A physiotherapy group put home exercise programs on patients' phones instead of printed sheets

Representative examplesEvery case study in this library is an illustrative composite of the kind of engagement we deliver — written to show our method and standards, not to name clients.

Where they started

Six physiotherapy clinics across a metro area, owned by two senior clinicians and staffed by therapists who see a patient every half hour. Programs were printed: an exercise sheet with hand-drawn sets, reps, and a photocopied diagram, going home in a folder. The group's clinical lead reviews everything patients receive, reception does double duty as print shop, and the clinics run fully booked most days, which means nobody has time to design a new process — it has to fit the gaps between appointments.

What it was costing

Therapists prescribed exercises as printed sheets; patients lost them, adherence was invisible, and progress reviews were argued from memory rather than evidence.

What they could see

• Patients arrived for review appointments without the sheet, or with a version three printouts old, and the session started from recollection.
• Therapists could not say whether a program was being done at all, so progress conversations turned into negotiations about honesty.
• Reception spent the first hour of each day printing, stapling, and re-printing exercise programs therapists had marked up overnight.
• The clinical lead had no way to see which exercises were being prescribed across the group, so content drifted between clinics.

The constraints we worked inside

• Clinical governance required that exercise content be approved by the clinical lead before any patient sees it — no free-form uploads.
• Patients skew older; type sizes, contrast, and one-thumb use were acceptance criteria.
• Therapists have eight minutes between sessions; the prescribing flow had to fit inside that.

What had been tried before

They subscribed to a commercial exercise-prescription platform and asked therapists to trial it for a quarter.

The catalogue could not be edited to the clinical lead's standard, so governed content was impossible, and the adherence data belonged to the vendor — a governance dead end.

A senior therapist built a shared spreadsheet of exercises and links that clinics were asked to copy prescriptions from.

Nothing enforced it between appointments; therapists prescribed from memory instead, and the sheet rotted within a month because nobody owned keeping it current.

What we proposed

We proposed an iOS app built around a governed exercise library: the clinical lead approves every video and parameter set before it exists in the app, and prescribing becomes selection plus dosage rather than authoring. Patients install from a clinic QR code with their program already attached — no account creation in the waiting room. Sessions are logged in two taps and surface on a dashboard the therapist reviews before each appointment, so the progress conversation runs on evidence instead of memory.

Just as important is what we ruled out, and why:

• Keeping the commercial platform and building around it — Its content pipeline sat outside the clinical lead's control, which the group's governance requirement makes a non-starter no matter how good the app looks.
• A responsive web app instead of native — Programs must work offline in patients' homes, play large video reliably on older phones, and open from the lock screen — a web wrapper failed all three in a spike.
• Letting therapists author content freely in-app — The governance constraint forbids unapproved content reaching patients; free authoring would have recreated the exact quality drift the group was trying to eliminate.

How the work ran

Delivered by the experience pod — mobile engineer + designer over 10 weeks, with working increments reviewed with the client every week.

The stack, and the reasoning

Swift

The group supplied a fleet of clinic iPads and patients overwhelmingly use iPhones; staying native bought offline video caching and HealthKit without compatibility work.

SwiftUI

Large type, high contrast, and one-thumb reach were acceptance criteria; SwiftUI's dynamic-type support made the accessibility bar a default rather than a retrofit.

HealthKit

For patients who consent, workouts and step counts enrich the adherence picture a therapist sees — context the paper sheet never had, at no extra patient effort.

Firebase Auth

Patients must never create an account in the waiting room; anonymous auth bound to the clinic QR flow gives each program an identity without a signup screen.

Cloud Functions

The governed library, dosage rules, and adherence rollups run server-side, so the group's governance lives in one place a non-developer clinical lead can audit.

What went wrong

How we worked together

Cadence

A Thursday late-afternoon demo with the clinical lead and practice manager after last appointments, plus a fortnightly review of adherence data from the pilot clinics.

Client side

The clinical lead owned content governance and approvals; the practice manager handled clinics, devices, and scheduling; two therapists from different clinics piloted prescribing.

Decisions

Content disputes never went to a meeting — the clinical lead's review was final — and build decisions were settled in the demo or deferred to a written option note.

They provided

Therapist time for filming and usability sessions, the exercise catalogue with parameters, waiting-room posters and QR placement, and consent for adherence-data review.

What changed

The headline: every new patient onboarded to the app over the pilot quarter, with adherence visible to the treating therapist — Printed sheets → prescribed app programs, read from Clinic's own adherence dashboard. A second check: logged home-session frequency vs paper-program estimates at 2.4×.

The eight minutes between appointments stopped being a print run. Prescribing happens inside the gap between patients — the therapist builds the program while the patient dresses down — and the review opens with the adherence dashboard instead of a question about memory. Reviews became shorter and less adversarial because the evidence was on the screen. The clinical lead finally sees prescribing patterns across all six clinics, so weaker exercise choices get corrected once, centrally. Patients' home programs survive losing the folder, and reception's mornings no longer begin at the printer.

The result was read from Clinic's own adherence dashboard against the pre-engagement baseline over the stated window, with a guardrail check on logged home-session frequency vs paper-program estimates. Where platform-reported numbers and business outcomes differ, this record says which layer it is quoting.

What they own now

• Apple Developer account and signing credentials under the group's control
• Firebase project with billing, auth, and function deployment owned by the practice manager
• The governed library's editorial workflow, including the approval checklist the clinical lead signs off
• A filming kit and shot list so new exercises enter the library without us
• A runbook for clinic QR codes, device provisioning, and pilot-to-full rollout