Digital physical therapy app OneStep launches fall risk detection using only a smartphone

Physical therapy is undergoing a revolution thanks to technology. With the use of telehealth, sensors and wearable devices, patients can complete entire rehab programs at home, on their own time.

But physical therapy patients typically meet with their therapists for only an hour or two each week, making it difficult for them to measure their day-by-day, real-time progress and get feedback.

OneStep launched in 2019 as an app-based physical therapy service that puts a licensed physical therapist by patients' side and a motion analysis lab in their pocket. Founded in Tel Aviv, OneStep leverages smartphone sensors to continuously analyze walking and functional movement and provide lab-level gait analysis.

The app offers immediate gait detection and analysis for physical therapists and patients along with a personalized recovery plan.

The three-year-old company has now expanded its technology to include fall risk detection capabilities.

Gait can be a key health indicator, and monitoring it can prevent future health problems like falls, Patrick Tarnowski, chief commercial officer at OneStep, said in an interview.

"We know that gait speed, which has been dubbed the sixth vital sign, is able to track how a patient is doing over time," he said.

For instance, when there is a decrease in gait speed or increase in gait variability, it likely indicates an impairment that should be addressed for mobility, safety and overall wellness, Tarnowski said.

It only takes 30 seconds for a gait analysis, no wearables or equipment required, he noted. 

Using OneStep, providers that are alerted of a trend that may indicate increased probability of falls can take immediate action to correct gait impairments, provide assistive devices and implement fall safety education before a medical event occurs, according to executives.

"We can tell the provider through the dashboard about changes in Ms. Jones and indicate that she is likely to fall very soon," Tarnowski said. "We can reach out through the OneStep platform and deploy one of your clinicians to see her in her home. It's exciting for providers because they can move upstream in their care continuum. It's not just being reactive to a fall. The technology doesn’t just notify someone when a fall has occurred but looks at trends that she is going to fall."

The technology is being deployed together with OneStep’s partners, including physical therapy clinics, throughout the U.S. The company works with Mount Sinai, Health University of Utah, APOS Health, Haifa University and smart surgery provider Kinomatic.

Apple has made some strides using smartphone sensors to detect falls. The company's Apple Watch has a fall detection feature, which is connected with the Emergency SOS feature. If the watch picks up on a hard fall and the user is immobile for a minute, it will call emergency services.

But this is still reactive rather than preventive, noted Tomer Shussman, OneStep CEO and co-founder.

"Other companies are still focused on the wellness aspect of musculoskeletal care and pain. Our technology is most applicable to the most severe cases, such as neurological conditions, multiple sclerosis and joint replacement is a huge part, with amputees and severe spine injuries. We're partnering with providers on hybrid workflows where the patient goes to the clinic once a month and then continues remotely in between," Shussman said.

OneStep's database contains over 600,000 walks and 29 million steps analyzed as of May 2022. The company's technology measures 40 parameters of gait to provide evaluations.

The company is seeing "significant traction and uptake" in the U.S., particularly in physical therapy clinics and senior care-at-home companies, Tarnowski said.

More than 120 million Americans require physical therapy for at least three months every year, but only 11.7 million actually get to a meeting with a physical therapist, Tarnowski said. There is an opportunity for technology to help bridge this gap.

OneStep's technology also is generating interest among orthopedic surgeons and in the prosthetics space, he noted.

"Providers are able to quickly document objective measures to help them determine how to best treat their patients with expensive prosthetics," he said, adding that the technology provides objective data to payers that the care being provided or the medical intervention is effective.

Orthopedic surgeons are interested in using the technology for pre- and postoperative care, specifically for hip and joint replacement surgeries, he said. The gait analysis technology gives orthopedic doctors a better sense of how the patient walked before and then after surgery.

Medical device companies also are interested in longitudinal data that look at how a device or prosthetic performs over time.

Digital physical therapy is an area ripe for investment. MSK funding grew sixfold between 2020 ($236 million) and 2021 ($1.4 billion), according to Rock Health's annual funding report. Virtual MSK clinics Hinge Health and Sword Health are now what are called digital health "unicorns" with valuations surpassing $1 billion.

According to the company, OneStep's program has a 75% 12-week retention rate for patients actively engaged in their at-home rehabilitation through the app, which is 40% higher than patients only using in-person physical therapy. OneStep patients are five times more likely to adhere to their PT plan, resulting in a faster, more prominent recovery, executives said.

As musculoskeletal issues are a key cost driver for self-insured employers, it opens up another key market for OneStep.

"Our strategy is to work with payers and employers. We’re just in the early stages of what that looks like today," Tarnowski said.