Shifting the Paradigm in Home Physiotherapy: Implementation and Implications of Adherence Monitoring with Artificial Intelligence

物理治疗对于常见肩关节损伤和肩关节手术后的成功康复至关重要。患者可以通过私人支付或私人保险接受一些肩部物理治疗的培训和监督，但他们通常负责在家中独立进行大部分物理治疗。目前尚不清楚患者多久进行一次家庭锻炼，以及这些锻炼是否在没有监督的情况下正确进行。没有既定的工具来衡量这一点。我们的团队最近开发了一个智能物理治疗活动识别系统（SPARS），用于使用商业智能手表中的传感器和人工智能（AI）来跟踪家庭肩部物理治疗练习。SPARS在实验室环境中成功地识别了健康成年人的肩部运动。需要进一步的调查来确定该技术的临床有效性，并调查其使用的潜在个人和社会影响。拟议的研究将1）进一步开发和验证SPARS技术，用于评估肩袖病理临床患者人群对肩部运动参与和技术的依从性，推进康复工程AI的最新技术。2)使用SPARS来量化家庭物理治疗依从性的比率，确定依从性对康复的影响，并确定成功依从性的障碍;从而对当前治疗方案提出新的可操作见解。3)开发并试点测试一个有道德意识的SPARS康复计划，根据患者的依从性进行个性化护理。仔细研究与自我管理医疗监测相关的伦理和政策挑战，将有助于确保SPARS和相关技术得到认真部署，并使患者和社会受益。

Physical therapy is essential for the successful rehabilitation of common shoulder injuries and following shoulder surgery. Patients may receive some training and supervision for shoulder physiotherapy through private pay or private insurance, but they are typically responsible for performing most of their physiotherapy independently at home. It is unknown how often patients perform their home exercises and if these exercises are done correctly without supervision. There are no established tools for measuring this. It is therefore unclear if the full benefit of shoulder physiotherapy treatments are being realized.Our team has recently developed a Smart Physiotherapy Activity Recognition System (SPARS) for tracking home shoulder physiotherapy exercises using sensors in a commercial smart watch and artificial intelligence (AI). SPARS was successful in identifying shoulder exercises in healthy adults in the laboratory setting. Further inquiry is required to establish theclinical effectiveness of this technology and investigate the potential individual and societal impacts of its use.The proposed research will 1) Further develop and validate the SPARS technology for evaluating adherence to shoulder exercise participation and technique in a clinical patient population with rotator cuff pathology, advancing the state-of-the-art in rehabilitation engineering AI. 2) Use SPARS to quantify the rate of home physiotherapy adherence, determine the effects of adherence on recovery, and identify barriers to successful adherence; leading to novel actionable insights on current treatment protocols. 3) Develop and pilot test an ethically conscious SPARS-powered rehabilitation program thatindividualizes patient-care based on their adherence. A careful examination of the ethical and policy challenges related to surveillance for self-managed medical treatments will help ensure SPARS and related technologies be deployed conscientiously and to a benefit of patients and society.