As an attender of many TED events over the years, I often yearned for #physicaltherapy to make the stage on such a universal platform.  My wish was granted through the release of this past March’s TED2015 talk:  #Physicaltherapy is Boring, Play a Game Instead by Cosmin Mihaiu the founder of Mira Rehab, a software platform designed to make physiotherapy fun and convenient for patients recovering from surgery or injury.  I am of the adage that any publicity for #physicaltherapy is generally good so despite my criticism and issues of this talk, I am genuinely thankful that at least our profession had the stage at TED-even for a short stint.

Unlike most 18 minute TED talks, this one clocked in just below 6 minutes and had it been the very video game that Cosmic has invented and wants to engage physical therapy patients, it would have been below a single medicare unit and therefore would have to be billed as group therapy raising the red flags of CMS for audits or simply the PT wouldn’t have even charged. But let’s not let economics get in the way since Mr. Mahaiu whose company is in London is not likely steeped in American 3rd party billing conundrums.

Mr. Mihaiu recounts an accident in his youth in which he broke his arm and once the cast was removed he was “”forced to flex and extend his elbow hundreds of times day for 6 weeks””. He found it boring-thereby taking another six weeks to regain his range of motion. His mother, victimized by frozen shoulder had a similar experience with needing to do exercises at home which she found boring and it took 5 months before she was feeling better.  Admittedly at this stage of the talk, I was intrigued. Unfortunately, he completely lost me with his explicit definition of physical therapy:

 I required physical therapy, a process of doing a suite of repetitive exercises in order to regain the range of movement lost due to an accident or injury. At first, a physical therapist works with patients, but then it’s up to the patients to do their exercises at home. But patients find physical therapy boring, frustrating, confusing and lengthy before seeing results. Sadly, patient noncompliance can be as high as 70 percent. This means the majority of patients don’t do their exercises and therefore take a lot longer to get better. All physical therapists agree that special exercises reduce the time needed for recovery, but patients lack the motivation to do them

Taking a component of what we do and extrapolating as the only thing we do would be like saying the job of a baseball player is to spit tobacco. I am sure the UK physios would take issue with this definition as well but the bigger issue is that we have to eradicate this image that physical therapy is the home exercise and range of motion profession (addressed in this blog previously HERE and HERE).  We can deliberate and debate the differences in the role of a PT in a broken arm and a frozen shoulder but suffice it to say that a patient taking some responsibility for one’s own rehab and being “bored” are not the responsibility of the PT’s.  Doing arithmetic tables, spelling tests, and repetitive memorization are also boring but foundation to something larger-a point completely missed in the talk.

Of course, using video or games in #physicaltherapy is not new or unique. We have been told that PT clinic’s equipment would be replaced by Wii Rehab. While there is clearly some use of this approach (e.g. vestibular), we are already aware that this technology trend was just a fad and that aren’t any PT clinics in Toy’s R Us. Besides, at $400, I highly doubt you will see Mira Rehab’s software as any type of disruptive force in rehabilitation.  I am often reminded that these approaches are simply marketing outpacing research and application.  I sincerely hope Mira’s software stays in the lab for testing for a long time before any market adaptation of yet another attempt to displace PT patients to a substitute or home market.

Maybe one day we will get us a full 18 minute TED talk on how physical therapy is the most undervalued and underutilized system and is a key solution in reducing healthcare costs in musculoskeletal medicine.  And hopefully, unlike Mr. Mihaiu’s home repetitive experience, the presenter can recount their experience with a compassionate, empathetic physical therapist who listened, cared for, used their hands and evidence based skills to enable recovery without the use of drugs, imaging, surgery, or even animated videos.

Thoughts?

@physicaltherapy