Mymobility lets Joint Implant Surgeons patients work on their recovery from the comforts of their phone.

After a total hip replacement late last year, New Albany resident Barbara LeVeque never went to physical therapy. Instead, her “therapist” came to her in the form of an Apple Watch app being used in a nationwide study to determine if there’s a better way to prepare patients for joint replacement surgery and guide them through rehabilitation.

LeVeque’s surgery center, Joint Implant Surgeons in New Albany, is one of nine group practices in the nation to participate in the Zimmer Biomet Mymobility clinical study, which could enroll up to 10,000 participants. Warsaw, Indiana-based Zimmer Biomet manufactures joint devices and is funding the study.

The watch alerted LeVeque to pick up rugs and remove other tripping hazards prior to surgery, and it reminded her about other to-dos before she went in.

“Surgery can be scary, and there’s a lot to remember,” she says. “They give you a lot of paperwork beforehand, and there’s a lot to think about. The fact that it came to me through my phone was really helpful.”

Joint Implant Surgeons is involved in the study’s first phase, which will determine how user-friendly the app is and answer other mechanical questions, says Dr. Keith Berend, who performed LeVeque’s hip replacement. As one of the largest orthopedic practices in the Midwest by volume, the group could enroll 800 to 1,000 patients, Berend says.

More than 1 million hip and knee replacements are performed annually in the U.S. That number is expected to grow to 3.5 million such surgeries by 2035. Approximately half the cost of a joint replacement arises during the post-acute period, including physical therapy, Berend says.

The new technology has the potential to find what’s best for each individual using data collected before surgery and after. The app measures heart rate, walking patterns, gait, cadence, speed and stair-climbing ability.

It also allows surgeons and other members of the healthcare team to send therapy and education reminders to the watch and receive feedback on potential complications.

Keeping Them Honest

After surgery, LeVeque appreciated that she didn’t have to host a therapist in her home when she wasn’t feeling her best or make arrangements to get to a therapist’s office. “It was nice to have the physical therapist there with me on my phone,” she says.

Knowing she was being monitored “absolutely kept me honest. My husband joked with me that I just love getting an ‘A.’ It was good to have accountability. There was no way I wasn’t going to keep up my end of the bargain.” Research suggests more than half of patients aren’t fully compliant with their physical therapy program, says Tom Pennington, CEO of Physician Rehab Solutions, a Louisville, Kentucky-based company that manages orthopedic rehabilitation for surgeons nationwide, including Joint Implant Surgeons.

The Mymobility technology “can show us exactly what the patient did or didn’t do at home, and that data is powerful. It’s really a road map. There is communication back and forth with the physical therapist and the surgeon so the patient knows they are not alone in the process,” Pennington says. “It’s a personal care plan that doesn’t require a mountain of folders.”

Developers will be able to modify exercise sequences based on patient feedback, says Rob Kraal, vice president and general manager of connected health at Zimmer Biomet. “This gives us a view into a patient’s lifestyle we’ve never had before,”

Having a clearer picture of a patient’s status prior to surgery can help provide a more personalized care plan, Berend says. A 75-year-old diabetic patient may need a strengthening program before surgery and the services of a skilled nursing facility after, for example.

Man vs. Machine

The next phase of the study will compare the Mymobility app with standard physical therapy.

Traditionally, physicians and therapists have used range of motion to gauge a patient’s recovery progress following joint replacement. The study will try to determine if the functional indicators measured by the app are as good or better. Measuring joint function over a long period of time might yield data that could eliminate some office visits and thereby reduce cost, Kraal says.

“The data we are collecting is the real exciting piece. It’s where the real power is,” Berend says.

By running the data backwards, he says it might be possible to fine-tune the physical therapy process so that it benefits even those patients who aren’t wearing a watch that tracks their activities and progress.

Berend and Pennington say they don’t see apps replacing the need for the care physical therapists can provide. “My personal opinion is that it will supplement traditional physical therapy,” Berend says.

Doug Ebner, a physical therapist at Ohio State University Wexner Medical Center, says he finds such technology promising. Typically, patients spend only a couple hours a week with a therapist, and “that’s a lot of time in between. If this keeps them on track, that’s great.”

Ebner says he has some concern about technology and artificial intelligence “minimizing our impact. I think there’s still something about going in and seeing someone face-to- face, and getting that personal reassurance.”

Berend acknowledges some physical therapists might think yet another mobile app focused on health care won’t move the needle much. Others, however, see it as a way to make physical therapy more efficient.

“This is another tool in the bag of tools,” Pennington says.

“Robotic surgery doesn’t replace the need for surgeons. The data we collect will allow us to create more care pathways.”

With the shift toward value-based healthcare rather than rewarding providers for volume, Pennington says, “We want the best, evidence-based outcomes at the lowest possible cost. There’s real accountability here. Those practitioners or facilities with the best outcomes and are the most efficient are the ones patients will be directed to. It’s a kind of survival of the fittest.”