Low back pain (LBP) is no stranger to most of us. Given its 57-84% lifetime prevalence, most people will be affected by LBP at some moment in life. In the US alone, about 66 million adults suffer from low back pain; in the working population, about 26% have reported low back pain in the previous 3 weeks.

Risk factors for low back pain at work

Low back pain is a symptom that can result from different abnormalities and diseases. Most cases of LBP, however, are classified as non-specific, which means no specific cause can be defined as a source of pain. Non-specific low back pain is usually attributed to muscle sprains or strains and bad postural habits, which can be associated with work-related activities:

• heavy lifting, pushing or pulling, so often required in more physical jobs, can lead to injury and, consequently, to back pain;
• poor sitting posture and inactivity, common traits of desk jobs, can make way for low back pain to settle.

Other work-related risk factors are:

• repetitive tasks, such as manual packing of goods;
• maintained positions, which often happens while working with computers or driving long distances;
• and vibration, from operating with tools.

The impact of low back pain on the American workforce

Low back pain is the leading cause of disability in working-age groups. Medical spend per adult with spinal problems is estimated at $6,000, with a total estimated amount of up to $102 billion per year. A recent study found that, although only 1.2% of US adults with newly diagnosed LBP and lower extremity had surgery, they still accounted for almost 30% of total 12-month health costs — $784 million. On the other hand, the total spending on healthcare for the other 98.8% who did not receive surgery was $1.8 billion. Interestingly, one-third of these patients received care that was inconsistent with clinical guidelines, which included expensive but dispensable imaging, and opioids. On top of this, guidelines also discourage the use of opioids, but one study showed they were prescribed for about 60% of ER visits for low back pain in the US. Also, prescription medication abuse is common in patients taking opioids for back pain, with up to 24% of cases showing aberrant medication-taking behavior. Surgery and opioid consumption are not only costly for employers, but also burdensome for employees. Surgery recovery typically takes long — around 12 weeks, and opioids are known to foster addiction. Therefore, it is easy to understand why low back pain is also associated with indirect costs related to work absenteeism and productivity loss. All things considered, there’s a need for new and effective alternatives to surgery and prescription drugs when managing low back pain.

How SWORD Health helps manage low back pain

SWORD Health has come up with a solution that provides positive outcomes while reducing health spending. In short, it brings advantages to both employees and employers.

We deliver better results for the patients

Current clinical guidelines recommend the promotion of exercise therapy and positive health as the first-line treatment for non-specific low back pain. Positive health entails person-centered care that promotes the concept of living well despite the pain by focusing on self-management and education as a means to avoid bed rest and continue with usual activities — including work. The SWORD Health LBP Program is an evidence-based 12-week program to tackle low back pain. Following the most up-to-date guidelines, this program is based on the three pillars of musculoskeletal care: exercise therapy, patient education, and behavioral coaching, all delivered through our unique Digital Therapist and continuously supervised by our clinical team. Our approach allows patients to perform their therapy from the comfort of their homes, which not only is feasible and safe, it’s actually better. Some of the factors that explain this positive outcome are the patients’ higher engagement and adherence to a home-based therapy program with real-time feedback on performance; the data-driven decisions the system allows our physical therapists to make; and the access to a behavioral training program.

We provide the best treatment while cutting medical costs

Because patients are treated faster and better, they are able to return to work and their daily activities sooner than what was previously expected. And what’s more, because we educate them with strategies and new behaviors to conquer pain, their use of opioids dramatically decreases. Our approach translates into an up to 75% reduction in surgeries, a 33% reduction in opioid use, and an overall reduction of at least 35% in medical costs. If you would like to set up a benefits plan that helps you reduce your workforce’s burden with low back pain, reach out to our Strategic Business Development team.

From the very beginning, SWORD Health has followed two unwavering principles: we would never compromise our technological quality and we would never jeopardize our clinical validation. We chose these premises because we knew this was the only way to give patients the best possible musculoskeletal care. And we delivered. Our efforts have been recognized a number of times this year. SWORD was ranked as one of the world’s 150 most promising digital health companies at the CBInsights ‘Future of Health’ conference in New York. We were also featured on Wired’s 2019 list of the Hottest 100 Startups in Europe and won honorable mention in Fast Company’s World Changing Ideas 2019.

The best Employer Wellness & Prevention solution

Last week, we achieved a new milestone: SWORD won the Employer Wellness & Prevention category at the UCSF Digital Health Awards 2019. SWORD was recognized as the “best wellness or prevention digital health product or solution aimed at employers.” [caption id="attachment_892" align="alignnone" width="650"] Our Founder and VP of Strategic Business Development receiving the award on behalf of SWORD Health[/caption] We were picked among more than 500 global entries in the competition by a distinguished panel of judges from the technology sector, healthcare companies, medical professionals, and investors. After a couple of rounds, we were awarded the “best wellness or prevention digital health product or solution aimed at employers.” “This award validates SWORD as the company that is leading innovation in the musculoskeletal space,” said our CEO and founder Virgilio Bento. “To have a jury composed of the most brilliant people working in both technology and health acknowledge our excellence is especially satisfying.”

About SWORD Health

SWORD has developed a ground-breaking Digital Therapist, which has been proven to work more effectively than conventional physical therapy while bringing treatment to patients’ homes. The technology is set to make treatment of Musculoskeletal Disorders (MSD), which affects more than half of all Americans every year, affordable to millions of people. SWORD works with some of the biggest self-insured employers and health plans in the world to treat and prevent MSD. SWORD’s ultimate goal is to cut the costs of treating MSD by half. More than 50 percent of Americans struggle with MSD, requiring a yearly expenditure of $190 billion, making it the second-largest contributor to healthcare spending.

Pain is an evergreen topic when talking about musculoskeletal conditions. Although every patient sees and feels pain differently, it plays the main character in their daily life. But pain can be demoted to a lesser, supporting role. How? By understanding pain, what it entails, and how we should behave towards it. Then, recovery won’t seem as difficult and unattainable as before.

Pain is not just pain

Pain is the way our body responds to a threat by prompting protective behaviors, which includes focusing attention on pain sources and avoidance. However, these protective behaviors may persist beyond the healing time, and this is when pain turns chronic, leading to pain-related disability. So, pain is more than just pain. It's the fear of pain and movement, the loss of function, and the inability to do the things we used to do out of the fear of them being harmful — even though most times they are not. However, feeling pain does not mean we have serious damage, nor it means we are doing further damage. The same applies to exercise therapy.

Exercise-induced pain is common and to be expected

When patients with a musculoskeletal condition are about to start their treatment, they often fear that physical therapy is painful. The answer is quite straightforward: yes, it is painful – at first. But this pain is normal, bearable, and nothing to be worried about. As the body gets used to the therapeutic exercises, the higher loads patients can tolerate, and the less and less pain they feel. In other words, there's a dose-response to exercise for musculoskeletal pain. Over time, patients learn to expect increasingly challenging exercises while knowing they can tolerate them.

Moderately painful exercises are actually beneficial

Research has shown that doing moderately painful exercises offers better outcomes than doing exercises with no pain at all. It has also proved that exercising into pain has no apparent adverse effect when the aim is to manage chronic musculoskeletal pain. One of the discussed reasons for this response to exercise into pain was the positive impact on central pain processes, the immune system, and affective aspects of pain. In short, moderately painful exercises challenge the body’s threat response to pain, helping “reconceptualize” pain as safe and non-threatening. Consequently, patients no longer perceive pain as equal to harm, being then able to reintroduce the same movements they were avoiding before. Patients learn how to cope with pain — and conquer it.

Being a coper, not an avoider, is the best way to conquer pain

During a painful event, it’s better to cope with pain and not give in to paralyzing pain-related fear. Changing the perception about pain is a tipping point between having a coping over an avoidance behavior. It includes challenging the attention bias, which happens when we focus our attention on how painful a particular movement is and end up feeling it more strongly. In other words, we end up catastrophizing pain. Exercising, as mentioned before, is a way of challenging this bias and reframing pain as not harmful. Another one is making a valued life goal a priority over pain. Focusing our attention on what really matters to us outweighs our pain-related fear. When we set goals and are optimistic about them, it becomes easier to hold back our fear-related protective behaviors.

After the pain, the recovery

SWORD Health team took all critical aspects of pain management into account when developing our solution for musculoskeletal care.

• We promote exercise therapy as the first-line treatment for MSDs;
• We make goal-setting a priority, enabling patients to divert their attention from pain to their more objective, valued goals;
• We foster patient education as a way of empowering patients to put pain into perspective and go through with treatment despite it.

At the end of the day, our Digital Therapist yields undisputed results, with a reported 74% decrease in pain after only eight weeks — all while helping people stay away from opioids and surgeries, too. After we overcome the pain obstacle, the path to recovery becomes clearer. Pain is no longer a barrier to treatment, so patients can set their minds into a more relevant thing: getting better, faster.

Falls are responsible for up to 30% of both fatal and non-fatal injuries, as well as for 10 to 15% of all emergency department episodes in older adults. Falls represent major expenditures in healthcare, with yearly medical costs estimated at $50 billion in the USA alone. Clinical evidence favors well-designed exercise programs in the prevention of falls. Most of these programs are costly and heavily dependent on specialized human resources: the therapists. Currently, there are no satisfactory solutions: those that exist are either expensive and complex or lacking enough clinical validation. SWORD decided to address this problem and test whether the Digital Therapist was a fitting solution for it. Through the SWORD Care project, we developed high-quality exercise programs specifically designed for fall prevention.

What exactly is SWORD Care?

SWORD Care is an integrated, engaging, efficient, and cost-effective approach to fall prevention, including both diagnostic and therapeutic tools. It includes automated assessment tools, thus overcoming the dependence on subjective and time-consuming scales. SWORD Care was developed in a two-year period, under a project co-financed by the Programa Operacional Norte 2020 through the European Regional Development Fund (ERDF). It was tested in a Porto-based facility with patients typically in the fall risk group. There was a total of 1130 sessions performed, adding up to more than 10h30 of treatment per patient during the 6-month testing period.

What results did SWORD Care get?

We used several different tools and scales to measure SWORD Care’s results: • Timed Up and Go Test (TUG): 32% improvement • Five Times Sit to Stand Test (5xSST): 25% improvement • Berg’s Balance Scale (BBS): 56% improvement • Short Falls Efficacy Scale - International (FES-I): 34% improvement The results show that participants improved their overall balance by over 55%, while also reporting that their fear of falling decreased by more than a third. The advantages of the program are perfectly showcased by this 79-year old participant, Mrs. Veríssimo: "There are things I do here I would never have done in my life! It helps me throughout my day, my joints feel less rusty, I can move a lot better. The pain is gone and so is my instability.” Participants were asked to rate the program and they gave it a perfect ten. Their feedback truly shows their satisfaction, as you can tell by Mr. Godinho, 81, who says "I can move my arms and legs better and do chores that used to bother me. (…) I'm perfectly capable of performing the sessions on my own. I'm very satisfied, I really like this."

Whether it is for leisure or business purposes, traveling is a frequent activity among U.S. residents. The latest numbers report about 2.2 billion person-trips in 2018, which translates into a considerable amount of time spent away from home — and daily routines. Traveling may get in the way of one’s habits and it can be seen as an excuse for skipping a few physical therapy sessions. However, we already know that complying with treatment is vital for a successful recovery. And we also know that staying physically active is key to control back and joint pain. So how can patients keep on with their sessions? The solution is fairly simple: by having the Digital Therapist in their travel packing checklist.

SWORD’s Digital Therapist: an unexpected travel companion

Our AI-powered physical therapy solution has been helping patients go through with their rehabilitation treatments and exercise programs successfully from the comfort of their homes. It’s now time to understand how the Digital Therapist can help them continue their physical therapy anywhere they go:

Absolute portability

The Digital Therapist is small and lightweight enough to move around with ease. It comprises a tablet and a few motion trackers that come in a practical bag, which can fit any suitcase. These portable devices are also safe for air traveling purposes.

Simple setup

Setting up the Digital Therapist is easy and requires little means: an available WiFi connection and a stable surface for performing the exercises. Monica, one of our patients, took the Digital Therapist on vacation with her and she even used it by the pool while using a bottle of wine as a weight. They say necessity is the mother of invention, don’t they?

Flexible session scheduling

Trips usually involve a program of some sort: whether it is a work-related event or a city break, chances are users are going to need to adjust their sessions to a more hectic timetable. The Digital Therapist makes it easy to create a routine during a trip and to fit sessions in at any time of the day, be it first thing in the morning or later at night.

Remote access to a physical therapist

Thanks to the Digital Therapist, patients can keep in touch with their human physical therapist. They know there will always be someone available to address any question and tend to their needs. It is this human touch that our patients most appreciate about the SWORD’s solution. They feel its guidance throughout the entire process, which increases their confidence in the care they are given. Ultimately, they feel encouraged to comply and go through with the prescribed program — even when they are away traveling.

Clinical validation has always been at the core of our company. SWORD’s Digital Therapist has already shown to recover patients faster and better than traditional physical therapy. However, there is more to be done, tested, and proven. Therefore, we are proud to announce the appointment of our company’s new Clinical Advisory Board (CAB). The group of specialists, whose expertise ranges from orthopedics to cognitive psychology, will help SWORD devise a long-term clinical strategy and supervise the clinical studies within the company. “SWORD Health knows clinical validation plays a crucial role in our company’s differentiation,” says SWORD’s CEO, Virgílio Bento. “It is the touchstone for every development we bring into our Digital Therapist. The addition of this knowledgeable group of clinical experts is not only welcome but also the extension of our understanding that science has to lie at the very core of everything we do at SWORD.” Members of SWORD Health’s Clinical Advisory Board include: Jose Rodriguez, MD (Chairman of the Board): Orthopaedic Surgeon, Hospital for Special Surgery; Editorial Board of Journal of Arthroplasty, Bone and Joint Journal, Clinical Orthopaedics and Related Research; Jorge Lains, MD: Physical and Rehabilitation Medicine (PRM) Specialist; President of the International Society of Physical & Rehabilitation Medicine (2016-2018); Gerard Francisco, MD, PhD: PRM Specialist; Board of Directors of the American Board of Physical Rehabilitation and Medicine; Chairman and Professor, McGovern Medical School, PRM Department; Chris Furmanski, PhD: PhD in Cognitive Psychology; Director of Innovation, Stanford Health Care (2013-2016)

Further evidence ratifies SWORD Health’s Digital Therapy

The newly appointed Clinical Advisory Board joins the team at a particularly fitting time, since SWORD also reported the outcomes of its most recent study, the first proving a digital solution (SWORD Digital Therapist) can achieve better outcomes than conventional face-to-face rehabilitation (35% better functional outcomes), requiring 80% less time from the physical therapist. The clinical validity of the digital program, that has once again shown very high patient satisfaction (91% rated their satisfaction with 10/10) and engagement (83% of patients performing five or more sessions/week), makes SWORD Digital Therapist an evermore interesting solution for both post-operatory and chronic scenarios. “On one hand, SWORD directly addresses the increasing rehabilitation needs we see every day in every health system,” says Jorge Lains, member of the CAB and President of the International Society of Physical and Rehabilitation Medicine. “On the other hand, this a solution that obeys all the golden rules of physical therapy: it’s intense, it’s repetitive, it’s task-specific. SWORD upholds not only the highest physical therapy standards but also the scientific and psychosocial ones.” José Rodriguez, who is also joining the CAB, says that “SWORD Health is leading an effort to engage patients more directly in understanding their role in their rehabilitation, and in this way inspire them towards improved functional outcomes.” The prominent surgeon from the Hospital of Special Surgery also states that “Being part of this effort is both fun and exciting. Helping people get even better is why we are here.”

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”.