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Friday / September 24.

Telespine: Transforming the Delivery of Spinal Rehabilitation

BOULDER, Colo. – In 2006, Mark Barnes designed a detailed physical therapy exercise plan for his own back injury. Deeply frustrated after leaving his instructions at home during a short trip to the mountains, Dr. Barnes found himself thrust into an internal dialogue:

“This is crazy. This is the same thing many of my patients go through. The 99% of the time that patients aren’t with us, they don’t have any resources. They have a piece of paper with my writing on it and with line drawings or mimeographed photographs. On one hand my job is to get people better, and I know that for my patients getting better depends on doing the activities I have designed for them. But all I give them is a piece of paper!”

A new mission: “extending care beyond the clinic walls”

Version 2

Dr. Mark Barnes, founder and CEO of Telespine.

In that initial insight, Barnes found a new mission: “extending care beyond the clinic walls.” He conceived of an online service that would replace traditional paper instructions with an interactive and monitored online physical therapy program. Founded in 2006, Tx Xchange LLC became the first company providing virtual orthopedic physical therapy.

Licensed to physical therapy practices, the home-based therapy program was prescribed following an initial in-person evaluation. Patients logged in to the Tx Xchange portal, proceeded with video-based exercises specific to their condition, messaged their therapist as needed, and scheduled follow-up video consults. Patient progress was monitored virtually and the regimen was adjusted as needed.

Pivot to providing online spinal physical therapy

Although slow to take off, Tx Xchange became successful. Nevertheless, envisioning a more focused clinical offering, in 2011 Barnes courageously pivoted and created a new company. A look at his background provides the foundation for this new direction.

After obtaining a degree in Exercise Physiology at the University of Colorado Boulder, Barnes completed a 3-year physical therapy masters program at Shenandoah University in 1993. Following a decade in clinical practice, Barnes entered the physical therapy doctoral program at Regis University to study spinal biomechanics and the pathomechanics of back pain.

With his new focus on back pain, Barnes restructured Tx Xchange LLC and created Telespine as a provider of spinal physical therapy marketed to self-funded employers. The Tx Xchange software was rebuilt and Dr. David Tinkelman of National Jewish Hospital was recruited as the company’s medical director.

Once logged in to the Telespine portal through any connected device, patients can access a customized, 8-week treatment program containing instructional videos of each assigned exercise. A status bar shows their progress. They can receive reminders and view workplace and lifestyle tutorials. A certified health coach remotely monitors their progress and is available through live chat. If not progressing well, Dr. Barnes, Dr. Tinkleman, and a therapist will review their case.

Comparing the Telespine model to traditional spinal rehabilitation


75% of users report higher satisfaction with Telespine than with traditional rehabilitation.

Unlike using paper-based instructions, online video-guided, therapist-monitored physical therapy closes the therapeutic loop between the patient and provider. Intuitively, viewing a video of a therapist guiding a patient through the proper steps of each exercise is likely more effective than following instructions on paper. Active guidance through virtual monitoring, the ability to adjust the program, messaging, and follow-up virtual consults further strengthen the program. Thus, it should not be a surprise that 75% of users report higher satisfaction with Telespine than traditional rehabilitation.

An initial study found that Telespine treatment is more effective than traditional therapy. Fifty-one percent of patients suffering from mechanical low back pain, postural low back pain, or lumbar strain improved versus 23% with traditional management. At first glance, this seems puzzling. However, login data shows Telespine patients are highly engaged, accessing their portal an average of 8.5 times per week. Adherence to the Telespine program is also significantly higher: 75% with Telespine versus 35% with traditional therapy.

What about the cost? United Healthcare evaluated 1,721 patients with spinal diagnosis whose treatment included Telespine and found a 21% reduction in office visits versus the average number of visits within its network.

Telespine, relationships, and the future of orthopedic rehabilitation

Americans spend $120 billion each year on back pain. With guidance and support from Innosphere, Techstars, The Colorado Health Foundation, and investors, Telespine is becoming part of the solution.

To extend its reach, the company has partnered with the benefits companies New Benefits, Savvy Benefits and MyHealthPass as well as health and wellness provider Health to You (H2U). Partnerships have also been developed with BackJoy, designer and marketer of products that improve posture, and UpRight, creator of a wearable device that vibrates when the user is slouching.

Recently, Telespine won a position in the Techstars++ Mayo Clinic Business Accelerator Program to help refine and enhance its back pain treatment program. To further study Telespine’s impact on spinal care, the Mayo Clinic Spine Center and Telespine have recently been awarded a $1.7 million NIH grant.

Navigating the ongoing expansion and planned research, Barnes takes a moment to reflect on his insight a decade earlier:

“What I am most excited about is that we have successfully taken the brick and mortar clinic and turned it into a digital health clinic.”

Indeed, far beyond that sheet of paper Barnes left behind, increasingly back pain sufferers will be able to participate in a collaborative and interactive therapy program wherever they have internet access. The increased engagement seen with Telespine’s synthesis of video learning, frequent communication, and progress tracking and guidance, suggests their chances of improvement will be greater than a decade ago.


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