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How VERA Scored a World-Class Net Promoter Score (NPS), and What It Means

By August 1, 2019 August 26th, 2019 No Comments

From academic publications to the mainstream business media, much has been written about the ability of our Virtual Exercise Rehabilitation Assistant (VERA™) platform to cut the costs of post-acute care for payors and practices — particularly following 2018’s announcement of the initial results of the VERITAS study by the Duke Clinical Research Institute (DCRI).

Conducted over the course of two years, the VERITAS study — or “Virtual Exercise Rehabilitation In-home Therapy: A Research Study” — was “the first large-scale randomized controlled clinical trial that compares virtual physical therapy with traditional physical therapy” for patients following total knee replacement (TKR) surgery, per a news release announcing the initial results.

And the results were truly exciting, finding that the use of VERA can save payors and providers as much as $2,745 per patient in a bundled-payment setting for TKR rehab without any compromise in outcomes or patient safety.1 (Indeed, many of the outcomes from VERA were superior to that of traditional PT; you can get the full details with our exclusive VERITAS infographic.)

VERA’s ‘World-Class’ Net Promoter Score (NPS)

Yet despite these clinical milestones, and the buzz they’ve generated, we firmly believe that our patient-centric focus is really what drives our success. VERA was designed first and foremost as a means to give people the opportunity to recover from surgery or injury from the comfort of their own home, letting them avoid the inconvenience of frequent travel to their therapists’ office (and the co-pays that go along with those visits).

To accomplish this goal, the animated avatar behind VERA was created by a world-class team of clinicians, developers and advisors, who leveraged the latest Hollywood-quality 3D motion capture technology and presented it in a way that’s intuitive, easy to use, and even fun for patients. (“If you can turn on your TV, you can use VERA,” as one hip replacement patient told us.)

But gratifying as it is to receive high-level clinical validation and awards and honors like being named 2019’s Digital Trailblazer by the Xconomy Awards San Diego, these are simply milestones on the longer road of providing patients with the most convenient and effective means of engaging with post-acute PT at home, period.

And to that end, we’ve achieved what’s perhaps our proudest accomplishment, earning a Net Promoter Score (NPS) of 91.2 — or within the very highest percentile, and considered to be “world class.” It’s a score that also outranks such household names like Apple and Amazon.

And that isn’t just our assessment, either: No less a clinical authority than Yale New Haven Health (YNHH) arrived at the 91.2 NPS ranking as part of a larger study called “Tele-rehabilitation for the Total Hip and Knee Arthroplasty Patients: No Increase in Readmissions,” presented at the Annual Meeting of the American Association of Hip and Knee Surgeons (AAHKS) in November, 2018.2



What’s It Take to Achieve a ‘World Class’ Net Promoter Score?

So, what is a Net Promoter Score, and why does it matter? Introduced in 2003 by an article by Fred Reichheld published in the Harvard Business Review, the NPS is a method of measuring the customer experience offered by a company or brand based on one simple question, scored on a scale of 1 to 10: “How likely is it that you would recommend [brand] to a friend or colleague?”

Based on how they respond to this question, customers are classified as promoters (score 9-10), described as “loyal enthusiasts who will keep buying and refer others,” passives (7-8), “satisfied but unenthusiastic customers who are vulnerable to competitive offerings,” and detractors (6 and less) — “unhappy customers who can damage your brand and impede growth through negative word-of-mouth.”

From this data, the NPS is determined by subtracting the percentage of respondents who rank as detractors from those who rank as promoters. And that’s a tough metric: even brands with the most enthusiastic promoters can have a middling NPS if they also have a sizable group of detractors. This is true of many popular consumer brands (think Apple and Amazon, whom people love and hate in seemingly equal measure).

With that in mind, then, NPS rankings for even the most popular brands rarely exceed 50 out of 100. “Based on the global NPS standards, any score above 0 would be considered “’good,’” writes NPS expert Dana Severson, who points out that “50 and above” is considered excellent, “while 70 and above is considered “’world class.’”

For the Yale New Haven Health study, all of the patients who used VERA “were very satisfied with both their therapists and with the ease of use of the technology as noted in two separate satisfaction surveys,” as the authors wrote in their AAHKS presentation.

When asked to rate their comfort in using the system on its own, their confidence in whether it could help them obtain their goals, and their confidence in their managing therapist, “the average scores were all 9.7” on a scale of one to 10, the authors add.

“Based on the question if they would recommend the VERA system, the Net Promoter Score (NPS) was 91.2. This correlates to a satisfaction rating of ‘world class’.”

How VERA’s World-Class NPS Can Translate into Patient Satisfaction

With its world-class Net Promoter Score, then, it’s safe to conclude that VERA possesses the very highest levels of consumer approval. And that’s an important feature in a tool designed to enhance the patient experience. The fact that people who have used it are enthusiastically on board as active promoters strongly suggests that there’s an excellent chance they’ll engage with, and adhere to, the therapy that VERA provides.

And we’re not the only ones to discover this delight patients have with VERA. In addition to the YNHH study, patient satisfaction has been cited again and again by the clinicians and therapists who have used our FDA-cleared, at-home rehab tool to help people recover from surgery or therapy in a more convenient, comfortable and cost-effective way.

“I have patients where I did their first knee conventional and second knee (using) VERA, and they way preferred VERA,” as orthopedic surgeon Dr. Stephen Lucey told North Carolina’s Triad Business Journal. “Because they didn’t have to go anywhere; they can do it right there in their home.”

And in another presentation of the YNHH study, this time at the American Academy of Orthopaedic Surgeons (AAOS) 2019 Annual Meeting, the use of VERA was found to deliver “high patient satisfaction,” along with lowered costs and increased compliance.3 “We have been very pleased with our experience to date, particularly the very high level of patient satisfaction,” as lead researcher and orthopedic surgeon Dr. Mary O’Connor stated in a news release about the VERA study.

“An elderly knee replacement patient of mine told me how much she loved VERA. I asked her why and her response surprised me,” she continued. “She said: ‘Dr. O’Connor, I don’t have to make sure my house is clean, or my hair is done and I have makeup on as when the physical therapist comes to the house. I can do my exercises in my housecoat.’”

“I was skeptical going in, thinking patient compliance would be an issue and that not having hands-on therapy, they would not progress as quickly,” North Carolina-based orthopedic surgeon Dr. Frank Aluisio told Modern Healthcare. But compliance was “phenomenal,” he added: “The patients said they felt accountable because they knew someone was watching, and that made them do the exercises more.”

Bringing Comfort and Convenience to Physical Therapy Rehab

We hear similar sentiments from the patients who have used our groundbreaking telerehab service. “VERA is an outstanding program if you are motivated to recover,” as one knee replacement patient recently told us about his experience using VERA.

“I can’t think of a better result,” he added. “Knowing that my physical therapist was watching me do my daily exercises kept me honest and confident, and being able to wake up early in the morning and get my exercises done on my own time made me feel like I was really in charge of my own recovery.”

It isn’t hard to understand the appeal from a patient’s perspective: After all, VERA was built with their comfort and convenience top of mind. Because VERA lets people recover from surgery at home, it reduces the frequency they need to travel to a clinic, whether they’re driving themselves or relying on the help of caregivers. It also helps them avoid therapists coming to their home, and cuts the costs of co-pays.

Reflexion Health President and CEO Dr. Smith explained the emphasis on patient convenience in more detail in a recent podcast. “We would ask people who are trying to recover to come back and forth to a clinician’s office for physical therapy, or we would at times have physical therapists visit them in the home,” he said, “which is a similarly awkward circumstance for many.”

Why not make use of “technology that’s readily available,” he continued, “that can educate and monitor and coach and reward patients to do their therapy in the safety and comfort of their own home?”

How Can Our World-Class Net Promoter Score Work for You?

What does it mean for a virtual PT technology to not only achieve a world-class Net Promoter Score, but also consistently generate rave reviews from patients? In short, it means that the experience using VERA is an overwhelmingly positive one. Not only do people enjoy using VERA to recover from surgery, but they also tend to encourage others in their position to do the same, citing the system’s ease of use and convenience as huge motivators.

Learn more about how VERA’s world-class Net Promoter Score can translate into patient satisfaction within your hospital, orthopedic practice, or other related facility: Contact us today to schedule a complimentary consultation with a Reflexion Health specialist.



  1. Bettger, Janet Prvu et al. VERITAS: Effect of Virtual Exercise Rehabilitation In-home Physical Therapy versus Traditional Care for Total Knee Arthroplasty. Poster presented at American Congress of Rehabilitation Medicine (ACRM) 95th Annual Conference; 2018 Sept 30-Oct 3; Dallas, TX.
  2. O’Connor MI, et al. Tele-rehabilitation for the Total Hip and Knee Arthroplasty Patients: No Increase in Readmissions. Poster presented at the 2018 Annual Meeting of the American Association of Hip and Knee Surgeons (AAHKS); 2018 November 1-4; Dallas, TX.
  3. O’Connor MI, Moore AR, Rubin LE. Tele-Rehabilitation for Total Hip and Knee Arthroplasty Patients: No Increase in Readmissions (Paper 850). Presented at the 2019 Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS); 2019 March 12-16; Las Vegas, NV.