A Conversion Conversation with Stabilo Medical’s Josh Lobo
Josh from Stabilo Medical is tackling the complicated problem of patient rehabilitation. But as we all know, startups are hard. Budgets are limited, runways are short, and there are a ton of unknowns. To maximize their chances for success, Stabilo has carefully developed a plan that — of course – includes experimentation.
Rommil: Josh, Josh, Josh. So good to catch-up with you. It feels like ages since we worked together; And here we are — you’re a founder, congratulations — so exciting! Tell us about Stabilo and how you came up with the idea.
Josh: Thank you! You’re right, definitely feels like forever. So yes, I’m currently working on a company called Stabilo Medical. We’re developing a smart vest that allows those undergoing inpatient rehab to exercise safely and properly without a therapist. The device essentially repeatedly moves the patient into a position that encourages core engagement throughout the day. Despite patients actually living at these physical rehab facilities, they often get as little as 1 hour a day with a therapist. As you can imagine, people who’ve just had a stroke or spinal cord injury can’t exercise on their own without risking injury or doing the exercises improperly. By allowing them to exercise on their own, we increase the amount of productive exercise time patients get in rehab.
The idea actually started while we were in school and doing our fourth year design project. It was initially supposed to be a fall prevention device for the elderly. We quickly found out that measly undergrads were not qualified to achieve such fast actuation times within 8 months. Eventually we ended up at the local rehab facility and, upon talking to the therapists there, discovered that the same design has a lot of potential with rehab patients.
Such an amazing concept — the world needs more ideas like this. Since this is such a new space, how did you go about validating your idea?
It was hard! I mean when we started all we had going for us was some literature that suggested early recovery of trunk control is correlated to better overall recovery in rehab. We also had a sliver of insight into stroke rehab by shadowing the local therapists for a day.
We established two statements from these: that trunk recovery was important and that patients spend most of their time in rehab not exercise because they can’t see a therapist. Now we wanted to see if our customers — the rehab facility — actually saw these as a significant problem — enough to actually spend money on.
To validate our idea we went back to those same therapists and started asking them specific questions about what the general approach is to rehabilitation. We also poked and prodded into what their personal qualms were with the current state of rehab.
We asked open ended questions and specifically avoided bringing up anything about the trunk or the proportion of time patients actually spent exercising. We wanted to see if these things were a big enough problem that they would bring them up on their own. And they did!
We also did research to corroborate these problems, of course. But I think it’s important to hear your customers acknowledge them as real problems rather than it just being documented somewhere.
A majority of this was done during our first 3 months at the incubator. Since then, we’ve talked to over 100 frontline clinicians about their thoughts. A lot of these were cold calls into the US (our biggest market).
The response was so positive that we upped the stakes. We started asking them if they would be willing to run clinical trials on our device. The reason for this is that therapists ultimately don’t have the power to purchase, so saying they would be interested in buying a unit was low risk for them. Conversely, conducting clinical trials actually involves commitment from the therapist and asking this shows us if they’re interested enough to commit to the work. 92% of therapists asked still said yes.
To a lesser degree, we have also validated our product with value analysis directors, directors of finance and directors of stroke rehab — those more involved with the purchasing of medical devices. However, therapists on the frontline are by far the champions for the sale within facilities so we’ve focused heavily on meeting their needs first.
Experimentation is so hard to pull off with physical products. How did you go about designing your prototypes and iterating on them? How do you prioritize what questions to answer?
Well after validating the problem, we conceptualized a product that would solve it. We created a list of requirements it would need to meet in order to be successful, based on what we learned about the problem. We tried to be as specific as we could. For example, we specified how much weight it needs to be able to handle based on averages found online. From an early point we were advised to build for the average user. This way we don’t spend ridiculous amounts of time creating technology to accommodate even bodybuilders when it’s much quicker to just accommodate for a frail, elderly person — our actual target demographic. The bodybuilders will have to wait till after we’ve got revenue.
After this, we kept building out our prototype and pitch it to therapists to see what they say. Up until now, it’s primarily been verbal descriptions or drawings. Building out a prototype for a hardware product takes a long time but you still need to get feedback from your customers along the way. We found that verbal descriptions, drawings and renders can be great substitutes until a prototype is complete.
I love that you tried something, collected data, and iterated. So awesome.
The questions we ask to prompt feedback vary sometimes. Often we open with no questions and allow them to tell us whatever comes to their minds. We’re no therapists. They’ll consider things we don’t even know exists so it’s best to let them speak freely first. After that we ask more targeted questions based both on their initial thoughts and what we perceive as potential flaws in the design.
What is your plan for experimentation?
For prototype development, we have 3 studies planned. The first two will be on healthy individuals. Study #1 is informal and involves clinicians and your average joe trying on our product and giving feedback on its ability to correct body position as well as comfort. Study #2 will be a formal study done on healthy individuals to quantify the amount of muscular engagement our product elicits. Study #3 will be the same informal study as #1 but now on impaired patients — stroke, spinal cord injury etc.
Ideally we would want to show that our product improves rehab recovery so much that we can shorten the length of stay. But that involves rigorous trials, following a significant amount of patients around for an extended period of time to see if we impact their rehab length of stay — expensive stuff.
We plan to prove our product works a different way. There’s already plenty of research that shows that the core plays an important role in activities of daily living, that early core recovery expedites rehab, and that repetition and muscular engagement are important elements in rehab. Therefore, by simply showing that our device encourages core engagement, we can build a compelling, data driven narrative around how our device improves rehab without conducting an extensive study.
Following this logic, our fourth and final study will be the same as Study #2 but on impaired patients. This will be done to showcase efficacy during sales.
Finding a leading indicator/metric and pushing on that — I love it. Changing gears, gauging demand is always tricky — I think we both can agree on that. What are your plans for measuring demand for your product?
Measuring demand is difficult for a medical device. There are so many levels of approvals needed within the hospital that no one person’s interest can be used as a definite sign of demand. It’s actually team of people evaluating the device that will approve a purchase.
To get around this, we plan to use interest in running clinical trials on our device as a proxy for demand. Interest in clinical trials shows interest in what the product does, enough to investigate efficacy.
As mentioned before, clinical trials require actual commitment from therapists so their interest in participating is of greater value than saying they would like a unit (but we gauge interest in both).
This same approach can be done for other clinicians as well. Having clinicians from medtech conferences or other product showcases express interest in running clinical trials on our device can also be used as a sign of overall interest.
Time for the lightning round! Amplitude or Google Analytics?
Google Analytics. You always remember your first.
Frequentist or Bayesian?
My head says frequentist but my heart says Bayesian.
Will you hire me when you become rich and famous?
Of course! But only as a mechanical engineer.
LOL — That was about a half-dozen careers ago! Here’s my CV just in case haha!
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