msk physiotherapy device


  • COVID 19 propelled digital adoption of digital health technologies 
  • Private insurance companies are adopting digital tools faster than any public system
  • re.flex & NN Insurance Partnership in Romania
  • Educating patients and meeting their orthopedic doctors
  • Why the involvement of private insurance companies will speed up the adoption of digital 
COVID 19 propelled digital adoption of digital health technologies

2020 will most probably be remembered as the year of the Covid pandemic. It was a year full of uncertainty and doubt. A year full of restrictions and maybe one the most difficult times in history for healthcare professionals and healthcare in general. One that put a lot of weight over the entire medical industry, propelling some sectors and impacting others. Orthopedic surgery and physical therapy were two sectors which were well hit by the turns of events. Doctors have been forced to postpone surgeries which didn’t require a quick intervention, such as the total knee replacement surgery.

Fig 1: For the first time in history the population over 65 is higher than the population below 5 years old

Because of this, many patients have been forced to endure a great amount of pain. Physical therapy practices had to close during the lockdown for a few months, in most countries. Practitioners started putting more attention online, but their tools did not have maturity and evidence to reach the masses of people who were suffering from musculoskeletal diseases.
Why is this important? Because the demand for physical therapy tripled in the past 50 years due to the aging population and increased obesity rates.

Estimations suggest that worldwide there are 1.7 billion people affected by musculoskeletal conditions, making it the greatest contributor to the global need for rehabilitation. Billions of $ getting spent every year on expensive surgeries and rehabilitation. Knee and hip Osteoarthritis are the most common condition after lower back pain and the leading cause of disability. This joint disease has no cure and standard treatment requires physical therapy care, in order to build back the muscle strength, recover mobility and elevate the pain, with the objective of pushing back in time the total knee or hip replacement surgery.
The physical therapy sessions are limited to 1-hour sessions, and public reimbursements cover very few sessions.

An effective treatment requires around 100 hours, while the average number of sessions reimbursed in Europe is around 10. Digital technologies offered solutions to align to the standard of treatment (for better medical outcomes), reduced costs patient’s convenience of doing it from home. They can compensate for the shortage of therapists (60000 in Europe only) and people’s reduced physical activity during the COVID lockdowns.

The European countries which have already made the first major steps into creating a framework for the adoption of digital healthcare solutions are Germany, UK, Belgium, France, Hungary and Romania.
Implementing new frameworks in the public health reimbursement pathways is usually a slow process. One that will be developed over the months and years to come.
The Digital Supply Act, abbreviated DiGA, allows doctors to include digital therapies, while Belgium also offered reimbursement for the first time, but only for a selective few digital products, including one for total knee replacement rehabilitation.

Fig 2: The DiGA model explained

Private insurance companies are adopting digital tools faster than any public system

Private health insurance companies have been preparing the implementation of digital health services for years. In the context of the ever-increasing need for rehab, efforts have been put into allowing clients to access digital health treatments for prevention purposes and not only, which are cost-effective and very effective in many cases.

The secret weapon of the private health insurance companies is speed. Now that the digital trend is clear in the public sector, having digital partnerships is key. Building a network of such partnerships to cover for the larger yearly spendings can reduce the budgets in the long run.

But competition is high and the costs vs. medical outcomes is a crucial metric to assess. And very few players in the digital ecosystem are able to back their medical claims and technical capabilities with data.

re.flex & NN Insurance Partnership in Romania

Some private health insurance companies have already completed the first implementation tests and are planning further stages. With re.flex we started pilots with private health insurance from 2019, in Europe and Australia.

In 2020, re.flex completed a study with Charite University Hospital, recording a 4% deviation from the Gold Standard of the motion tracking measurements, the VICON system.

In the summer of 2020 we met NN insurance Romania and learned we share some common goals and values. The need of implementing the prevention programs for the patients with musculoskeletal conditions was a long term strategy.
The deep market research of NN was concluded in 2018-2019, and involved corporate customers and also private customers. On the re.flex side, the self-funded clinical trials we developed showed the potential of reducing the costs of treatment while keeping the medical outcomes comparable with the traditional intervention.

Fig 3: A snapshot from a 3D-assisted exercise session with re.flex

Combining the information we manage to analyze the data and then structure everything in a multi-phase plan.
In the first part we will advocate knee & hip Osteoarthritis prevention, educating the patients and supporting the medical community in onboarding the digital treatment, particularly tailored for orthopedic doctors, physiotherapists and rehabilitation specialists.
The next phases will take on post-surgery interventions and lower back pain.

Educating patients and meeting their orthopedic doctors

Following the publishing of our academic studies, conducted by Tuebingen University, which proved that patients had better adherence (90%)  and recorded significant improvements in quality of life, reduction of symptoms, pain, and daily activity during a 12-week program, better medical offerings with convenient pricing models are set to be introduced for the provider side.
With already 2 years of experience in running the first fully digital physiotherapy clinic in Romania and treating over 500 cases, re.flex is ready to expand its reach.
Together with NN insurance we are committed to advocate the potential of digital health technologies among doctors and therapists, but also directly addressing patient’s needs.

NN Insurance Romania introducing re.flex to their clients

When the public sector is missing regulations or it’s moving slow, private insurance can benefit a lot by being first movers and timely addressing the challenges.
In Romania, the digital healthcare laws for the public reimbursement are still missing, but some interest was announced by the Government in 2020.


NN asigurari re.flex
Fig 4: NN insurance Romania is offering digital solutions to their customers through re.flex

In the meantime, Romania is struggling to keep it’s citizens healthy with a limited access to physical therapy and a ratio of only 7 therapists per 100,000 people. A city with around 3 million citizens like for example Bucharest, has around 300 outpatient clinics.
Very few people in need of physical therapy are able to commit the time to reach the outpatient clinics, while the residents from small areas are finding physical therapy totally not sustainable. Cutting costs and improving access to physical therapy will continue to be our priority in Romania.

Further medical studies and private insurance pilots are under the loop for re.flex, in Europe. And more digital heroes will step in the scene. Are you one of them? Or maybe you just want to learn more about the available opportunities in your country? Reach out at and let’s talk!

Stay on top of the latest digital physical therapy trends.

Leave this field blank
Blog Authors

re.flex team

+ posts