WHY THIS MATTERS IN BRIEF
In a large trial AI matched and outperformed human physiotherapists and now it’s been put in charge of a major UK NHS clinic.
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In a major first a UK NHS Artificial Intelligence (AI) run physiotherapy clinic is to be rolled out this year in an effort to cut waiting times amid growing demand and staff shortages. The new platform will provide same-day automated video appointments with a digital physiotherapist via an app that responds to information provided by a patient in real time.
It is the first platform of its kind to be approved by the health regulator, the Care Quality Commission, as a registered healthcare provider. Patients seeking physiotherapy for issues such as back pain can be referred to the platform, which is called Flok Health, through a community or primary care healthcare setting, such as their GP. They can also self-refer directly into the service.
The service aims to provide faster care and reduce waiting times and pressure on clinicians, those behind it say.
The Future of AI in Healthcare, by keynote Matthew Griffin
Waiting lists for treatment for musculoskeletal (MSK) problems such as back, neck, and knee pain have grown by 27% in the UK since January last year. According to the NHS website, more than 30 million working days are lost to MSK conditions every year in the UK, and they account for up to 30% of GP consultations in England.
However, some in the industry say that AI cannot yet replicate the skill of a fully trained physiotherapist, and that treatment needs to be nuanced due to the complexity of cases.
The Chartered Society of Physiotherapy (CSP) said the number of physiotherapy posts in the NHS was not keeping pace with demand from Britain’s ageing and increasingly obese population.
CSP health informatics lead, Euan McComiskie, said of the AI clinic: “There is no doubt that more needs to be done to tackle huge NHS waiting lists, particularly for musculoskeletal services and AI has huge potential to be an adjunct to the work of physiotherapists. However, AI cannot yet replicate the clinical judgment and skills of a physiotherapist, who is required to be registered with a statutory regulator, the Health and Care Professions Council (HCPC).”
McComiskie added that physiotherapists manage “increasing complexity in patient presentation and their treatment needs to be individually tailored”. He said: “It is early days to know how much AI can eventually provide clinical decision making and more research is needed … but not at the cost of patient access, safety, experience nor trust.”
Those behind the Flok app, co-founded by the medic and former professional rower Finn Stevenson, say initial trial results show its effectiveness. As part of a series of three-month pilot studies between May and December 2023, more than 1,000 NHS staff suffering from back pain self-referred to an AI physiotherapist for treatment.
All of those surveyed patients from the NHS pilot said their experience with Flok had been at least equivalent to seeing a human physiotherapist, and 57% of patients said they thought the AI experience was better.
Stevenson said: “Our technology means every patient gets a constantly individualised experience and care pathway based on their feedback, symptoms and progress. It’s like having a structured video call with a physiotherapist, but our side of the call is being assembled on servers.”
He added that it was “getting harder” for patients to access physiotherapy, “leaving them in pain and often unable to continue their daily routines”.
Participants in each of the organisations involved in the pilot – NHS Lothian, NHS Borders, Cambridge University hospitals, and Royal Papworth Hospital NHS Foundation Trust – could self-refer themselves to the AI service.
An initial video assessment with an AI physiotherapist was performed to evaluate their symptoms. Once approved for treatment, patients had weekly video appointments. The digital physiotherapist prescribed exercises and pain management techniques, monitored symptoms and adjusted patients’ treatments.
More than four in five participants reported that their symptoms had improved during treatment with the platform. 97% of the patients who self-referred to Flok within NHS Lothian received an automated triage outcome; 92% were immediately approved for AI physio and given access to an appointment that same day; 5% were automatically referred to another NHS service such as a GP.
Data from the trial at Cambridge University hospitals indicated that the digital clinic had helped reduce wait times for physiotherapy. Waiting lists for in-person musculoskeletal appointments increased by more than 50% once the pilot had ended.
Flok is the first and only digital MSK provider to be approved by the CQC, the app founder said. This means that rather than being a technology supplier licensing software to NHS trusts, Flok can directly treat and manage patients on behalf of their trusts. The CQC assesses regulated services at initial registration and then inspects at variable intervals to ensure that all quality and governance requirements are met.
Flok is also the first technology to be granted medical device clearance under MHRA regulations for fully automating the triage, assessment and treatment of back pain.
The system provides autonomous assessment and triage as opposed to diagnosis. Flok uses an automated process to determine whether a patient can instantly have access to physiotherapy appointments or is triaged to another service such as NHS 111 or their GP. Flok has not received any reports of missed red flags from the trials, they said. Stevenson said: “The autonomous triage process is subjected to rigorous continuous testing.”
The AI clinic is scheduled to launch with its first NHS partners this summer, although no specific dates could be provided.
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