Back in 2018 I finished my residency and became a doctor of physical therapy with a board specialty in orthopedics, a culmination of 7 years of school. I spent the next few years working and directing different physical therapy clinics, treating one patient at a time, and dealing with the ever changing landscape of healthcare for physical therapists.
The fact of the matter is that healthcare as a whole has not evolved over the years to fit the needs of the patient. Patients who have routine simple problems are put through an endless cycle of tests and referrals until they can receive treatment for something that only required minimal intervention. Most importantly, when a patient finally sees the medical provider, the patient is generally so uninformed that it’s hard for them to make educated decisions about their care.
These problems have led to a severe waste of almost $760 billion dollars a year, frustrated patients, and medical providers that are buried under paperwork for routine and simple fixes.
Just last week I discharged a patient who waited 4 weeks to get the appropriate imaging to diagnose a simple ankle sprain, during these 4 weeks her healing was poor since she didn’t get to physical therapy until she had bad scarring, limited range of motion, and decreased strength; she was too afraid to walk on it the first day I met her. What could have been managed in a 2–3 week treatment plan if managed early turned into a 6 month treatment since we needed to correct for all the time she didn’t receive care. During this time she wasn’t able to play softball or join her team on the podium for winning states.
In 2020 I made the career decision to enroll in App Academy. This was the best decision I could have made to try and impact the healthcare industry. App Academy gave me the skills to build the FulcrumPhysio Application. The goal was to develop an app that can mimic some of the questioning I would ask my patients on an initial visit.
Generally after asking patients a few questions I have a pretty good understanding of what’s bothering them and how I can help. I wanted patients to have this education and knowledge themselves. I wanted them to either be able to help themselves, or come to physical therapy more informed, having taken the correct initial steps to heal.
The final prototype of the application was a physical therapy rehabilitation plan generator that would give a patient a customized diagnosis and plan by navigating a multi-step questionnaire.
I created this application with React and Redux for state management on the front-end with Flask-SQLAlchemy (a powerful Object Relationship Mapper) and a PostgreSQL backend.
The design of the application relied on navigating a complex state tree using a directional graph with a time complexity of O(1) for optimization. Here is a sample of one of the graphs used to help a patient self-diagnose a hip condition:
When the user reaches the end of a line of questioning they are taken to a diagnosis which has the diagnosis name, some exercises they can do to manage the condition, and some education about what’s going on.
The patient having the power and knowledge to help themselves is an absolute game-changer for the healthcare industry. Creating the graphs and logic for graph traversal was challenging but the benefits far outweigh the costs. Even if my previous patient had some understanding of what to do after spraining her ankle she would’ve most likely enjoyed her senior year of softball and returned to function in a fraction of the time.
This application also involved several interesting design decisions. Creating a hoverable human body was particularly challenging. While you can buy an interactive human body I opted to create my own. I managed to make the hoverable effect by painstakingly clipping divs of different sizes and adjusting the margins and height and width of each to math exactly with the image of the body I used. After layering these divs on top of one another I added the transition and hover effects to make sure it was visually smooth.
Now this is far from done, in fact at the time of writing this article I have the graphs completed and implemented for only the hip and shoulder (each graph requires hours of labor and a small team of therapists to determine the correct questions), but this is an excellent start to having more independent patients that can manage their own health before or while going to see a medical provider.
This application was the culmination of years of work, effort, and frustrations, and it would be great if you can try it out and let me know what you think.
If you feel like there are any features that could be added or modified I’d love any feedback. These types of projects are absolutely critical to progress in healthcare and while this is just a starting contribution I’m looking forward to any pull requests or collaborators. As I make this transition from healthcare to software engineering I would appreciate it if I can be kept in mind for any exciting job opportunities that could help me utilize my skills to make a significant difference for people greater than just one person at a time.
If you’re interested in some interesting code snippets or would love to check out and contribute to the project for yourself please check out the repo below!