We were so excited to sit down with Laura Joszt of CHE, the first-ever Healthcare Analytics News podcast, to discuss the challenges with traditional physical therapy. Tune in to hear how OneStep improves the proportion of patients who complete their therapy and future uses for the technology being utilized in the app.
To learn more about the OneStep app, click here
* This transcription has been edited from the original format for clarity
Laura Joszt: Hello, and welcome to a brand new episode of Data Book, a Chief Healthcare Executive podcast. My name is Laura Joszt, and I'm the Editorial Director at CHE. Today, Tomer Shussman and Hila Glick of OneStep join me. We discuss how the OneStep app is transforming traditional physical therapy and bringing it into the home, which improves the proportion of patients who complete their therapy, as well as future uses for the technology being utilized in the app. Can you both introduce yourselves, tell us a little bit about the company? Tomer, maybe you want to start?
Tomer Shussman: Great to be here. My name is Tomer and I'm the CEO of OneStep. We founded OneStep almost three years ago - in order to help patients recover and turn physical therapy into a service that is both accessible to everyone while still maintaining the quality of it. We are currently 35 employees, headquartered in Tel Aviv and New York, and we're having fun!
Hila Glick: And I'm Hila Glick, VP of Physical Therapists and Patient Experience. I work at OneStep as a PT and as the head of customer success.
Laura Joszt: Great. Thank you so much. So, you're trying to transform physical therapy. What were the challenges that OneStep was really hoping to address?
Tomer Shussman: When we first started, we saw that physical therapy is a unique field because physical therapists are quite possibly the most dedicated and compassionate people in the healthcare industry. They are doing a great job, but they can only do so much in a day. And when a patient needs to go through the recovery process, they get one hour, maybe two hours of in-person physical therapy at best. And then, they go home -- and then what? They are left alone. They don't know how they're doing. They are not exercising well. Sometimes they are even repeating mistakes. And by the time they've got them back to the next session, they may have already lost motivation. So, this results in many patients quitting physical therapy early. This was the main problem that we were trying to tackle.
Laura Joszt: So, this is an app on the phone. Can you tell me a little bit about how the app works?
Tomer Shussman: Of course. OneStep developed an app-based physical therapy service. So, it's not only an app, it's a whole digital physical therapy service. You meet with a therapist, you have a dedicated physical therapist with you 24/7. And we developed a groundbreaking motion sensor analysis. So, when you just walk or move with the phone in your pocket, or anywhere on you, we analyze the way you move, which helps us translate that data into easy-to-understand scores for the patients and comprehensive gait reports -- or motion reports for the physical therapist.
Tomer Shussman: That way, the patient knows how they're doing. They communicate with their therapists through chats or meet with them, but we are enabling 24/7 communication. And finally, they get a personalized recovery plan consisting of exercises and insights directly into that. We're trying to augment the physical therapist's capacity, allowing PTs to do more, to treat more patients and make the patients feel as if they are with them the whole time, while actually saving the PT time.
Laura Joszt: So, what are some of the key medical conditions that may benefit the most with OneStep?
Hila Glick: While the majority of patients we treat are orthopedic pre-operation and post-operation, it's mostly knee and hip and lower extremity, however, our service is available to anyone. We can work with patients dealing with neurological, orthopedic, chronic or acute injuries. All of these are conditions that can benefit from physical therapy with OneStep.
Laura Joszt: So, how closely do the smartphone capabilities that OneStep has, match what is done in a clinic with more sophisticated medical equipment?
Tomer Shussman: OneStep's goal is not to replace the in-clinic equipment or to replace the in-clinic assessment by a PT. Our goal is to provide 24/7 PT, meaning to augment the therapy and liberate it to go beyond the clinic walls.
Tomer Shussman: We are providing tools that, actually, no PT clinic has. It's not about replacing or mimicking any equipment, it's about providing objective assessment tools for patients and physical therapists from anywhere. And to be honest, the technology that we have is not available for 99% of the professional PTs, which you can say is another interesting factor we’ve got going for us.
Hila Glick: As a PT in the in-person world, OneStep addresses something that's really missing. If someone wants to do a gait analysis, sure, a patient can walk into a lab have it done. But the option to have a lab quality gait analysis using your cellphone in your pocket or anywhere on your clothing, that's something that's only available using OneStep. And that's something that can be really beneficial not only to the patient, but to physical therapists as well.
Laura Joszt: So, you were talking about how patients receive reports, and they receive the information about their gait analysis. So firstly, how does that help them? And second, do patients always understand the information being presented to them? Is there any educational component they need to be able to understand that data?
Hila Glick: Even for a licensed physical therapists, gait analysis can be complicated. It's not easy to understand or even necessarily something that can be implemented right away. OneStep found a way to make it easier for the physical therapist to understand -- and the patient. The patient can view their progress with simplified walking parameters and real-time feedback from their phone. There's significant benefit in getting to see your progress, especially when that progress isn't something that's quite as easy to feel.
Tomer Shussman: When a patient downloads OneStep, the first thing they do is put the phone in their pocket and walk around, taking a few steps. They immediately get feedback. They automatically receive their OneStep Walk Score. This is a number between 0 and 100. Within seconds they know how they're doing and what they need to improve. And then the physical therapist on the other side gets a comprehensive report that they will then use to treat the patient, as well.
Tomer Shussman: Now, in traditional physical therapy, there are no objective tools, and there are certainly no tools to measure day-to-day motion. Physical therapists mainly use pain questionnaires and functional questionnaires. Still, these cannot actually provide objective info on how the patient is progressing, and they cannot be used as good motivational tools. So, by getting this simple Walk Score, it helps the PT build your personalized recovery plans and personalize the whole plan for you, the whole journey for you.
Laura Joszt: And so, the patient is being set up with a physical therapist after they sign up. How does that work...that they're set up with a physical therapist -- and who are these therapists? They're OneStep therapists, correct, it's not the patient's own therapist?
Tomer Shussman: Yes. OneStep pairs you with a licensed physical therapist - and we're growing quickly. We also have some interesting collaborations with clinics outside of OneStep, and we are always very happy to bring the OneStep technology and product to everyone.
Hila Glick: The entire service is from the app. You download the app and immediately record a walk. You schedule on your own time, at any time, to meet with a physical therapist, and get started right away with a relevant and personalized exercise plan and walk assessment, and continue from there.
Laura Joszt: And so, does the data stay with OneStep? Is there a way to forward it on to the patient's doctor that they've been working with?
Tomer Shussman: Definitely. We are also working with surgeons, who the patient can then transfer their information to, or in very special cases, we deliver the data to the surgeon with the patient consent, of course. But interestingly enough, when we founded OneStep, we thought about how there is so much data in the smartphone and there are so many companies who utilize that data to sell you better ads or sell your data to third parties. And it was our goal and commitment to always use the data to help the patient achieve better health first. And so, while we can share that data - we don't transfer any data, even to a patient's doctor, without making sure that the patient owns it first and knows what they're doing first.
Hila Glick: But most patients are very excited to go back to their surgeons for their check-ups and show them their progress in the app. We encourage them to share the different OneStep reports, really seeing how their walk analysis, and their speed, and their symmetry, and everything has improved since their operation.
Laura Joszt: Speaking of that progress, is there information or data that you have on a patient, how long they're using this, and their progress versus not having the app in the traditional in-person clinic?
Tomer Shussman: Of course. We've done that test repeatedly with and without OneStep, over and over. We see that OneStep patients, first of all, are super excited about the app. The combination of having an accessible physical therapist and knowing how you're doing really makes a difference for them. Second, we see that 65% of our patients finish their whole course of care, which is humbly unheard of in the recovery space.
Tomer Shussman: Most patients in traditional physical therapy don't get past meeting three or four, and here we can get two-thirds of our patients to finish the full course of care. For the first time, with OneStep, you can actually measure progress from home without needing a lab. So, we are also seeing that people at home are making almost twice as much progress compared to traditional physical therapy.
Laura Joszt: I know that the app is a 24/7 app, collecting data. So, it's collecting data when the app is open, but it's also collecting data when it's closed and the phone's just in somebody's pocket. So, how does having that continuous monitoring and data collection assist?
Hila Glick: It’s a really interesting question. This is a big issue with gait assessments in general, is what happens when you're aware that someone is watching you. It's like comparing the way you sing out loud when you're driving down the highway, alone in your car, to how you may sing when you arrive at a traffic light and notice a car next to you watching. It's funny, but gait is similar. When you're in a lab with sensors on you, or even if you're aware that your phone is in the pocket and think, 'I'm recording my walk now', I might walk in a specific, and different way. If I'm unaware of that, then I'm more likely to walk naturally. Maybe my steps are smaller, maybe I make a bad turn. I might walk with a very short stance, and those unconscious errors are actually the most important to record. These are the points where a patient can fall later on. How someone moves when they’re not performing is where we’ll find the movements we want to avoid.
Tomer Shussman: We actually have a very interesting study that we are going to publish, I think in the next few weeks, with Dr. David Putrino's group in Mount Sinai and the article is titled Recording Context Matters. What we're showing there is that conscious versus unconscious walks are very different from one another, in several significant parameters. And this strongly relates to what Hila just said, because sometimes patients make progress only when they are aware of the fact that they are walking, and by alerting them and notifying them when they are not aware and they're committing mistakes, that way we can actually accelerate their progress and also get them away from risky situations.
Laura Joszt: One of the things I've seen sometimes is with patients, they get too much data and it can be overwhelming. When they are being monitored 24/7, obviously you get things like seeing how their gait actually is when they're not consciously thinking about it. Do you run into issues though where if there's any concerning areas where you see their gait maybe was really off or something was of a concern, that maybe the patient can't remember what they were doing at the time or what might have caused it?
Tomer Shussman: Most of the time, we are more focused on trends than on individual walks, especially when it comes to background motion. When a patient chooses to record a walk, they have the context and they usually tag that context for us. They tell us whether they were with a cane, without a cane, they were barefoot, et cetera. And with background walks, we are mainly using them not to detect anomalies but to predict the overall trend and understand the overall situation. So, we are also trying not to be too judgmental with a patient that's had one bad walk. This happens to all of us, all the time. Gaining back your ability to walk is a skill, just like gaining any other skill. And sometimes it's better, sometimes it's worse, the bigger picture is what matters.
Hila Glick: Another point that I find surprising is, if I reach out to a patient and mention something about a walk that seemed off, they usually try to remember what that walk was, and very frequently, they'll say, "Yeah, I was walking with my husband. He walks slightly faster. So, maybe that's why my walk seemed different." Because the communication is ongoing, and we see the walks and feedback all the time, 24/7, it's very easy to go back to that patient with the alert that something is off and then understand what the reason was.
Laura Joszt: Finally, I guess, do you see any future potential uses for OneStep and the technology with the app?
Tomer Shussman: Yeah. So actually, it's a funny story because when we founded OneStep, our preliminary goal was to use walking patterns to help detect strokes, brain injuries, in real-time. We realize that when you have a stroke or when you're going through a stroke, your gait pattern significantly changes. And we realized that by doing that, and by monitoring gait from the background, we would be able to help patients get to the hospital sooner.
Tomer Shussman: And we actually developed that technology and we had some interesting studies and it worked in those studies, but then we realized that it is going to take years to commercialize this technology and get all the FDA approvals. And that instead, we could really help by just providing this tool as a recovery tool and use the data that we collect to help perfect the technology. So, the end goal is through the regulatory process so that one day we will be able to also do that.
Tomer Shussman: I would also say that we are addressing ourselves as the e-motion company. Our goal is to help people move healthier. And moving healthier, right now we are focused on physical therapy and recovery, but moving healthier is also about predicting medical emergencies and helping in medical emergencies. So, wherever there is motion, we want to be there. And the other part is, right now we are working through smartphones, but five years from now ... We all have watches or five years from now our TVs might have sensors in them. And so, we are committed to wherever there are sensors and wherever there is motion, we will bring feedback.
Tomer Shussman: In fact, I could summarize our value as OneStep in one word, I would say, feedback. The absence of feedback is really discouraging and good feedback given at the right time can motivate, can help facilitate accuracy, and can make the difference. So, our goal is to use every sensor out there in every motion related condition out there, to provide meaningful feedback.
Laura Joszt: Thank you so much for tuning into this week's episode of Data Book. Make sure you follow us on Twitter @ChiefHealthExec, and on LinkedIn and Facebook. Until next time, I'm Laura Joszt.