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Innovation 'Elevator Pitch':
Spring Active has developed an integrated digital and physical back pain coaching approach for the management of back pain.  We will drive improved efficiency of care for providers whilst reducing costs of delivery.
Overview of Innovation:
Spring Active has developed an integrated digital and physical back pain coaching approach for the management of back pain. Our treatment combines evidence-based clinical approaches with innovative internet and mobile platforms. This early intervention approach will result in reduced waiting times for patients, and enable patients to be in control of their care, having immediate access to self-management leading to improved compliance and improved outcomes. In turn, we will drive improved efficiency of care for providers whilst reducing costs of delivery.

HealthyBack Coach™ is a digital and physical “virtual” service that combines digital screening, HealthyBack™ workbook and remote video consultations with a qualified physiotherapist (Spring Active Back Coach).
 
Here’s how it works:
  • Following referral, Spring Active contact the patient immediately to arrange delivery of materials and consultations – All materials are provided digitally and all consultations are via remote video link.
  • A member of our Clinical Team (Physiotherapist) carries out the remote video assessment & consultations each week for 3 weeks.
  • By week 3 the patient has a recovery plan that’s right for them and the tools to ensure a full recovery.
  • All referrals are registered on digital outcomes in order to record and monitor their improvement over 5 years
This service is designed to improve access at scale, reduce waiting times and reduce costs for healthcare providers, by providing instant access to the expert help & advice needed for an efficient recovery from an episode of back pain.

The Spring Active programmes involve exercise and educational sessions, with an emphasis on working towards purposeful individualised goals and developing skills to improve back pain in the long term. In order to support long lasting improvements and functional gains the patient will also go through digital outcomes measures for 5 years.
 
Our programmes focus on self-management improvements through identifying unhelpful pain beliefs and behaviours, providing tailored exercises to improve movement and body awareness, psychological support and practical coping and problem-solving strategies.

Our programmes have been developed in line with Spinal Taskforce and NICE guidelines.
Stage of Development:
Close to market - Prototype near completion and final form may require additional validation/evaluation and all CE marking and regulatory requirements are in place
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Innovation 'Elevator Pitch':
Spring Active has developed an integrated digital and physical back pain coaching approach for the management of back pain.  We will drive improved efficiency of care for providers whilst reducing costs of delivery.
Overview of Innovation:
Spring Active has developed an integrated digital and physical back pain coaching approach for the management of back pain. Our treatment combines evidence-based clinical approaches with innovative internet and mobile platforms. This early intervention approach will result in reduced waiting times for patients, and enable patients to be in control of their care, having immediate access to self-management leading to improved compliance and improved outcomes. In turn, we will drive improved efficiency of care for providers whilst reducing costs of delivery.

HealthyBack Coach™ is a digital and physical “virtual” service that combines digital screening, HealthyBack™ workbook and remote video consultations with a qualified physiotherapist (Spring Active Back Coach).
 
Here’s how it works:
  • Following referral, Spring Active contact the patient immediately to arrange delivery of materials and consultations – All materials are provided digitally and all consultations are via remote video link.
  • A member of our Clinical Team (Physiotherapist) carries out the remote video assessment & consultations each week for 3 weeks.
  • By week 3 the patient has a recovery plan that’s right for them and the tools to ensure a full recovery.
  • All referrals are registered on digital outcomes in order to record and monitor their improvement over 5 years
This service is designed to improve access at scale, reduce waiting times and reduce costs for healthcare providers, by providing instant access to the expert help & advice needed for an efficient recovery from an episode of back pain.

The Spring Active programmes involve exercise and educational sessions, with an emphasis on working towards purposeful individualised goals and developing skills to improve back pain in the long term. In order to support long lasting improvements and functional gains the patient will also go through digital outcomes measures for 5 years.
 
Our programmes focus on self-management improvements through identifying unhelpful pain beliefs and behaviours, providing tailored exercises to improve movement and body awareness, psychological support and practical coping and problem-solving strategies.

Our programmes have been developed in line with Spinal Taskforce and NICE guidelines.
 
Stage of Development:
Close to market - Prototype near completion and final form may require additional validation/evaluation and all CE marking and regulatory requirements are in place
WMAHSN priorities and themes addressed: 
Wellness and prevention of illness / Digital health / Person centred care
Benefit to NHS:
Back pain is reported to be the largest cause of disability in the world. This has a huge impact, both on the economy with lost working days, and on the health systems trying to cope with demand leading to long waiting lists and high healthcare costs. Although the web is often the first port of call for people, with “back pain” the number one searched for complaint, web advice is patchy and often not evidence-based. It is estimated that those in chronic back pain consult their doctor up to five times more frequently than others according to the National Office of Statistics and that those with back pain have health care expenditures approximately 60% higher than individuals who do not suffer from back pain.

Our treatment combines evidence-based clinical approaches with innovative internet and mobile platforms. This will result in reduced waiting times and enable you to be in control of your care. Having immediate access to self-management leads to improved outcomes.
  • No waiting times – the patient has immediate access to evidence-based treatment.
  • An integrated digital and physical back pain coaching approach for the management of back pain – the flexibility of a digital format with the reassurance of a real professional healthcare provider.
  • Allows the patient to be in control of their care with a self-management approach.
  • Immediate access to self-management leading to improved compliance and improved outcomes.
  • Improved efficiency of care for providers whilst reducing costs of delivery.
Initial Review Rating
4.60 (1 ratings)
Online Discussion Rating
5.25 (4 ratings)
Benefit to WM population:
As a West Midlands based SME, adoption of the HealthyBack Coach within the region would allow the company to grow and take on additional specialist staff. Our current forecast suggests the creation of 45 jobs over the next 5 years in software engineering, e-commerce agencies, HealthyBack physiotherapists and sales and marketing.

Reduction in travel for patients (reduces pressure on the region’s transport infrastructure) a reduction in pressure to the primary Care system.
Current and planned activity: 
Due to lack of progress within the NHS Spring Active is currently trialling and developing the HealthyBack Coach in 2 areas;
  1. Direct to consumer trial – this is providing the opportunity to gather user feedback and develop the approach to suit the patient
  2. Trials with large insurance companies to provide HealthyBack Coach direct to client company employees
Procurement / Adoption of: - Require assistance with marketing to CCGs and commissioners.   
Spring Active is keen to work with NHS to develop case studies in order to demonstrate financial benefits specific to the NHS and support the develop of care pathways for the management of back pain.
 
 
Return on Investment (£ Value): 
N/A
Return on Investment (Timescale): 
N/A
Ease of scalability: 
2
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Innovation 'Elevator Pitch':
STarT Back utilises an innovative tool to screen patients according to their risk of persistent lower back pain disability. Ensuring their management is supported in primary care offering more effective and targeted physiotherapy treatment. 
Overview of Innovation:
STarT Back provides:
  • A simple prognostic screening tool used in primary care settings (GP / Community Physiotherapy) allocates patients to 3 risk groups (low, medium or high risk of persistent disabling problems)
  • Matched treatment pathways according to prognosis
    • Low risk treatment  - evidence-based consultation, simple messages about pain relief, exercises, written and verbal information – discharged after 1 session
    • Medium risk treatment – evidence based physiotherapy to reduce pain/disability, supporting patients to stay at or return to work – 4/5  physiotherapy sessions
    • High risk treatment – psychologically informed rehabilitation delivered by trained physiotherapists aimed at pain management, reducing disability and distress – up to 6 sessions
  • Improved clinical outcomes, patient satisfaction, reduced time off work
  • Reduced health care and societal costs
  • Prognostic screening tool guides clinical decision making – available in electronic and paper format
  • Training packages for primary / community and secondary care health practitioners to deliver targeted treatment
  • Resources available via website to support implementation – commissioners, clinicians and researchers (see website: http://www.keele.ac.uk/sbst/)
  • Supports review of clinical pathways for the management of back pain
In addition the following resources are readily available to any team wishing to implement stratified care for low back pain:
  • Established training course for physiotherapists in matched treatments
  • STarT Back website providing adoption and spread information on the roll out of the project across the West Midlands region and nationally through AHSN to AHSN working
  • Web resources supporting business case development, training, audit
  • Patient satisfaction audits
  • Audit of clinical pathways
  • Integrated IT platform for STarT Back within GP clinical systems
  • System to support automated referral to physiotherapy for medium/high risk material
  • High quality patient information to support self-management
  • GP resources to support consultations in primary care – available via website and patient.co.uk
  • Validated musculoskeletal patient reported outcome measure (MSK PROM)
Target groups are: general practitioners, physiotherapists, patients, commissioners, providers of musculoskeletal services.
 
Stage of Development:
Market ready and adopted - Fully proven, commercially deployable, market ready and already adopted in some areas (in a different region or sector)
WMAHSN priorities and themes addressed: 
Long term conditions: a whole system, person-centred approach / Wellness and prevention of illness / Education, training and future workforce / Person centred care
Benefit to NHS:
Low back pain (LBP) is the number one cause of years lived with disability worldwide (Global Burden of Disease). In the UK, 9% of adults consult their GP for LBP annually, accounting for 14% of consultations and an estimated annual cost to the NHS of £4.2 billion. Over 60% still report pain and disability a year later and up to 7% will develop severe persistent symptoms leading to high levels of re-consultation, work loss, and sickness certification.  In the UK low back pain is predominantly managed in primary care and yet there is wide variability in care in general practice. Implementation of STarT Back ensures that patients are directed to the right treatment at the first point of consultation. This approach of stratified care for LBP has been shown to improve patient outcomes and quality of life, reduce costs and days lost from work and reduce variation in practice. This translates into health and societal cost saving (est. £35 and £675 per patient); reduced physiotherapy wait times; reduced re-consultation; reduced sickness certification; less onward referral and imaging; up-skilling physiotherapy workforce.  The STarT Back trial identified broader health and social care savings including: reduction in the number of GP consultations, reduction in the number of visits to NHS consultants, reduced investigations (MRI/x-rays), reduction in epidural injections and medication usage (Whitehurst et al, 2012). Early STarT Back audit data shows “low risk” patients are being discharged earlier, reducing follow up rates in physiotherapy services and only 1% of patients being referred onto specialist pain services.
www.keele.ac.uk/sbst
Online Discussion Rating
4.80 (5 ratings)
Initial Review Rating
4.60 (1 ratings)
Benefit to WM population:
As above - stratified care means that individuals are directed to the right care at the right time, meaning individuals can return to work and manage their back pain reducing the amount of time that they are unable to work.  A healthier region is a wealthier one. 
Current and planned activity: 
Digital innovation: e-STarT Back tool currently integrated into GP clinical systems with associated self-management materials (available via patient.info) and auto-populated referrals for physiotherapy in accordance with care pathway.

Opportunity
Looking into the development of a patient App to support the STarT Back approach and provide patients with a further support system. PPI involvement will be used in the development of the APP and the review of patient information given within the GP consultation.
Potential development to support physiotherapy training.
Potential development to support occupational health departments.
What is the intellectual property status of your innovation?:
The STarT Back tool is a licensed tool ( ©2007 Keele University) that may not be modified.The copyright (©2007) of the STarT Back Tool and associated materials is owned by Keele University, the development of which was part funded by Arthritis Research UK:
i) the tool is designed for use by health care practitioners, with appropriate treatment packages for each of the stratified groups;ii) the tool is not intended to recommend the use of any particular product. For futher information please see http://www.keele.ac.uk/sbst/  
No license is required for non-commercial use.  If you would like to incorporate the tool in any way into commercial product materials, please contact Keele University for further advice.
Return on Investment (£ Value): 
high
Return on Investment (Timescale): 
1 year
Ease of scalability: 
2
Regional Scalability:
WMAHSN has worked in partnership with Keele University to support the rollout of STarT Back. Across the region GP practices/CCGs/physiotherapy service providers have worked to review care pathways to integrate the latest evidence for low back pain (STarT Back) into clinical practice. WMAHSN funded project management/clinical expertise to support engagement & training of healthcare professionals to adopt a stratified care approach to managing back pain. Care pathways have been negotiated with local CCGs/provider Trusts to support the roll out of this approach with the installation of the STarT Back screening tool into GP computerised consultation systems which “pops-up” each time someone consults with back pain. AHSN funding supported this change management/ training activity. The project plan also includes embedded audit to support evaluation of implementation of the STarT Back approach. This WMAHSN programme supported 15 CCGs/15 Provider Trusts to implement STarT Back into practice
Measures:
A series of measures around the use of the stratified care approach can be undertaken, these include:
  • Use of the SB tool to improve accuracy in matching patient to treatment
  • Ensure patients receive appropriate treatment by a skilled physiotherapist
  • Avoid over-treating patients (in low risk category)
  • Provision of patient information via patient.info
  • Improve pain and functions scores
  • Gain high patient satisfaction via a friends and family test
  • Reduce waiting times for routine and urgent physiotherapy appointments
  • Improve the discharge reporting process
  • Reduce the number of patients being referred on for a second opinion/diagnostics 
Individual service providers may undertake audits to support change in practice. This has been undertaken successfully in North Staffordshire and Worcester.
Adoption target:
It is anticipated all regional CCGs/Trusts will implement STarT Back endorsed by NICE Guidance/Pathfinder project. Other AHSNs are expected to embed a stratified care approach in the next 2 years areas of NWC AHSN are mandating the use of the tool across musculoskeletal pathways. International adoption Australia, Denmark, Scandinavia, Canada, USA 
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Innovation 'Elevator Pitch':
AposTherapy can reduce elective care waiting lists and costs significantly, whilst maintaining excellent clinical outcomes and patient satisfaction. For the CCG's/ Trusts with long waiting lists it will be a game changer.
Overview of Innovation:
AposTherapy technology is not new science. AposTherapy incorporates traditional concepts used in physiotherapy and surgery and puts it all into one easy to use device. AposTherapy methodology is based on changing the forces working on the joints and increasing proprioception through controlled instability. By doing this the biomechanics of movement can be changed whilst new/forgotton neuromuscular pathways can be formed.
For example, a patient who has medial knee osteoarthritis is likely to have varus knee alignment, increasing the adductor moment on the knee - therefore increasing pain and difficulty with movement/ weightbearing. AposTherapy can reduce this adductor moment to allow soft tissue around the joint to work in a more efficient way.
Gradually through frequent short daily usage (like slippers) the body will learn better improved movement patterns/ motor pathways, so even when not using AposTherapy the improvements will be maintained. This incorporates functional rehabilitation and self-management techniques.
 
Compliance to treatment is exceptionally high due to the immediate pain-relieving effects of the device.
The AposTherapy device is a footworn pair of shoes, with convex components in specific positions - depending on the patient’s mobility, irritability and severity of symptoms - so it is completely individual to each patient.
 
Patients are screened over the phone for suitability, and then fully assessed by a physiotherapist using internationally recognised PROMS, spatio-temporal gait analysis and traditional physiotherapy assessment techniques. If the treatment is a suitable option for the patient then they will enter into an initial year plan, with 5-6 follow ups spread across 12 months to work towards their goals. At each follow up all outcomes and the device are reassessed and progressed as required.
 
During follow up years we expect patients to receive follow ups for maintenance / continued improvements.
 
AposTherapy is both a Product and Service - as the device is only fully effective through attendance to follow ups and following a treatment programme. Throughout treatment, patients will receive ongoing advice on pain management and graded exercise.
 
Intended patient group size is at least 50% of patients who meet criteria for hip/ knee replacement surgery.
Stage of Development:
Market ready and adopted - Fully proven, commercially deployable, market ready and already adopted in some areas (in a different region or sector)
WMAHSN priorities and themes addressed: 
Long term conditions: a whole system, person-centred approach / Education, training and future workforce / Wealth creation / Innovation and adoption / Person centred care
Benefit to NHS:
-Reduced spend in this pathway. If less patients are requiring hip and knee replacement surgeries - and are being treated at 1/3 of the cost of surgery then funds saved here can be diverted to other areas, improving other pathways and not just this one MSK pathway. It also means waiting lists for surgeries have a better chance of meeting 18 week pathways.
-Improves skills of the physiotherapist work force by teaching them specialist gait analysis skills, and the implementation of a new treatment.
-Reduced GP/ healthcare professional visits
-Reduces analgesics consumption/ prescription
-Help with the fight against increasing antibiotic intolerance by reducing the number of surgeries
- Reduce obesity by reducing lower limb joint pain in this population to allow them to be more active
-More free beds
- Reduce antibiotic use as reduced risks due to reduced surgeries.

For Patients:
-Significantly improved pain and function in the long term,
-Greater understanding of their condition and persistent pain
-Allowing for improved self management techniques.
-An overall improvement in Quality of Life
-Avoidance of surgery in many cases.
-Reduced need to visit GP/ healthcare professionals
-Reduced intake of analgesics
 
Initial Review Rating
3.40 (2 ratings)
Benefit to WM population:
AposTherapy is able to provide a long term solution to persistent pain conditions, a key part of this is the immediate change in symptoms that patients feel when using the device, encouraging them to comply with the pathway.
-Non invasive,
-Produces excellent clinical results
-Has high patient satisfaction
-Is 1/3 of the cost of surgery
-Doesn't have the risks of surgery
-Doesn't have the waiting lists of surgery
-Free's up funds from this population to be used in other areas
-Risk Model ensures that for patients who do defer to surgery (<25%, as low as 9%)- Apos provides a proportional refund
-The effect size of Apostherapy for the OA hip/knee population is comparable to joint replacement surgery
Current and planned activity: 
Bedfordshire and Greenwich CCG- via Circle Health - treatment is prescribed to patients with hip and knee osteoarthritis - Circa 450 patients - ongoing
MECCG - Treatment is available for patients with knee osteoarthritis - follow ups for the next 3 years - Circa 250 patients
In the private market we have a network of independent physiotherapy/ multidisciplinary clinics providing AposTherapy for any suitable MSK condition of the lower limbs and lower back pain.
What is the intellectual property status of your innovation?:
IP is owned by Apos Global Assets the parent company 
Return on Investment (£ Value): 
Very high
Return on Investment (Timescale): 
0-6 mon
Ease of scalability: 
2
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