Technology in Physiotherapy Practice

May 3, 2023
McMaster University
Hello!
Maggie Bergeron
@maggiebpt
mbergeron@embodiaapp.com
Academic & Experiences
● BSc (Hons) Kin, University of
Ottawa
● Gee Gees women’s waterpolo
● MSc PT, McMaster University
● Northern Medical Exchange
● Bugando Regional Hospital,
Mwanza, Tanzania
● Continuing education +++
● Dragon Boating
 Businesses & Side Hustles
● Worked as an independent contractor in 5 out patient clinics
● April 2014: The Yellow Room Physiotherapy & Rehabilitation
● October 2014: Embodia Inc.
● June 2017: TechTO Health
● May 2020: My TP is your TP Fundraiser (Shopify Store)
 One platform for everything:

One platform for everything
- serving clinic owners,
physiotherapists
& their patients
● HEP
● Upload your own exercises
● Record your patients in session
● Patient education
● Online continuing education
● Questionnaires & outcome
measures
● Two-way messaging
● Telerehab
● Chart
● Schedule
● Bill
● Online booking

Available on web & mobile apps

(Apple & Android)
 Agenda
1. Why is healthcare the last industry to adopt technology
2. Drivers of change
3. Top digital health technologies
4. Top 5 questions all physiotherapists need to ask
themselves right now
5. Digital literacy and why it matters for PTs
6. Startups and pitches
Data Set: Why, Trends, & Drivers
Monica: Cross Reference
https://media.giphy.com/media/3oAV9wE5jzYn6/giphy.mp4
 A Few Key References
1. The Topol Review: Preparing the healthcare workforce to deliver the digital future. An
independent report on behalf of the Secretary of State for Health and Social Care. February
2019.
2. TechTO Health Presentations, YouTube 🎥
3. Telerehabilitation in physiotherapy during the COVID-19 pandemic: Survey report. Ontario
Physiotherapy Association. August 19, 2020.
4. The future of technology in health and health care: A primer. Canadian Medical Association.
2018.
5. Shaw J, Jamieson T, Agarwal P, et al. Virtual care policy recommendations for patient-centred
primary care: findings of a consensus policy dialogue using a nominal group technique. J
Telemed Telecare 2017;0(0):1–8.
First - to state the obvious: The world has changed
Why is healthcare the last to change?
“Digital technologies have transformed most sectors
which affect our daily lives, from communications to
transport, banking and entertainment, but not yet
healthcare. This is now changing as electronic patient
records and online services, as well as wearables,
smartphones and apps, are beginning to have a
positive impact.”

-Professor Lionel Tarassenko

Interoperability
 1. It wouldn’t connect to any other
fax machine
If your fax
2. It would take months to figure out
machine was how to use it
like your EMR
3. It would cost thousands of dollars

🎥 Joe Cafazzo of UHN (Oct 2018)

Complexity
Canada: The Land of Failed Pilot Projects
“We don’t put nearly as much energy into sustaining and
operationalizing change and transformation, compared
to setting up the initial pilot project.”

🎥 Lydia Lee of KPMG (April 2019)

Security & Privacy
Risk Averse
Drivers of Change
“We are at an unprecedented time in the history
of healthcare and, the history of humanity -
isolated, with an increasing need to stay
connected.”

COVID-19 and the Healthcare Capacity Crisis

COVID-19
Clinical Entrepreneurship
Canada as a Leader
“We will succeed in Canadian healthcare because of all of
you – all of you sitting in this room. We share a collective goal
that half of us involved in health technology should be clinical
entrepreneurs.”

🎥 David Klein (Dec 2018)

Patients are Consumers
 Patients are Consumers
What happens when you look up treatment for back pain?
 Patients are Consumers
What happens when you look up treatment for back pain?
Yoga Green Juice Cannabis
Dr. Ho Naturopath Surgery
Acupuncture Water Therapy Personal Trainer
Chiropractor Float Therapy Reiki
Physiotherapist Meditation Braces
Massage Therapist Psychotherapy Kinesiologist
The Biggest Competitor for Physiotherapists?

+ =
Everyone’s Joining In
Changing Models of Care
What Does the Research Say?
The Far Future - Coming Soon
https://waitbutwhy.com/2015/01/artificial-intelligence-revolution-1.html
Considerations in
Health Technology
Topol Report, February 2019
 ● Digital products and services that are
intended for use in the diagnosis,
prevention, monitoring, and treatment of
a disease, condition or syndrome.
● Encompasses a broad range of
Digital technologies: telemedicine, smartphone

Medicine apps, wearable devices, software used in

clinical settings, point of care tests, and
extended reality technology (VR and AR).
● Digital technologies can help empower
patients to manage their own conditions.
 There are important legal and
ethical implications arising from the
use of advanced digital
technologies in healthcare:
Ethical ● Patient safety
Considerations ● Data governance
● Equality and fairness (the ‘digital
divide’)
● Respect for human dignity
 Moral/Ethical Considerations?
“She was not trained as a doctor, but she was helping to
teach an artificial intelligence system that could eventually
do the work of a doctor.”
The New York Times (Feb 2020)
Top Digital Health Technologies
Telemedicine can offer inexpensive & effective alternatives to the
traditional delivery of care for…

Mental Health Corporate Wellness

Rehabilitation Disability Management

Home-based Care Medical Cannabis Clinics

Telemedicine/Telerehabilitation
 “Virtual care has been defined as any interaction between
patients and/or members of their circle of care, occurring
remotely, using any forms of communication or information
technologies with the aim of facilitating or maximizing the quality
and effectiveness of patient care.”
Shaw J, Jamieson T, Agarwal P, et al. Virtual care policy recommendations for patient-centred primary
care: findings of a consensus policy dialogue using a nominal group technique. J Telemed Telecare
2017;0(0):1–8.
 OPA Telerehab Survey 2020

• Key learnings about the successes and challenges PTs experienced

with implementing telerehab
• 365 participants
• 94% didn’t provide telerehab prior to COVID-19
• Success: Greater patient compliance, responsibility and engagement to
their treatment program and a more collaborative approach between
the patient and physiotherapist during the rehabilitative process
• Challenges in acceptance by patients to convert from in-person to
telerehabilitation and perception of value of telerehabilitation

https://opa.on.ca/wp-content/uploads/2020/08/Telerehab-in-Physiotherapy-During-COVID-19-Pandemic-Survey-Report.pdf
“Telerehabilitation is not simply a matter of moving to a
new platform; it requires a cultural transformation in how
physiotherapists and the public view physiotherapy – a
profession traditionally viewed as being hands-on and
physical.”

-Telerehabilitation in Physiotherapy During the COVID-19 Pandemic,

OPA Survey, August 2020
 What goes into a Telerehab session?
You already have many clinical skills that are well-suited to tele-rehab, including:

• Taking a good subjective history

• Observation (use different angle, static & dynamic)

• Questionnaires

• Exercise prescription

• Psychologically informed approach for persistent pain (ie. CBT, meditation)

• McKenzie Approach

There are evidence-based approaches that are appropriate for telerehab

Smartphone Apps
Practice Management Systems
Sensors and Wearables
Embodia Labs
•Machine Vision to track joint
position over time
•Machine Learning to rate the
movement
•Provide patients and clinicians
with feedback on ROM and
quality of movement in clinic and
at home
•Gamify the patient experience
•Smartphone technology only
Virtual (VR) & Augmented Reality (AR)
 ● Artificial Intelligence: technology that
exploits vast amounts of data to
identify patterns and make
Artificial automated predictions.
● Embodied AI: a fancy way of saying
Intelligence ‘robots with AI capabilities.’
● AI has the potential to transform the
(AI) delivery of healthcare
● Robotics surgery is now becoming
more common
 World’s first robot-assisted brain
aneurysm surgery performed in Toronto
(Nov 2019)

Robotic Rehab for the

Lower Extremity
 We are entering a new normal.
Digital healthcare is not going away.

What are the important questions we need to ask ourselves right

now to prepare for our big comeback and find out breakthrough?
 ➔ New ideas will never be easier and will never
be more readily received.

#1 ➔
➔
People will be looking new, novel solutions.
Unique needs as a result of COVID-19

New
Ideas
What are those new needs that
exist in physiotherapy and how can
you be the first mover in addressing
those needs?
 ➔ Normal growth opportunities are 2-3X
➔ Now, we have the opportunity for 10-100X

#2
➔ Big opportunities exist in blue oceans
➔ Businesses will go out of business;
therefore supply decreases

Blue
Ocean
Where are the 10-100X blue ocean
opportunities that are either in your
lane, adjacent to your lane, or are in a
pivot that you can accomplish with your
existing assets?
 ➔ We don’t always do what we want to or what
we should, but rather what we HAVE to do
➔ Whole new level of acceptance to digital
➔ Telerehab, distributed workforce, remote teams

#3 ➔ Consumer behavior will drive this in PT

Digital
What changes in patient/client
behavior have shifted, and how can
you respond?
 ➔ Why did Netflix beat Blockbuster?
➔ Why did Kodak lose?
➔ Why did the iPod take off even though CD
quality was better?

#4
➔ Convenience trumps quality

Convenience
What are the innovations in convenience
within how you do business or how you
deliver your services that you should take
first-mover advantage of?
 ➔ You can make a bigger impact on people's
lives than ever before
➔ Vitamins sell features
➔ Painkillers sell benefits
#5
Impact
Where can you help the most by selling
painkillers, not vitamins?
What is Digital Literacy and Why
Does it Matter?
 • Digital health literacy among the elderly
(and general public) is an important
consideration that would impact the
effectiveness of implementing
telerehabilitation (OPA, 2020)

Digital • Adoption of digital healthcare

Literacy technologies requires an effective culture

of learning at every level of healthcare that
enables the workforce to reframe their
knowledge within an increasingly
technology-driven world (Topol Report,
2019)
Startups & Pitches
A Few Key Take-Aways
 • A changing landscape requires a change
in our profession.
• “Digital health by design” lens that would
apply a “digital first” philosophy
• Digital healthcare encompasses a broad
Key range of technologies
• Digital technologies can help empower
Take-Aways patients to manage their own conditions.
• Digital technologies also risks increasing
the digital divide among other risks
• Digital literacy is an important
consideration for everyone - patients,
caregivers, and healthcare providers.
 @maggiebpt
mbergeron@embodiaapp.com