**4. Conclusions**

where the data stored on the repository use a pseudonymization to refer back to the data on

This kind of mitigation should be used not only for the storage of sensitive data but also in the way the data are exchanged between the several systems that these micro-services, cloud-based systems require, so that man in the middle attacks are thwarted, by using tokenization (**Figure 10**), which is a way to substitute sensitive data, such as an email and password pair with a token that has no meaning or representation outside of the system.

the database.

70 Biofeedback

**Figure 8.** Cloud-based architecture.

**Figure 9.** Physical separation of sensitive data.

High recurrence rates and high dropout rates lead to high economic and social costs in the treatment of musculoskeletal disorders (MSDs). Different reimbursement systems for the physical therapy treatments can be found within different countries in Europe, where private insurance or state health systems cover the cost and inefficiency of MSD treatments. In the US, the cost burden is shared between patient and insurers, where patient's co-pay at an average 50% per session. In other countries, as China, there are almost no physiotherapists; treatments of MSD are directed towards general practitioners who are overwhelmed with a large number of patients and tend to treat the pain and not address the root cause. Inefficiency and difficulty to assess the quality of treatments for MSD pain is a concern to the insurers and health-care systems, which are searching for more consistent diagnostic and treatment approaches, along with new models for reimbursement, in which reduced costs and objective outcomes of treatments can be demonstrated.

When discussing with insurers such as Achmea in Holland, they recognize that while physiotherapy represents around 7% of their cost expenditures, quality physiotherapy care ranks as the number one reason a patient will select an insurance plan or change providers. Therefore, insurers are acutely aware of the need to increase patients' actual or perceived physical therapy care and motivation to resolve underlying pains. With no objective information of physiotherapy treatments, the quality of the service and the consistency of treatment outcomes are difficult to assess. Moreover, unscrupulous practitioners can bill unnecessary treatments, leading to high costs and a strong effort from the insurances to fight fraud. This problem was stated in the front page of NY Times: 'Physical therapy has become a Medicare gold mine. Medicare paid physical therapists working in offices \$1.8 billion in 2012 alone, the 10th-highest field among 74 specialties' [12]. In this context, a huge insurance reform is coming where the capitation of reimbursement will be done in the model 'pay per treatment outcome' instead of 'pay per session'. Physiotherapy clinics are then going to be pressed to lower overall costs of treatments and improve overall quality and consistency. Thus, there is a pressing need within physical therapy practice for a validated method to improve the consistency of the outcomes of MSD treatment, and increase patients' satisfaction and quantification of treatment quality and efficiency. In this chapter, we present a novel biofeedback system designed to support part of the rehabilitation processes at home, further contributing to help mitigate the known issues associated with conventional approaches.

[4] Musculoskeletal Health in Europe Report v5.0. http://www.eumusc.net/myUpload-Data/files/Musculoskeletal%20Health%20in%20Europe%20Report%20v5.pdf

Bridging the Clinic-Home Divide in Muscular Rehabilitation

http://dx.doi.org/10.5772/intechopen.76790

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[9] Santos C. Protocolo de Fisioterapia, com auxílio de Biofeedback Electromiográfico, em utentes com disfunção do ombro: efeitos na dor, funcionalidade e estabilidade dinâmica [master thesis]. Portugal: Escola Superior de Saúde do Instituto Politécnico de Setúbal;

[11] Lyons GM, Sharma P, Baker M, O'Malley S, Shanahan A. A computer game-based EMG

[12] Pfitzmann A, Hansen M. Anonymity, unlinkability, undetectability, unobservability, pseudonymity, and identity management—A consolidated proposal for terminology

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biofeedback system for muscle rehabilitation

[10] NY Times, Front Page April 27, 2014

2011
