SWORD Phoenix is democratizing access to physical rehabilitation

Quality physical therapy services to post-surgical patients or those suffering from a chronic injury has been challenging in most countries where health care is generally state-provided (public) and often even in countries where healthcare is privately managed, due to availability in the former, and prohibitive costs in the latter. In fact, there is an undersupply of trained physiotherapists globally, and due to the specialization and high demand, costs are very high for patients and families, creating a significant global underserved population.

There are myriad issues, driven by an ageing population and shifting demographics, a dearth of public funding, few qualified human resources and importantly, limited access for patients to specialized service centers. For example, according to Fernando Correia, Chief Medical Officer of SWORD Health, the United States, China and Portugal are countries with an increasing underserved population due exactly to the factors mentioned above.

SWORD Health is a specialist provider of physical therapy services, and Correia has seen the mismatch between service supply and demand growing due to the difficulty in hiring skilled professionals and because of the increasing cases of knee and hip replacements by an ageing population**. "This requires effective responses from both public services and health insurance firms to the patients, but it is not happening", says Fernando.

Considering that access to physical therapy is an essential resource for quality of life, SWORD Health developed in 2014 SWORD Phoenix, a software for physical rehabilitation that uses body sensors and cloud technology to provide patients with high-quality physiotherapy at home, supported remotely by physiotherapists. The technology tackles underserved patients in Portugal, USA and Australia, made possible by replicable methods according to patient type and complemented by bespoke programs, available for patients at home through a tablet, computer or smart phone and hence removing the need for them to travel to a health center or for physiotherapists to come to them each session.

By offering this solution to the health services industry, Sword Health is strongly committed and aligned with two of the Sustainable Development Goals: Goal 3: Good health and well-being and Goal 8: Decent Work and Economic Growth. Both affect patients and their families as well as physiotherapists.

In practice, the changes reflected in these objectives have already directly contributed measurably to better health of 927 patients who are fully rehabilitated, and about 50 physiotherapists who perceived improvements in their career thanks to the new practices and the knowledge that SWORD Health brought to them through the platform, today in development in these countries.

A concrete contribution of SWORD Health is the improvement of Goal 3 - Good health and well-being, through the SWORD Center, a therapeutic unit that works in the Physician's Clinic Paulo Milheiro Maia (CPMM) in the city of Porto since September 2016. The objective of the SWORD Center is to function as a research and development center for the SWORD Phoenix system in Portugal. "The idea of the center is to test the service with clinic users in need of physical therapy in order to better develop the platform’s functionalities and, at the same time, to offer a different physiotherapeutic approach in CPMM, supporting effective patients’ recovery, said Joana Guimarães, the coordinator of SWORD Center.

Joana, 25 years old, is a physiotherapist graduated from the Cooperativa Politécnica da Universidade do Porto who joined SWORD Health in 2016. She currently treats six patients daily and says that the causes that bring patients (usually elderly people) to the center for treatment differ greatly. "Yet, when they arrive here and hear about the treatment approach, they get motivated to try something innovative that will help them to recover. So, our job in R&D is to study and improve SWORD Phoenix to meet their needs and satisfy their expectations", says Joana.

One of these patients is Diogo Bessa, 21 years old and in his third week of daily therapy aiming to recover from knee surgery (a football injury). "I see a huge evolution since I got here because I could not even bend my knee just a few weeks ago." Asked about how he perceives the technological interface in a therapeutic approach, Diogo answers that he prefers SWORD Phoenix to conventional therapy because of the software's rigor in identifying even the smallest of errors in his therapy, i.e. identifying motion flaws at the slightest signal that they occur. "Because of the sensors, the system interacts with me to tell me whether I'm doing well or not and assigns me scores at the end of my session and this allows me to be able to compare my performance along the treatment," he points out. "I can not fool the system as I could ‘fool’ my therapist when I was slacking, because it captures every move I make!" Diego jokes.

Two generations separate Diogo from Mr. Cândido António a 67 years old-patient who arrived with a left shoulder injury from a fracture. In daily therapy four months ago at the SWORD Center, Mr. Cândido says he is keen to continue the treatment because of the positive changes he has been experiencing. "Although my injury caused me other complications, I feel a lot better about with the progress of the arm that bothered me. The pain has decreased substantially and I have acquired more autonomy with the movements. Before I had no position in which to sleep comfortably and today I can do it", he emphasizes.

A similar opinion is shared by Mrs. Maria Manuela Meneses, a 67 years old-lady who arrived at the center to treat the pains of the cervical spine. She has been in therapy for only 11 days, but admits to evolving well overall. "I have arrived here seated in a wheelchair, because I could not walk nor lie down and I was under the effect of strong painkillers. Today, I do not need to take any drugs. I only feel pain when I spend a lot of time watching TV in the same position and, yes I attribute this improvement to the treatment."

Although these patients are satisfied with the technology in general, they agree that SWORD Phoenix does not replace a good therapist. They understand that the physical presence of the therapist is important throughout the therapeutic journey, either to assist them in scheduling exercises and setting the system with the right exercises, or in supporting them enthuisastically, during their sessions.

Complementarily, a recent study was conducted by SWORD Health's with 60 other post-surgical patients who use the technology in their homes, by the physiotherapist Ivo Magalhães. Along with the treatments, they had two physical contacts with the physical therapist, and these patients attributed to high score of satisfaction with the treatment using SWORD Phoenix 9.12 when 10.0 is the highest.

Having the therapist available remotely (via phone contact or through the online system/platform interface) did not create difficulties for accepting SWORD Health. In fact, according to Ivo, this satisfaction level proved that SWORD Phoenix is as much (or) even more effective than conventional physical therapy. "The family's support in turning on the tablet and activating the system is essential to breaking the technological barrier with non-tech-savvy audiences, so the patient can do the exercises and they feel equally followed by us via SWORD Phoenix, pointed out Ivo.

Green Innovations is proud to invest in SWORD Health aiming to accelerate the development of new digital therapies like SWORD Phoenix and address the needs of those people in need of physical rehabilitation. According to Virgílio Bento, founder and CEO of SWORD Health, which recently announced the close of its $4.6 million seed funding round, Green Innovations' investment supports SWORD Health’s mission to democratize access to effective physical rehabilitation therapy, and deliver increased operational efficiency to national health services, healthcare providers and insurance companies.

*http://www.rehabi.com.cn/ch/reader/view_abstract.aspx? flag=1&file_no=201306003&journal_id=cjrm**


** The demand for primary total hip arthroplasty is estimated to grow by 174% and the demand for primary total knee arthroplasty is projected to grow by 673% until 2030 (in comparison to 2005). Reference: Kurtz, S., Ong, K., Lau, E., Mowat, F., & Halpern, M. (2007). Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. JBJS, 89(4), 780-785.