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Introduction: Exercise-based physiotherapy is an established treatment of rotator cuff injury. Objective assessment of at-home exercise is critical to understand its relationship with clinical outcomes. This study uses the Smart Physiotherapy Activity Recognition System to measure at-home physiotherapy participation in patients with rotator cuff injury based on inertial sensor data captured from smart watches. Relationships between participation and clinical outcomes, long-term durability of outcome improvements, and factors predictive of participation were evaluated., Methods: Patients participated in a 12-week rotator cuff physiotherapy program in a prospective single-center study. Patients wore smart watches during supervised weekly in-clinic physiotherapy sessions and while performing exercises at home. Demographic information and rotator-cuff diagnosis were collected at baseline and assessed as predictors of physiotherapy participation. Outcome measures (pain, disability [Disabilities of the Arm, Shoulder and Hand], strength, range of motion) were collected over duration of treatment and at 12-month follow-up (pain and disability). Machine learning algorithms identified and classified periods of exercise to evaluate participation and adherence., Results: One hundred ten patients enrolled and initiated treatment, with 92 patients included in the analysis. All outcomes showed significant improvements from baseline at each time point. Mean total weekly at-home participation decreased from 35.6 ± 28.9 minutes in weeks 0 to 4 to 28.9 ± 25.7 minutes in weeks 8 to 12 (t = 2.23, P = 0.023). For the full cohort, significant relationships were found between physiotherapy participation and disability, manual strength, external rotation, internal rotation, and abduction. Significant predictors of participation included greater age, being unmarried, diagnosed rotator cuff tear, and measures of self-efficacy, social support, and comorbidity. Higher participation rates led to significant improvements in outcomes for partial thickness/no-tear patients but not for full-thickness tears., Discussion: Machine learning methods applied to data collected from smart watches enabled objective assessment of physiotherapy participation in the home setting. Although most patients improved with physiotherapy, patients with full-thickness rotator cuff tears were not similarly responsive to higher exercise volumes., (Copyright © 2025 by the American Academy of Orthopaedic Surgeons.)

Background: The purposes of this study were to examine the reliability and factorial and convergent validity of a virtual performance measure (VPM) in patients with osteoarthritis (OA) of the hip joint and to compare the known-group validity of the VPM with traditional self-report and performance-based outcomes., Methods: The VPM score was based on the results of 10 videos showing increasing difficulty in performing specific functional tasks. Patients were requested to choose the video that best reflected their own level of function. Clinical presentation and radiological findings were documented. Self-report measures were the lower extremity functional score (LEFS) and pain scale. The performance-based measures were the 30- second Chair Stand Test (CST) and the 40-meter fast paced walk test (40 m FPWT) test., Results: Data of 100 patients, 64 (64%) females, mean age: 67 ±10 were examined. The Cronbach's alpha coefficient that examined internal consistency of the VPM total score was 0.88. Factor analysis showed two distinct domains. Moderate correlations were observed between the VPM total score and the LEFS, pain score, and 40 m FPWT (r > 0.50). The VPM and the LEFS were able to differentiate between candidates and non-candidates for hip arthroplasty and between those with and without assistive walking devices. There was no statistically significant difference between the overall accuracy of the VPM and LEFS in the area under the curve value (0.72 vs. 0.71) with respect to candidacy for surgery., Conclusions: This study provides substantial evidence towards the validity and reliability of the VPM outcome measure in patients with moderate to severe OA of the hip joint. Digitally based outcome measures have the potential of enhancing remote measurement of functional difficulties in specific situations., Clinical Trial Number: Not applicable., Competing Interests: Declarations. Ethics approval and consent to participation: The study protocol was approved by the Human Ethics Research Board of the Sunnybrook Health Sciences Centre. All procedures and methods were carried out in accordance with a Declaration of Helsinki regulation and guidelines. All patients provided informed consent for participation in the study. Consent for publication: Not applicable. Conflict of interests: The Authors declare that they have no conflict of interest., (© 2025. The Author(s).)