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Smartphones for Smarter Rehabilitation

July 2017
Dr Samantha May

Recently I was thinking about rehabilitation exercises that sports medicine doctors or physiotherapists prescribe to their patients. Having just come back to playing women’s football from an injury myself, I have a fresh take on what it’s like to be a patient. It is at times mentally frustrating standing on the sidelines at training doing heel raise repetitions while your teammates are practicing kicking at goal! How many patients are 100% compliant with their prescribed exercises? I admit I was closer to 70% compliance. This lack of dedication was probably the reason as to why I needed an extra week of rehabilitation before return to play. How can we encourage patients (like myself) to complete hundreds of reps on a daily basis? How can we make rehabilitation less mundane and more interactive at an affordable cost?

This got me searching online for some answers…specifically, searching contemporary Smartphone applications! I wanted to find a tailored physical exercise app that could allow me to become more engaged with my rehabilitation. Phones are available, portable, and apps are usually affordable. I figured if it helped me personally, then it could potentially be translated to be used as a tool in clinical practice. I sifted through many and managed to find 3 apps that help facilitate the self-care aspect of rehabilitation:

1. Countup
This app allows you to set up your rehabilitation exercises, then record and track your progress. You can choose between the repetitions, duration and frequency per day. You can also add videos of yourself performing the exercises under supervision, as a future reminder of how to correctly perform the exercise. This was the app I was looking for that can hold me accountable. It cost $3.

2. Pain Therapy: Physical Therapy Exercise Videos
This app contains a library of exercise and stretching videos. It has the potential to support patients who might need constant guidance with their home exercises with video reminders of how to perform the exercises correctly.

3. Physioadvisor
What sets this app apart from other apps is that all of the content is provided by physiotherapists, who have selected a range of the most common exercises used in clinical practice. There are more than 500 exercises with 800 images and detailed instructions on how to perform the exercises correctly. You can create a custom rehabilitation program, but unfortunately it only allows you to choose exercises that are ready-made on the app. The best part about this app is the reminder feature that makes sure you never forget to do your exercises.

Whilst exploring and testing these 3 apps gave me some new tools to use both personally and with future patients, I’m not convinced that all rehabilitation apps are appropriate to use in clinical practice. There are over 100,000 healthcare related Smartphone apps, but little is known about the reliability, validity and clinical relevance of these. In 2015, a study by Wong et al. identified a total of 76 individual Orthopaedic & Sports Medicine themed apps, with 27 of these specific to rehabilitation and exercise programs. Most of the apps taught users how to perform sets of exercises, ranging from rehabilitative types mainly for post-operative patients, to stretching and strengthening exercises such as plyometrics to prevent common sports injuries. Only 10 (37%) of the rehabilitation program apps had named medical professional involvement evident from the overview pages or associated links provided. There is a concerning lack of medical professional involvement in app design, and whilst they have great potential to be of significant benefit to patients, the content still needs to be regulated and authenticated by well-conducted scientific research. I recommend personal interaction with Smartphone rehabilitation apps prior to using in clinical practice.

Reference:
Wong, S. J., Robertson, G. A., Connor, K. L., Brady, R. R., & Wood, A. M. (2015). Smartphone apps for orthopaedic sports medicine - a smart move? BMC Sports Sci Med Rehabil, 7, 23. doi:10.1186/s13102-015-0017-6