Evidence-Based Digital Pill

Digital therapeutics (DTx) is a black horse of digital health. Following available medical research, a new generation of software and apps help the patients to prevent, manage and treat physical and mental disorders. Back pain therapy kaia is one of the best examples in this field. An interview with Stephan Huber, Chief Medical Officer at Kaia Health.

In the ’80s, people were buying video-cassettes with Jane Fonda workouts to stay fit. Today there are apps. Is it only a slight change in technology or a brand new concept of fitness and health?

I think, at first we need to distinguish between medical and fitness use cases. Even though they have certainly been converging and the same technology is expected to affect both. Exercise and so-called mind-body therapies based on physical movement and mindfulness have gained their reputation as effective methods for managing many chronic medical conditions. There are recent guidelines from well-recognised medical societies that recommend exercise or yoga as first-line therapies for the management of low back pain before even trying medications. That development certainly has extended the concept of exercise and mind-body therapies well into the medical space. When it comes to fitness or prevention, apps and associated technology for home-based use have indeed reached an audience so broad that was inconceivable for video workouts to reach back in the day. The convergence of science, technology but also overall trends towards active lifestyles in some parts of the population have greatly expanded the horizon of exercise for medical, as well as fitness use.

Digital Therapeutics (DTx) offer better access to medical services, delivers knowledge empowering patients to exercise at home. But doesn’t rehabilitation need a human touch?

I think we should emphasise that we do not see digital solutions as a general replacement but rather an extension to conventional rehabilitation. There is so much demand that cannot be met at the moment. Many studies have shown, for example, that only a tiny fraction of patients that would profit from multidisciplinary rehabilitation for back pain are treated in this way. And that is only one of many potential examples for lack of conventional rehabilitation to meet actual demand. So the question is: How digital rehabilitation can cooperate with any kind of provider to generate scalable access so the demand can be met? And – at the same time – how to achieve good results in relevant outcomes, including patient satisfaction?

We see excellent results when digital tools are combined with either chronic care coordination programs or coaching. These programs involve extensive human interactions. Generally, digital rehabilitation tools also provide excellent results when recommended by trusted providers like in primary care. So generally, approaches that include this human touch seem to work well for patients, and at the same time, such solutions would extend access to rehabilitation.

Apps combined with sensors are called “the digital therapists in the pocket.” Do these online therapists are convincing enough to motivate patients to take more significant responsibility for their own physical condition?

I think many factors suggest that DTx is indeed pushing many patients to play a more active role in the rehabilitation of their condition. Both study results and also market uptake suggest this. Recent studies show a positive effect of these apps on disease-relevant parameters as compared to control groups. The increasing uptake of these therapies and the number of users we observe is also encouraging. It shows how many people affected by a condition, like back pain, are actually willing to take a more proactive role.

Back pain is one of the most common complaints associated with a modern lifestyle. Patients often look for quick help, so they take medicines or expect from the doctor “to do something”. Why should they believe in a therapeutical value of the Kaia app? After all, it doesn’t offer any shortcuts, instead requires self-engagement, self-motivation and time… 

We see that clear communication of the actual effectiveness of digital therapies is convincing. Quick-fix treatments for back pain are undoubtedly desirable from a patient perspective. But for example, an injection is usually not going to cure a lifestyle-associated condition for more than just a brief period. A stable change in habits like embracing exercise and gaining insights into the real causes of the disease has proven to be more effective in the long-term. Guidelines, like the most recent on the management of back pain by the American College of Physicians, also recommend this approach. It is not only less harmful but also more effective. Based on these facts, patients can be convinced that they will have to manage the disease themselves if they want the best chances for enduring recovery.

Is the DTx the future of rehabilitation? 

DTx will be an addition to many fields of current healthcare and rehabilitation. Rehabilitation works best when steady habits are induced. Healthcare providers do not have enough time to help all the patients to build these critical habits over a long period. Especially when patients are in a home setting. Furthermore, there are considerable constraints on the availability of healthcare professionals involved in rehabilitation, especially in rural areas. Technology can undoubtedly help current systems to provide scalable and enduring access to rehabilitation. We are just at the beginning of this development. But I can imagine that digital therapeutics will soon manage many cases that are straightforward and have a low-risk profile. This will help to free the hands of professionals so they can focus on the cases where they are actually needed.

Kaia is an example of a startup that has succeeded to scale-up quickly. A good idea, team and strategy were crucial. What’s more?

It is essential to understand the problem you are trying to solve. This works best by integrating relevant stakeholders in the ideation phase but also in the later stages of the life-cycle. It’s crucial to listen to all stakeholders. The scale of the problem one is trying to tackle certainly also adds extra visibility. Low back pain, the first disease that we developed a digital therapeutic for, is considered to be one of the leading factors for disability and among the leading drivers of healthcare costs globally. That certainly helps to attract attention.

For DTx apps, the most crucial factor is to build trust. People must be convinced that digital therapy is reliable and bases on the best guidelines. How did you manage to do it?

Digital therapies will ideally not reinvent the wheel at first but find a technological solution to provide better access to well-proven principles of management for diseases. It certainly helps to have good evidence and a strong consensus among different stakeholders that the concept of what the DTx is digitising overall is useful. By ensuring this, it is feasible to simultaneously convince many medical stakeholders and patients at the same time. And this is the best way – convince healthcare professionals and patients alike, so doctors are ready to recommend a digital tool.

How do you manage to improve the user experience?

We are constantly in touch with our users and also other stakeholders like insurances and medical experts. This process helps us to find out what improvements are actually requested by users but also what is needed to create extra layers of safety. A good and constant interplay between customer-related roles, the product management team and other internal and external stakeholders enables us to process these insights into future improvements.

In which way will DTx evolve in the future to better navigate patients and offer personalised exercises?

DTx will undoubtedly evolve from a collection of relevant content that is displayed to the user to a product that includes relevant technological features and will be individualised. The tech features can be a disease-relevant diagnostic feature that personalises the therapy, a tech-feature that improves how content is delivered or that enhances the user experience. Harnessing inbuilt smartphone technology, like sensors or cameras with computer vision, all offer rich potential to pursue such technological features. These features will enable manufacturers to improve outcomes and value as well as to generate stable intellectual property, especially when they will be validated scientifically.

At the end some fire questions…

The principle that Kaia is always following… 

We put our users first.

Three users’ complaints that were most surprising for Kaia:

“The people in the videos are too flawless.” “I de-installed the app because it asked for my e-mail address when creating an account.” “Can you include exercises for feet and toes?”

Digital health or e-health?

Digital health.

A perfect way to build a strong team is…

… to work with people who are mission-driven in the first place.