[Press][Doctors in Ventures] Rehabilitation Doctor 'RingDoc' Enters the Smartphone

Prof. Rhee Sung-min (Orthopedic Specialist) of KHU Hospital, who founded the startup 'Itphy' last July,
is explaining the three major shoulder diseases: frozen shoulder, calcific tendinitis, and rotator cuff tear. [2023.03.06]

Patients with shoulder pain, such as frozen shoulder or rotator cuff tears, must undergo appropriate exercise along with treatment. If exercises are not done properly, recovery takes a long time. Conversely, excessive exercise can have a negative effect on the shoulder.

The problem is that it is difficult for patients to know how much exercise is appropriate. It is also difficult for doctors to know if patients are exercising regularly and properly at home. CEO Rhee Sung-min of Itphy, who is also a professor of orthopedic surgery at Kyung Hee University Hospital, thought the same. He believed it would help recovery if he could kindly teach patients how to exercise at home.

Meeting in his hospital lab on the 26th of last month, CEO Rhee Sung-min said, "Orthopedics usually focuses only on surgery, and I felt there was a lack of focus on rapid rehabilitation or functional improvement after surgery." He added, "I developed 'RingDoc', an app that provides customized exercise methods to patients because consultation times are short and there are limits to explaining exercises."

Q. My shoulder hurts, why should I exercise?

“Frozen shoulder (Adhesive Capsulitis) is a disease where the joint capsule surrounding the shoulder joint hardens due to inflammation. Rotator cuff tear is a disease where the tendon moving the shoulder is damaged and torn. Both diseases can cause extreme shoulder pain, making it difficult to raise arms above the head. Appropriate rehabilitation exercise after surgery helps recover arm movement. This means the angle at which you can rotate and lift your shoulder increases that much faster.”

Q. What does Itphy mean?

“Itphy is a name combined from 'IT' (Information Technology) and 'Phy' from Physical. I named it with the idea that rehabilitation treatment can be solved with IT.”

Q. I am curious about the reason for founding the company.

“Patients who have undergone surgery have many questions while doing rehabilitation exercises. They wonder if continuing exercise won't strain them, if they can apply cold or hot packs to painful areas, or if they can stretch even when it hurts. However, university hospital consultation times are short (3~5 minutes), making detailed explanations difficult. There are also limits to patients following exercises from YouTube. So, I thought I should make an app that proposes customized exercises to patients and monitors if they are actually exercising regularly. That’s why I founded Itphy and developed RingDoc, an app meaning the 'Ring' (connection) between 'Doc' (doctor) and patient.”

Q. What kind of app is RingDoc?

“RingDoc is a service that provides opinions on exercise or exercise-related content to patients via chat. It continuously monitors whether the patient is performing exercises diligently. Simply put, it teaches exercise methods through the smartphone screen and checks if the patient is following properly via the camera. The patient receives an analysis of their condition at the hospital. Then, based on those results, the doctor assigns the most suitable exercise program to RingDoc. RingDoc tells the patient what exercises to do at each stage, and records are kept every time they exercise.”

RingDoc developed by Itphy

Q. How is it different from doctors advising rehabilitation exercises?

“For example, if a patient's joint score was 80 out of 100, in the past, we just advised them to 'exercise.' Now, we show the exercises that suit that patient on the screen and tell them how much to move their shoulder and at what angle to lift it. The patient follows the exercise while seeing themselves on the screen through the camera.”

Q. How do you know if the patient is exercising properly?

“RingDoc's motion recognition AI automatically and clearly detects joint positions. Based on this, the AI calculates the range of motion of the joint. We are currently upgrading this technology. We also plan to apply additional sensors. Since AI still has limitations, we intend to assist it with sensors. This will allow for a more accurate analysis of joint range of motion recovery. We have currently filed patents in Korea and the US for motion recognition technology using AI and the rehabilitation program linkage service based on it.”

Q. So the doctor can know if the patient exercised or not?

“Correct. Records remain of how regularly and accurately the patient exercised. Then, during the next outpatient visit, the doctor can see this record and know if the patient performed appropriate exercises. Not only exercise records, but pain or recovery levels are also compared with the average of other patients. For example, for a woman in her 60s, it tells her what percentile her health data falls into compared to her peers, and how much faster or slower her functional recovery is compared to others for that specific disease.”

Q. Can you advise on personalized rehabilitation using RingDoc data?

“Looking at RingDoc data, doctors can change exercises to easier ones if they were too hard, or harder ones if they were too easy. RingDoc also provides necessary health information to each patient. For example, since most patients with rotator cuff tears lack Vitamin D, it advises them to take Vitamin D, which is known to be good for muscle and tendon recovery. Currently, about 30 major hospitals in Korea, including Kyung Hee University Hospital, intend to use RingDoc. Also, various medical experts at home and abroad are providing advice for RingDoc.”

Q. Can you communicate with patients?

“Yes. We answer questions patients are curious about via chat service. Also, we send messages like 'Great job' to patients who exercised hard the day before, or 'It was tough yesterday, but let's cheer up together today' to those who skipped exercise. Patients say they like feeling as if they are exercising with a doctor at home every day.”

Q. I heard you verified RingDoc's effectiveness through experiments.

“We tested RingDoc on 300 patients who underwent suture surgery after rotator cuff tears for about 6 months and completed verification of its usability. We confirmed that function recovered significantly faster and pain decreased more rapidly after surgery compared to cases where RingDoc was not used. Existing frozen shoulder patients are known to take months to years to recover, but using RingDoc shortened that recovery period by several times. One patient exercised with RingDoc for 2 weeks after being diagnosed with frozen shoulder, and was able to lift their arms easily in just 2 weeks. Since positive results appear so directly, not only are patients satisfied, but we were also able to reveal that RingDoc is effective in daily life.”

Q. Can doctors use it for research purposes?

“RingDoc can be used as a tool in university hospitals to compare which method is more effective when performing certain surgeries for research purposes. Pharmaceutical or medical device companies will be able to express with data which product is more effective when using a specific drug or medical device, or how much better it is compared to existing drugs or devices.”

Q. Are there apps similar to RingDoc?

“In Korea, there are apps for fitness or Pilates purposes. However, it is rare for a doctor to create one for rehabilitation purposes. RingDoc is an IT platform service created by an expert doctor for rehabilitation purposes. Based on clinical research results, we plan to launch the official version of RingDoc this November. We expect to receive medical device approval from the Ministry of Food and Drug Safety soon. In the US, there are several companies making such apps. A representative company is Hinge Health. The rehabilitation app market is expanding rapidly in the US and Europe. Since medical accessibility is lower than in Korea, there is high demand in the market. We also plan to expand overseas in the future. Since there are already many such companies in the US, proving equivalence can allow for quick FDA approval.”

Q. I am curious about your future goals.

“We are developing technology that can track exercise with AI and sensors just by wearing a single sensor on the wrist. I also hope RingDoc will be used for rehabilitation of patients in other departments, not just orthopedics. Stroke and breast cancer patients often feel shoulder pain after surgery. I want to help them recover their whole body joints, including shoulders, hips, knees, and spine.”