Patient Self Monitoring to Transfer Physical Therapy Exercise from Clinic to Home

Each year, more than 17 million patients are diagnosed with conditions that might benefit from physical therapy. Although adherence to home exercise is the most important factor in functional recovery, patients often fail to perform the exercises correctly or as frequently as prescribed. Factors that affect adherence include patients’ feelings of helplessness and level of motivation, methods and adequacy of instruction, and physical therapists’ guidance and encouragement.

This project developed an image-based electronic health record (IBEHR) to give patients visual feedback in real time and provide accurate information on home exercise to the physical therapist. The IBEHR shows patients their exercise performance by recording an avatar when they exercise at home and comparing it with an avatar recorded of the patient exercising correctly in the clinic under the physical therapist's supervision. The IBEHR reveals deviations from correct exercise form to help patients perform their exercise correctly.

The specific aims of this project were to:

• Develop the software for synchronizing the clinic and home avatars, aligning them, and measuring deviations.
• Perform alpha and beta testing. The alpha test measures the limits of accuracy of body tracking by the IBEHR. The beta test verifies that the user interface is easy to use by both physical therapists and patients.
• Assess the efficacy of the IBEHR to improve adherence in 60 patients with anterior knee pain or anterior cruciate ligament (ACL) injury.

The hardware and software for IBEHR was developed and underwent alpha and beta testing. The initial study plan had been to evaluate the impact on adherence of IBEHR for those with anterior knee pain or ACL injuries. However alpha testing found inaccuracies in the software’s ability to track lower extremity exercises. Despite modifications to the software, the accuracy was unable to be improved. When testing showed that these exercises could be more accurately tracked in shoulder injuries, the clinical target was changed. Implementation of the IBEHR for shoulder pain was completed and an exercise library for shoulder pain in various medical conditions was developed. Beta testing was completed with one physical therapist and three patients. All reported the system easy to use. The planned clinical testing of the system was not completed during the grant term due to lack of time.

The project team concluded that currently available IBEHR technology is accurate at tracking exercise involving the upper but not the lower extremity. Given the speed at which the field is moving it is likely that lower extremity tracking will be possible in the near future. The results of this research demonstrated a high level of acceptance of the IBEHR by both the physical therapist and patients. Its ready acceptance demonstrates the potential value of IBEHR for helping patients transition from clinic to home-based physical therapy exercise.