Physiotherapy exercises go digital

A new approach to physiotherapy has transformed rehabilitation for NHS patients in Manchester. The digital system, called MIRA, turns exercises into video games, making the therapy fun and easy to follow.

NIHR has supported the GAME study, which is trialling the MIRA system.

Cosmin Mihaiu is the CEO and Co-founder of MIRA Rehab, which was established to help patients to regain their mobility by using clinically guided ‘exergames’. He’s keen to convey the benefits of MIRA:

“MIRA is a medical device that uses motion tracking sensors to gamify physical therapy and increase patient compliance, enabling them to play their way to recovery.

“The system is being used in over 72 institutions worldwide, helping over 600 patients each month for a variety of neurological or musculoskeletal conditions. The patients’ ages range from 3 to 102 years old.

“The software can be programmed in different ways, it’s a tool that physiotherapists can tailor depending on the needs of their patients.

“The GAME study, which is taking place in Manchester, is one of several studies around the world investigating the potential of MIRA. The gaming approach has very wide appeal among patients and there are clear benefits for the NHS too, which we hope GAME will help demonstrate.”

Digital and standard physical therapy working together

Mr Bibhas Roym, a consultant orthopaedic surgeon at Trafford General Hospital, Manchester, is the Chief Investigator of the GAME study. He agrees that there could be many advantages of introducing a product like MIRA to physiotherapy services:

“The main benefit is that it will complement standard physio. The patient can do their exercises at home with the game acting as the guide to make sure that exercises are done correctly. This will create real potential to replace up to one third of live physiotherapy sessions. For example, a patient requiring 15 face-to-face sessions may only need 10 if they use MIRA.

“In addition, when using MIRA, 1 physiotherapist will be able to treat 2 people at the same time by working between 2 gaming stations in the clinic.

“This cuts live physio sessions again by half, which means that more patients can be treated with the same resource. It will mean reduced costs to the system and reduced trips to the clinic for patients.

“Another key benefit is better patient engagement. The gamification principle allows you to set targets and track and compare scores. This incentivises patients to comply with their therapy programmes, but most of all, it’s fun."

Conducting the digital physiotherapy study

The GAME study is an Investigator Initiated Study which is classed as a non-commercial study on the NIHR Clinical Research Network Portfolio.

It received NIHR support to set-up 4 sites and also in the form of Clinical Research Nurse, Amy Barratt, to help deliver the study.

Bibhas Roy believes this support from the NIHR was invaluable and speaks highly of Amy’s involvement:

“Amy is funded by the NIHR and I have to say she is the main engine of the study. We need to recruit a minimum 72 patients to achieve statistical relevance. With Amy’s help we’ve recruited 67 patients so far and the study is open until March 2019 so we are pleased with our progress.

“The recruitment process is challenging because, although pre-consent is achieved in patient consultations, actual patient consent has to be acquired on the day of surgery.

“This means that Amy has to be present whenever I am operating. She is absolutely crucial in gaining that consent. Then, once the consent is acquired, Amy has to complete a system of measurements of movement with each individual patient to establish a baseline before their surgery.

“Amy is flexible and supportive, she fits in well as an integrated member of the clinical team."

Results for digital physio

Although the findings of the study are not ready yet, Bibhas is optimistic about the prospective results:

“The aim of the GAME study is simply to show that MIRA is ‘just as effective’ as standard physiotherapy following arthroscopic subacromial decompression procedure - an operation on your shoulder which is used to treat a condition called shoulder impingement. This is when the bones and tendons in your shoulder rub against each other when you raise your arm, causing pain.

“If we can prove that is the case, and we hope that we can, then the resulting time and resource savings will enable us to extend our physiotherapy services to more patients.

“And there could be real advantages to be gained from introducing MIRA more widely. We already have plans for a further study in the pipeline looking at the prevention of falls in the elderly.”

Related information

Read the related blog: Developing a digital solution for patients to play their way to recovery.