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Quantifying the Relationship Between At-Home Shoulder Physiotherapy Participation and Outcome: What can a Watch Tell
Philip Boyer1, David Burns, Helen Razmjou
1From the Holland Bone and Joint Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada (Boyer, Burns, Razmjou, Renteria, Sheth, Richards, and Whyne), the Division of Orthopaedic Surgery, University of Toronto, Toronto, Ontario, Canada (Burns, Sheth, Richards, and Whyne), the Institute of Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada (Boyer, Burns, and Whyne), the Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada (Razmjou), and the Sunnybrook Orthopaedic Upper Limb (SOUL), Sunnybrook Health Science Centre, Toronto, Ontario, Canada (Sheth, Richards, and Whyne).
Smart watches objectively measured at-home physiotherapy for rotator cuff injury. Higher participation improved outcomes for some patients, but not those with full-thickness tears, highlighting the need for tailored treatment.
Area of Science:
- Orthopedics
- Rehabilitation Medicine
- Biomedical Engineering
Background:
- Exercise-based physiotherapy is a standard treatment for rotator cuff injuries.
- Objective assessment of at-home exercise adherence is crucial for understanding treatment efficacy.
- Smart wearable technology offers a novel approach to monitoring patient participation in physiotherapy.
Purpose of the Study:
- To objectively measure at-home physiotherapy participation in rotator cuff patients using smart watches.
- To evaluate the relationship between participation and clinical outcomes, including long-term durability.
- To identify factors that predict patient adherence to at-home exercise regimens.
Main Methods:
- A prospective single-center study involving 92 patients with rotator cuff injury undergoing a 12-week physiotherapy program.
- Smart watches equipped with inertial sensors were used to capture data during supervised and at-home exercise sessions.
- Machine learning algorithms classified exercise periods to assess participation and adherence, with clinical outcomes measured at baseline, during treatment, and at 12-month follow-up.
Main Results:
- All outcome measures demonstrated significant improvements from baseline.
- Mean weekly at-home participation decreased over the 12-week period.
- Physiotherapy participation showed significant relationships with improvements in disability, strength, and range of motion.
- Predictors of participation included older age, unmarried status, rotator cuff tear diagnosis, self-efficacy, social support, and comorbidity.
- Higher participation improved outcomes for patients with partial-thickness/no tears, but not for those with full-thickness tears.
Conclusions:
- Smart watch-based machine learning provides objective assessment of home-based physiotherapy.
- While most patients benefit from physiotherapy, those with full-thickness rotator cuff tears may not respond to increased exercise volume.
- Objective monitoring can inform personalized treatment strategies for rotator cuff injuries.
