We describe the development of a cyber-physical system (Rehab Tracker) for improving patient compliance with at-home physical rehabilitation using neuromuscular electrical stimulation (NMES) therapy. Rehab Tracker consists of three components: 1) hardware modifications to sense and store use data from an FDA-approved NMES therapy device and provide Bluetooth communication capability, 2) an iOS-based smartphone/tablet application to receive and transmit NMES use data and serve as a conduit for patient-provider interactions and 3) a back-end server platform to receive device use data, display compliance data for provider review and provide automated positive and remedial push notifications to patients to improve compliance. This system allows for near real-time compliance monitoring via a secure web portal and offers a novel conduit for patient-provider communication during at-home rehabilitation to improve compliance. The system was tested in patients (n=5) who suffered anterior cruciate ligament rupture and surgical repair to provide proof-of-principal evidence for system functionality and an initial assessment of system usability. The system functioned as designed, recording 89% of rehabilitation sessions. Thus, Rehab Tracker is a functionally correct system with the potential to be used as a tool for studying NMES and mobile communication methodologies at scale and improving compliance with at-home rehabilitation programs.

T1rho MRI, spin-lattice relaxation in the rotating frame, is postulated to be sensitive to early biochemical changes within articular cartilage that may lead to osteoarthritis. This means that it has potential as a non-invasive, early biomarker for disease progression. However, T1rho has been primarily studied in a research setting. Therefore, the main question posed in this work is: Can T1rho MRI be used in an at-risk population (ACL-rupture patients) and translated to a clinical setting? To answer this question, two tools (Relaxometry program, Line Profile Analysis) were created and validated for measuring T1rho within living subjects. These tools were used to answer the following sub-questions: 1) Is there a quantifiable difference between healthy (normal subject)and injured cartilage (ACL-rupture patient) in living subjects? 2) Is there some measure which can be tracked over time and used as a meaningful pre-screening procedure for post-traumatic osteoarthritis development at 3.0T MRI? 3) Is it possible to obtain the same or similar quality data from 1.5T T1rho (predominant MRI field strength found in clinics) as found from 3.0T T1rho images? These questions were answered affirmatively, and the author concludes that T1rho could be translated and applied into a clinical setting across the nation.

Introduktion: En främre korsbandsskada är en vanlig idrottsskada där många efter rehabiliteringen inte återgår till sin tidigare aktivitetsnivå. Förutom nedsatt knäfunktion kan många faktorer spela in i valet att återgå eller inte exempelvis motivation, rädsla och identitetsförlust. Studiens syfte var att utforska fysioterapeuters tankar, erfarenheter och rutiner kring psykosocial hälsa hos patienter med en främre korsbandsskada med målet om att återgå till tidigare idrott. Metod: Studien har genomförts genom en kvalitativ intervjustudie med en induktiv ansats samt en semistrukturerad intervjuguide. Fem fysioterapeuter som aktivt arbetade med främre korsbandsskador inkluderades. Intervjuerna analyserades utifrån innehållsanalys enligt Graneheim och Lundman. Resultat: Innehållsanalysen resulterade i ett tema; Psykosocial hälsa, en gråzon för fysioterapeuter med tre kategorier; Psykosociala faktorer påverkar patientens rehabilitering, En god rehabilitering kräver engagemang och ett helhetsperspektiv, Delad syn på betydelsen av psykosocial hälsa inom rehabilitering. Resultatet visar på en medvetenhet om att en korsbandsskada kan påverka patientens psykosociala hälsa negativt, men hur fysioterapeuterna arbetar med psykosocial hälsa skiljer sig åt. Slutsats: Psykosocial hälsa är en synlig faktor i rehabiliteringen av en främre korsbandsskada och är ett område där fysioterapeuterna saknar rutiner, resurser och tillräcklig kunskap. Det lyfts en delad åsikt hos fysioterapeuterna kring vem som ansvarar för patientens psykosociala hälsa. Den här studien illustrerar en brist på tydlighet kring fysioterapeutens roll vid psykosocial hälsa i rehabiliteringen och kan ligga till grund för framtida forskning.