their specific case and prescribed by certified physical therapists. A tailored exercise program will provide the guidance they need to engage in suitable physical activities that promote their rehabilitation and physical function.

More physical activity, more pain relief and self-confidence

The piece that people usually miss in understanding why physical activity is so important is exactly how it can change the way their bodies behave and adapt. First, exercise improves overall physical ability as well as muscular strength and flexibility, reducing stiffness and improving mobility and range of motion. Secondly, exercise promotes the release of endorphins, which act like opioids in our system and lead to a decreased perception of pain. All in all, exercise helps surpass the fear of movement, regaining confidence in movement, self-esteem, and self-efficacy. It's fairly simple to recognize why these factors may contribute to an improvement in quality of life and overall health.

The missing factor: compliance

By this time, the association between physical activity and effective back and joint pain management is well-established. However, there's another critical factor for this equation to work: compliance. In research, studies showing greater compliance with exercise programs also reported more positive outcomes. But how do we promote compliance? According to the report mentioned above, individual-level interventions may be an effective way to "increase the volume of physical activity (…), especially when the interventions are based on behavioral change theories and techniques." Moreover, "information and communication technologies (...) can be used to enable self-monitoring, deliver messages, and provide support”, which can help promote regular physical activity.

Why SWORD is the go-to solution for pain management

Summing up what we have discussed so far, there are three key ideas to take away: - physical activity is an effective strategy for the management of back and joint pain; - exercise programs should be customized to the individual needs of MSD patients; - exercise is more effective when there is compliance, which can be achieved through one-on-one interventions, patient education, and remote support. SWORD covers all three aspects for the successful management of MSDs: we promote physical therapy as the first-line treatment for joint and back pain, we prescribe tailored exercise programs that address the specific needs of our patients, and we enable our patients to perform their programs at home while receiving real-time feedback. The result? A faster and better way to treat MSDs. And when it comes to relieving pain, our program’s positive impact is best described with one of our patient’s words: "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".

The nationwide shortage of physical therapists (PTs), especially as PTs will eventually start to retire, is the focal point of the latest projection by the American Physical Therapy Association. If we factor in the impact of shifting demographics and an aging population, this gap between supply and demand becomes evident. As a result, physical therapy becomes a scarce resource, increasingly costly and out of reach for most people. The solution? Some would be very quick to say “train more PTs, increase supply”, but the answer might go beyond the obvious: let’s make PTs superhuman.

Giving superhuman abilities to physical therapists

Science fiction has been telling us stories of robot-ruled worlds for a while now. However, having robots replacing humans, especially in healthcare, is nothing but a scaremongering tale that does little for innovation and stepping towards a brighter future. Instead, we must develop and explore technologies like Artificial Intelligence (AI) as a tool to augment the capabilities of practitioners, to make them better at their jobs. In physical therapy, AI has the potential to improve the decision-making process by providing superhuman level diagnostics and measurement. For instance, collecting data with motion trackers offers physical therapists a rich source of information that enables them to accurately identify and modify a patient’s progress. Nevertheless, as our CEO put it, “while [AI is] great for analysis and research, healthcare still needs a human touch.” This approach calls for collaboration between machine and human rather than choosing between one or the other. “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.” Another way AI is giving super abilities to healthcare providers is through scalability. As Vinod Khosla, founder of Khosla Ventures, put it, “There are probably a million doctors in the United States, give or take, but with AI systems, we could create ten or a few hundred million doctors worth of expertise and use human doctors only for what they love to do, which is interfacing with patients, making health more personal, accessible, convenient, and less costly.” At the end of the day, “AI will do much better diagnosis, monitoring, and follow-up than most human doctors and complement the human element of care humans might provide”.

The Digital Therapist as an ally for better care

SWORD knows AI is bound to make physical therapy patients’ lives easier; the fact that it makes the physical therapists’ jobs more scalable is a welcome plus. Besides prescribing therapeutic programs, the work of physical therapists includes assessing movement patterns and monitoring the progress of a patient. The Digital Therapist performs these tasks and provides more accurate data to SWORD’s clinical team, who no longer has to measure off how high should the patient lift their arm or exactly how many degrees is their left knee’s range of motion. In the end, the human PT receives unique, precise information to create a more personalized program, and this saves them precious hours in their busy schedule. By being able to distribute their time more efficiently, PTs can assist more patients without compromising treatment quality. Moreover, the Digital Therapist is capable of providing instant feedback on patient performance during a session, which not only maximizes the recovery process but also fosters the PT’s availability to delve into continuous patient education. As Lauran also said, “trying to fix people isn’t the only thing that’s needed, you have to try to get them to change and modify their behavior so they can achieve a lifetime of function and not just a period of function.”

Human+digital physical therapy provides better results

There’s one more reason why human physical therapists should not fear their digital counterparts apart: they can make their practice more effective. Our combined human+machine physical therapy solution has been clinically validated by several studies so far. In our first study, a group of patients under the SWORD program improved twice as much as the control group following a conventional PT treatment, not only on the objective measurement of their recovery but also on their perceived quality of life. The follow-up study then showed that these results were maintained for months without additional treatment, proving that the Digital Therapist can also provide long-term benefits. And as we continue our scientific research and validation, the testimonials from our patients and physical therapists will keep corroborating the positive impact of SWORD on their lives.

Musculoskeletal care still has a long way to go when it comes to keeping up with treatment recommendations. Treatment options are still way behind in what comes to what the CDC advises, for instance. Surgery and prolonged drug treatment are the go-to options to address chronic back and joint pain, and that’s partly due to the fact that conventional physical therapy cannot solve the problem.

MSD treatments: a quick recap

Musculoskeletal care is essentially being addressed in two ways: via surgery or through a more or less continued use of opioids and other pain medication. The costs of surgery are, as it should be apparent, very high (both by economic and by quality of life standards). Of course they would be completely justifiable if these interventions had a high likelihood of success. Alas, this is not the case. Back in 2007, the New England Journal of Medicine had already published a study that randomly assigned sciatica patients to either surgery or conservative treatment. A year after, the study found no difference in pain or perceived recovery for either treatment. As for spine surgery, the rate of failure is so high that there is even a syndrome named after it: Failed Back Surgery Syndrome (FBSS), which according to recent medical literature affects 20 to 40% of all patients submitted to back surgery. This being said, according to The Bone and Joint Initiative’s study “The Burden of Musculoskeletal Diseases in the United States”, roughly 12.000 procedures are still performed every year to treat MSDs. As for opioids, we’ve already covered the subject at length.

Crooked: a harsh history of back pain

Crooked, the book where New York Times bestseller Cathryn Jakobson Ramin exposes the problem with the entire back treatment  industry, painstakingly explains the never ending cycle of pain many musculoskeletal patients have to endure: “In 2004, Chris Livingston, (...) stood up after a couple of hours of pounding nails into a subfloor and heard a loud pop.  (...) his primary care doctor sent him to a physical therapy clinic, one that was conveniently in network with his health care plan. ‘I didn’t have to pay much for it (...) and that was important. (...) I was looking for convenience and price’. After the facility’s head therapist did a quick evaluation, a young assistant took charge of his care. (...) ‘I’d say that I had pain and tingling down my leg’, Livingston said, ‘and she’d tell me to stop for the day’. After several weeks of no progress, the head PT told Livingston that he’d used up his sessions, and should see a spine surgeon. He followed this advice. After a couple of unsuccessful lumbar discectomies, the surgeon sent him to a pain management doctor. Under the influence of strong opioids, he couldn’t find the motivation to get back to work. ‘I let the business go, and the house, too,’ he said. ‘The pain was too great, and I couldn’t handle it, and to be honest, the drugs made me really not care.’” Jakobson Ramin’s book is filled with gruesome stories about opioids, surgery and conventional physical therapy. But above all, Crooked is a book about a patient’s struggle with pain and the twisted path she underwent to find a solution for it. It’s a story we’ve heard many times but one very worth your reading.

The problem with conventional Physical Therapy

Therapeutic exercise is, as we pointed out, the CDC’s recommended treatment to tackle musculoskeletal disorders. The problem with traditional physical therapy, as we can see from Crooked’s example, is first of all its cost: good physical therapists are costly, many are not in network with health care plans, and even if they are, out of pocket expenses are prohibitive for the vast majority of Americans. The second problem is how cumbersome physical therapy is: going to a clinic every day for weeks or months is not exactly doable for many patients. And clinics have yet another problem: you are dependent on the attention of a very scarce resource: physical therapists. Not only that, a PT’s quality can range from the assistant that dealt with Mr. Livingston to the highly trained Doctor of Physical Therapy (DPT) that eventually helped Cathryn Jakobson Ramin (which, by the way, was not covered by insurance and cost around $125/session).

Why SWORD just works

Let us quote Cathryn Jakobson Ramin again: “Everyone who goes to PT is assigned home exercises, but very few people do them. For an exercise to work, you not only have to do it but must do it correctly. For the patient left to his own devices, that’s unlikely. As the late Karel Lewit, who led the Prague School of Rehabilitation, was famous for saying: ‘The capacity of the patient to alter his prescribed exercises knows no bounds’.” This is the exact point we’re solving at SWORD, along with the cumbersomeness of the entire back-and-forth to clinics. To encourage patients to perform the exercises correctly, our Digital Therapist evaluates the patient’s motion with clinical precision and provides detailed feedback on how to perform better. Alongside our human DPTs, who assess, orient, and prescribe sessions to every patient and are available whenever they need them, we have created a solution that solves everything that is wrong with conventional physical therapy. And because contrary to what happens at a clinic our DPTs are not overbooked with hour-long sessions, we can treat patients more cost-effectively and better, reducing the number of surgeries by up to 75%, medication intake by 33%, and pain by 74% (in only 8 weeks)   But perhaps the most prominent feature about SWORD is something a patient of ours once pointed out: “The best thing about SWORD is the ability to perform physical therapy in our pajamas”.

At age 14, Lauran suffered an injury to her ACL that required physical therapy. From that moment on, she decided physical therapy was what she wanted to do: “I thought ‘Oh, I can help people, that’d be great’. So I consulted with my sister [who was studying occupational therapy], but she told me I would have to work on my communication skills too, because I was super-shy [laughs]”. Since that moment, Lauran’s life has revolved around making other people healthier.

From College Sports to Workers’ Comp

In college, Lauran volunteered with the basketball and soccer teams, partly as a way to overcome her shyness. But make no mistake, these weren’t your run-of-the-mill college teams – this is the legendary Lady Vols and SEC tournament winning soccer teams we’re talking about. As a part of the team, she went on a trip to North Carolina, and she found the state so beautiful she decided to apply to (and attend) Duke University to become a Doctor of Physical Therapy. After college, Lauran started working at outpatient clinics, and eventually focused on workers’ compensation cases because they aimed at “trying to help people get better faster to do the job they need to get on with their lives, and I like that approach”. We asked Lauran what had brought her to SWORD after twelve years working in clinics: “[SWORD] was completely different. It was very technology-based and technically I’m a millennial but I didn’t grow up with technology, so I knew I would be expanding my boundaries. It would challenge me.” That’s our kind of people.

A Brave New World

One of the things Lauran enjoys the most about SWORD is that “It facilitates patient independence. Given the research and my years of experience, what I realized is that no matter how good your hands and your skills are, if you don't get compliance from the patient and you don't approach them empathetically, they're not going to get better. And if you don't give them tools that empower them to keep going, they're just going to keep coming back and create a dependence which shouldn't be created. I want people to think of me when they get injured but I don't want them to have the same injury and keep coming back to me.” Self-confidence plays a big role in the patient’s recovery. Lauran is adamant about this: “[Sometimes we have to tell patients] “You know, just because it hurts doesn't mean it's hurting you” and give them a sense of security in movement, because people build their anxieties and their fears and they want to have somebody there saying ‘Yes, I saw what you did’.” SWORD has a big advantage on this end: “I wouldn't be able to do that in a clinic because I would never be able to see what they could do and measure it.” Her first experience with the Digital Therapist was quite baffling: “Of course you know there's people that do research and they can put sensors on and identify movement. But turning that into something that can be offered to a large mass of people, [something] that physical therapists can follow and see ‘Oh, my patient’s not being able to do this’... It eliminates measurements on the PT’s side, because it tells you right there how much patients are able to do. It makes my job a little easier and it gives me more data than I would have in a clinic, and that’s helpful.”

Change you can act upon

When Lauran decided to join SWORD, she was taking a course on clinical blind spots: “ It was pretty much the science behind what we would typically see in a musculoskeletal patient, particularly in low back patients.” The course focused on challenging physical therapists’ ability to interview a patient and see things as they see and perform cognitive behavioral therapy. As Lauran puts it, “we've focused our profession on hands-on approaches and getting people better that way. But then we realize that, number one, the research doesn't prove that that's the most effective way with some people and, number two, that trying to fix people isn’t the only thing that’s needed, you have to try to get them to change and modify their behavior so they can achieve a lifetime of function and not just a period of function.” SWORD’s approach was a perfect fit for what the course was teaching her. But there’s a little more to it: “You can get as educated in a topic and challenge yourself as much as you want to, but in the end [a therapy like SWORD’s] is very reliant on me doing what I'm learning instead of just saying ‘Oh, yeah, I went to that course’. I actually have to apply what I got from it.” A doer with a challenge-oriented mindset? She definitely had to be one of us.

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.”