Developing a digital solution for patients to play their way to recovery
An elderly man smiles as he guides a twin-engine aeroplane across a blue cloudy sky. The plane changes course as he sweeps his arm in different directions... Today aeroplanes, tomorrow submarines, it’s all in the name of fun. Or is it? The elderly man is a resident at a care home in Manchester, playing a state-of-the-art video game on MIRA, a software application which uses motion tracking sensors to gamify physical therapy, making it fun and easier to follow. This increases patient compliance, which improves patient outcomes, which ultimately has the potential to save NHS resources.
You might be surprised to hear then, that it started off as a student software engineering project in 2011.
Translating technology into a clinical setting
Having bought into the concept of ‘exergames’, my colleagues and I researched what systems were out there and we observed how therapists were using the Nintendo Wii for physiotherapy. However, the Wii games were developed for recreational purposes and were not designed for therapy. We quickly realised that there was great potential for a new system that could be adjusted to meet the needs of patients with different conditions, and with different mobility patterns and abilities.
Next we had to build a prototype to demonstrate how it would work and what it could do. But this was not something that we could achieve on our own as software engineers. It was absolutely imperative for us to work with clinicians in the NHS to understand how our product could function in a clinical setting; what would clinicians and physiotherapists want from it, and how could it could benefit patients?
We began by developing MIRA for upper limb therapy, specifically for shoulder and elbow exercises. Mr Bibhas Roy, a consultant orthopaedic surgeon at Trafford General Hospital, Manchester University NHS Foundation Trust, and a team of physiotherapists provided excellent feedback on how we could build MIRA for shoulder rehabilitation. This ultimately progressed to become the GAME Study which involved MIRA being offered to patients who had undergone shoulder surgery. The study, which is an investigator initiated study, has received NIHR support to set-up four sites in and around Manchester plus clinical research nurse support to help recruit patients and deliver the study activities.
Clinical collaboration is the key
Meanwhile, Dr Emma Stanmore, Senior Lecturer in Nursing, University of Manchester was specifically interested in a product that could help prevent older people from falling. We expanded our work to focus on lower limb and balance exercises, working closely with Dr. Stanmore, therapists and older people to develop MIRA to provide a solution. This turned into a bigger project which, led to a feasibility study, and a Randomised Controlled Trial – the results of which have recently been published.
I cannot emphasise enough how important the clinical expertise has been in our journey. They are the people who are delivering the health service, their knowledge is an invaluable resource to ensure a product is improving care and delivering better outcomes. MIRA would not have grown to be used in so many different clinical environments if we had not had that vital clinical input. Working with multiple clinicians and organisations has been crucial in helping us to build and develop MIRA to meet the needs of so many different and diverse patient groups.
Each round of feedback from the end users has helped to improve the product. As a result MIRA has grown into a complex software package, with different features that therapists and clinicians can utilise during therapy sessions with their patients. It is now being used in a variety of clinical settings; from inpatients to outpatients, from sport schools to care homes, for a range of conditions from musculoskeletal to neurological, with patients from as young as three to as old as 102 years.
Support throughout the product development pathway
For a small medical device company like ours, just starting out, if can be difficult to know how to engage with that crucial clinical expertise for the first time. We now know that the NIHR specialises in connecting MedTech companies with clinical experts to help translate ideas and innovations into the clinical setting. Then once the idea is ready, the NIHR can also help to design and deliver research to generate clinical evidence demonstrating that your product is safe and effective, and also a cost-efficient treatment option.
It has been a fascinating journey so far which is about to become even more interesting. This month MIRA and I were absolutely thrilled to be awarded an NHS Innovation Accelerator (NIA) Fellowship - a scheme which supports individuals to scale their innovations for greater patient and population benefit. It’s a real milestone for my company to receive this recognition and as I reflect on how far we have come since 2011, the one thing that stands out for me, more than anything else, is just how important that clinical expertise and collaboration has been.
The views and opinions expressed in this blog are those of the authors and do not necessarily reflect those of the NIHR, NHS or the Department of Health and Social Care.