'Telerehab' system allows patients to do physiotherapy at home

Mr Chin Tian Loke tries the Smart Health TeleRehab system as Senior Minister of State for Health Chee Hong Tat (centre, in red)  watches.
Mr Chin Tian Loke tries the Smart Health TeleRehab system as Senior Minister of State for Health Chee Hong Tat (centre, in red) watches.ST PHOTO: MARK CHEONG
Mr Chin Tian Loke, 72, trying out the Smart Health TeleRehab system.
Mr Chin Tian Loke, 72, trying out the Smart Health TeleRehab system.ST PHOTO: MARK CHEONG
Mr Chin Tian Loke, 72, trying out the Smart Health TeleRehab system.
Mr Chin Tian Loke, 72, trying out the Smart Health TeleRehab system.ST PHOTO: MARK CHEONG

SINGAPORE - It is a Friday afternoon and Mr Chin Tian Loke, 72, is watching a video on an iPad Air in his five-room flat in Jurong West. He mimics the movements of the person on screen, lifting his arm, which has a sensor attached to it at a 90-degree angle. A voice from the iPad then congratulates him: "Spectacular!"

It appears as though Mr Chin, a retired odd-job worker, is playing a game. But he is actually undergoing rehabilitation therapy, to help him gain strength in his limbs after he fell and broke his spinal tail bone in November last year.

Mr Chin is one of the first to try out a novel healthcare system, announced on Friday (May 5) by healthcare technology agency Integrated Health Information Systems (IHiS).

The system aims to make physiotherapy as painless as possible: by allowing patients to exercise at any time of the day, within the comfort of their own homes. This removes the need for a patient to commute to and from a rehabilitation centre and hopefully, boost participation rates in attendance for rehabilitative therapy, which would then prevent the chances of re-admission to hospital. As National University of Singapore's Associate Professor Gerald Koh, who pioneered the system, noted: "Often, the reason why a patient needs therapy is the reason why the patient finds it hard to go for therapy."

The solution is technology.

All that is required is an iPad and two sets of sensors - which will be loaned to the patient by the healthcare institution - and an open mind.

Believed to be the first of its kind,Smart Health TeleRehab, as the system is known, will enable Mr Chin's physiotherapist from Touch Home Care to keep tabs on his exercise regime remotely. Each exercise session will be automatically recorded and saved to a digital cloud, which his therapist views within two working days.

If a patient has completed the prescribed exercises successfully, the physiotherapist can increase the difficulty of the exercises at the touch of a button. If not, she will call Mr Chin to guide him on the right way to do the exercises. If further explanation is required, the physiotherapist will pay him a home visit within the week.

Smart Health TeleRehab is currently being used by 11 patients at two healthcare providers - Touch Home Care and NTUC Health. But 12 more -including Changi General Hospital, Khoo Teck Puat Hospital, and SPD (formerly known as the Society for the Physically Disabled) - will come on board by the end of this year (2017), as Singapore ramps up programmes in line with its Smart Nation ambition.

An estimated 1,000 patients are expected to benefit from the pilot programme by the end of next year (2018). IHiS' latest initiative follows its April roll-out of a video call system for medical consultations to six public healthcare institutions that enables patients to consult experts from the comfort of their homes.

Mr Chee Hong Tat, Senior Minister of State for Health, visited Mr Chin on Friday at his home to see how the Smart Health TeleRehab system could be deployed. He said: "Smart Health TeleRehab could transform how therapy services are delivered in Singapore. Patients will benefit from greater convenience, cost savings and better outcomes. Therapists and therapy service providers will also benefit from the productivity improvements."

The cost of Smart Health TeleRehab sessions depends on the various healthcare institutions, and the subsidies that a patient qualifies for.

As a gauge, at Ang Mo Kio Thye Hua Kwan Hospital, which will run the programme from next month (June 2017), a patient can expect to pay between $3 and $50 for one Smart Health TeleRehab session. In comparison, a patient has to pay more than $80 for one treatment session at the centre (excluding transportation costs, which could go up to $75 per way), or more than $160 for a therapist to visit him at home.

Singapore's therapists too, will benefit from productivity gains. In 2016, there were about 2,570 occupational and physiotherapists here. However, figures from the Health Ministry show that 53,000 patients had to undergo physiotherapy in 2014 - and the health authorities are only expecting this number to grow over the years as the population ages.

An initial study led by Prof Koh found that the system could help therapists reap productivity gains of more than 30 per cent. A telerehab session, on average, takes about 52 minutes. A therapy session conducted in the patient's home, however, could stretch up to almost 80 minutes. So in the time that a therapist usually takes to see three patients the conventional way, the therapist can see four patients instead via the TeleRehab method.

Smart Health TeleRehab may not be suitable for all patients, such as those who have diabetes or other complications.But with more patients on the technological platform, it frees up therapists so they can have more face-time with more needy patients.

Singapore Management University's (SMU) School of Information Systems' Associate Professor Tan Hwee Pink volunteers with the Stroke Support Station (Singapore) and has an elderly father recovering from a complex hip fracture after a road accident last year. He welcomed the new platform as a timely one.


Despite the benefits, however, he pointed out that most patients recovering from an accident or stroke would have weakened mental strength. "This needs to be addressed for the patient to be motivated to do the rehab at home. As we know, patients tend to do what they are told in a controlled environment, but not necessarily so when they are in the home environment," he added.

One possible way to do this is to allow more functions to be used on the iPads, such as watching TV or making calls, for example, he suggested.

Professor Atreyi Kankanhalli, from the department of information systems at the National University of Singapore's School of Computing, said the TeleRehab method also give patients a greater sense of autonomy and control, as they can do the rehabilitation exercises on their own. She added: "With the increasing incidence of chronic diseases, shortage of healthcare professionals, and yet the availability of more intelligent technologies, healthcare is a prime sector that can benefit from Smart Nation initiatives - in addition to other key sectors such as transport, commerce, utilities, security and education."