Abstract
Dear Editor,
We read with great interest the study by Kim et al. regarding the effectiveness of a personalized digital exercise and nutrition-based rehabilitation program for gastric cancer patients following surgery. 1 The integration of wearable devices and mobile health applications into oncological rehabilitation represents a significant step toward bridging the gap between hospital-based interventions and home-based self-management. The authors are to be commended for their rigorous multicenter randomized controlled design and the emphasis on long-term follow-up.
However, we believe there is a structural limitation inherent in the current approach—one that characterizes much of the broader digital therapeutics (DTx) landscape. The intervention in this trial utilized a pre-developed commercial platform (Medi Plus Solution) with a fixed software architecture. While the system allowed for personalization based on specific variables (e.g., surgery type, BMI, comorbidities), any further modification would necessitate coordination with the vendor, formal service agreements, and potentially costly updates. This creates a structural rigidity that may hinder real-time adaptation to the rapidly evolving needs of the patient.
In rehabilitation medicine, patient needs are dynamic. For instance, in stroke-related hand rehabilitation, subtle improvements in fine motor control may require immediate adjustments to task complexity or feedback mechanisms. 2 In commercially locked systems, such granularity is often unattainable without external technical intervention.
To address the feasibility concerns regarding physician workload, we propose the adoption of low-code/no-code (LCNC) platforms. Recent evidence suggests that LCNC frameworks can democratize digital health innovation by allowing clinicians to build secure, functional tools via visual interfaces, requiring significantly less time than traditional programming. 3 Such clinician-developed “micro-applications” can be instantly tailored to patient-specific goals without the “black-box” constraints of proprietary software.
This approach offers three primary advantages: 1. Clinical Relevance and Responsiveness: The treating physician ensures interventions are evidence-based and context-specific. 2. Cost-Effectiveness: It reduces dependency on expensive proprietary updates for minor clinical adjustments. 3. Scalable Customization: While large platforms provide stability, clinician-developed tools offer the agility needed for precision rehabilitation.4
Admittedly, challenges such as data security and user-centered design quality must be addressed through standardized frameworks. However, we believe the future lies in a hybrid model: robust commercial platforms for large-scale deployment, complemented by clinician-developed applications for highly individualized therapy. (Figure 1). Incorporating digital design and “low-code” literacy into residency training could foster a new generation of “clinician-developers” capable of bridging medical expertise with digital flexibility. Conceptual framework for a hybrid model in digital rehabilitation: Integrating commercial platforms with clinician-developed micro-.applications.
