FisioMotion: The First Telephysiotherapy App in Indonesia

Help patients attain the key to physical recovery by achieving consistency and accuracy: giving personalized therapeutic-exercises based on patients' diagnoses and providing guidance in performing the exercise movements with AI.

Physiotherapy involves therapeutic exercises that are used in the management and rehabilitation of most MSDs. Despite being fairly effective, pitfalls such as cost, mobility, and time have made it hard for continuous follow-up.

• Based on the 2018 Global Burden of Disease Study, MSDs were unshockingly identified as the leading cause of global morbidity. Despite not necessarily associated with high mortality rates, some cases of morbidity have led to a devastating impact towards one’s Quality of Life (QoL), with the para-condition affecting one’s ability to execute daily necessities, work, and undergo leisure. If left unmanaged, this subset of the community may become marginalised, making it difficult for them to reintegrate to society. Hence, rehabilitation (in this case physiotherapy) is pivotal in addressing this issue, not just from an individual-scale wellness perspective, but also from a national-scale macro perspective.
• As mentioned previously, the core problem of physiotherapy currently lies in its accessibility. Considering that most patients with MSDs have impaired mobility and/or motoric functions, getting to the rehabilitative clinics in the first place is considered a hassle. Furthermore, several barriers that exacerbate this problem include: long distances between home and clinic, limited transport options that are also associated with costs, and the lack of disability-friendly facilities in current urban-planning. Moreover, physical and geographical isolation due to COVID-19 have significantly halted any sort of patient-therapist interaction, yielding it excruciatingly difficult for patients to continue their sessions regularly.
• The main stakeholders affected by this problem are the ones who are directly involved in the physiotherapy sessions - which are the patients and healthcare workers leading the therapy sessions. Despite some therapeutic exercises being able to be conducted at home, the patient lacks the privilege of supervision, which is crucial in ascertaining the correct range of motion achieved to receive optimal benefit from the exercises. Personal caretakers could possibly help with this role, although this needs proper education and prior-communication with the related physiotherapist in doing so. Furthermore, this method also eliminates any sort of direct observation that is potentially needed by the physiotherapist to determine the course of the regime.
• Hence, unless there is an updated solution for these problems, physiotherapy will remain incredibly difficult to continue in the long-run, gradually affecting the change of these patients to return-to-normal, and ultimately causing a steady decline in the QoL of the global population 

Based on the problems we’ve stated above, we plan to approach the issues in aspects of mobility, accuracy, and consistency of consultation and rehabilitation process. 

Therefore, we propose FisioMotion, an AI-powered telephysiotherapy-based treatment mobile app that provides personalized exercise based on patients’ diagnoses that is directly supervised by physiotherapists. 

FisioMotion has five main features such as motion accuracy detection that helps minimize patients’ errors in performing therapeutic exercise movements, thus their movements become more precise and accurate. We use Pose Estimation technology to guide and evaluate patients' movements in real-time with the help of a smart voice assistant.

Secondly, we have a progress tracker and reminder feature that helps record patients’ therapeutic exercise performance progress during the rehabilitation period so that patients can make consistent progress in their exercise program. FisioMotion provides a medical teleconsultation supported with Electronic Medical Records (EMR) that connects patients with physiotherapists despite some mobility limitations that may occur. 

Approximately, 1.71 billion people suffer from musculoskeletal conditions (MSD) worldwide. Moreover, MSDs are identified as the leading cause of global morbidity and the biggest contributor to YLDs (Years lived with disability). The disability associated with MSDs has been increasing and is projected to continue to increase in the next decade, and the pandemic has accelerated the rate of increase in MSDs. Those are the people we want to help. Specifically in Indonesia, the core problem of the current physiotherapy lies in its accessibility. After conducting research, we found that most patients in Indonesia share several challenges in common as stated below:

• Patients have a hard time following through with all the common paper-based prescribed exercises
• Most patients have impaired mobility and/or motoric functions,
  so getting to the rehabilitative clinics in the first place is considered a hassle.
• Patients lack the privilege of supervision when performing the therapeutic exercise. Thus, there is a possibility of doing the exercises wrongly and causing further damage to the muscles.
• During therapy, patients often develop a lack of motivation due to no visible significant progress in their mobility functions; causing neglect of the exercises as a result.
• Patients often forget to do the therapeutic exercise daily

And those problems are the gap we want to bridge with FisioMotion.

Our team consists of three individuals who are experienced and skilled in different areas of expertise (Project Management, Product Design, and Software Development). We've work experience in top companies like Deloitte, Shopee, Kompas, and many more. As a team, we have collaborated in numerous national and international competitions together while developing FisioMotion. We eventually raised acc. of €10,000 in funding from several different organizations.

We used user-centered design method in developing FisioMotion. We have conducted heavy research and were able to empathize with ±60 Musculoskeletal Disorder patients. We also partnered with a physiotherapy clinic that led us to understand more about the context of telephysiotherapy situation in Indonesia. Moreover, we also did several expert validations not only in the physiotherapy sector but also in application development and artificial intelligence. Because of our "user-first" approach to development, we were awarded as the 4th winner in the biggest user experience design competition in Indonesia.

As for now, there is no particular app to help physiotherapists-patient in Indonesia. If a patient needs help with their exercise, they have to do an offline consultation with their physiotherapists where the physiotherapist will give direct feedback right at the moment the patient is doing the exercise. The same goes with your personal exercise, you have to do it on your own, without knowing whether you’re doing it right and properly or not. 

However, to do an online consultation, especially during the pandemic, most physiotherapists use WhatsApp or Zoom to monitor the progress of the patient’s exercise. These methods (Zoom and WhatsApp) are widely used in Indonesia and are easy to use. Not only physiotherapists, these methods are commonly utilized to help online consultations with patients. As for the gold standard, it depends on the physiotherapist where the physiotherapist will give you instructions and corrections regarding the exercise. In short, the gold standard is that the patient does all the exercises given by the physiotherapist correctly and efficiently (in number, 100%).

Moreover, about the gold standard, the key to physiotherapy patient recovery is the accuracy and the consistency of the exercises. If they’re doing the exercise incorrectly, it’ll worsen their physical condition. Moreover, the principle of your body is working well when you’re doing it consistently, where your body is getting used to your exercise.

The target is to achieve consistency and accuracy of the exercise. It’s hard to achieve because patients sometimes forget to do the exercise, and they don’t always have a physiotherapist to guide and correct them in real-time anywhere, anytime to help the exercise.

We are partnered with and under the supervision of Vocation Wellness Center University of Indonesia. We're currently working on producing more datasets of therapeutic exercises. We also aim to test our first prototype in the Vocation Wellness Clinic's environment.