Enhancing Physical Therapy With Artificial Intelligence

Alaina Victoria, PT, DPT, Clinical Content Manager, OneStep

In 2014, Stephen Hawking cautioned that “the development of full artificial intelligence could spell the end of the human race….It would take off on its own and re-design itself at an ever-increasing rate..”

Artificial intelligence (AI) has advanced rapidly in recent years, with its impressive power and capacity to change so many areas of human life. It continues to become more embedded in the lives of average consumers. While AI might not yet be the end of humanity as we know it, we’re certainly seeing the boundaries being pushed. 

In healthcare, where human interaction is critical, AI continues to ingrain itself within the patient-clinician relationship at a breathtaking pace. Advanced technologies are quickly showing their potential to create meaning out of vast amounts of data – creating opportunities to make treatments more accurate, care delivery more convenient and care coordination more streamlined. Now, we are seeing what many in healthcare view as an alarming trend: an increase in the automation of tasks previously done by human hands. Naturally, this evokes images where machines are outperforming their human peers with diagnostic precision and replacing clinicians altogether. In a profession like physical therapy, which at its core is grounded in empathy and patient rapport, the impact of such a future becomes amplified.

However, the idea of AI making a sudden leap in which it can achieve intelligence superior to clinicians is more illusory than inevitable. We are a complex species and can adapt to many variables and environments all at the same time. Attempts for AI to achieve such feats continue to be met with replication challenges and other technological limitations. In healthcare, there is the added burden that any intervention worth doing must demonstrate clinical rigor, meet the highest standards of care, show evidence, and be clinically validated.

Notwithstanding the hype of AI replacing humans, its impact on the healthcare industry is transformative and continuously evolving. And its current advancements simply cannot be ignored, even in physical therapy. So perhaps it’s better to look at AI through a more pragmatic lens and ask a different set of questions. Can AI actually benefit physical therapy and its clinicians? More specifically, can harnessing the benefits of AI actually enhance the crucial patient-provider alliance?

Physical therapists are human, not AI technology

The recent release of AI software steps into the uncharted territory of replacing the licensed clinician with technology. According to the release, this technology “can identify if a member is practicing a physical therapy activity incorrectly” and offer “tailored feedback regarding how members can improve and more closely align with the appropriate posture or motion for the exercise.” In this scenario, the AI algorithms analyze movement data, identify problems and then provide feedback to the patient. There is some guidance as needed from health coaches, but not a licensed physical therapist. There is also minimal interaction between the patient and the licensed provider – a scenario in which the use of AI technology is overstepping its boundaries, taking a good idea a little too far. While using AI to analyze movement can be a resource that offers meaningful and actionable data, the lack of oversight from a licensed physical therapist negates the critical value of the therapist’s clinical decision-making. Consider, what happens if there are complications outside the scope of the AI to detect? Physical therapists are trained to constantly reassess their patients from a holistic viewpoint so that any changes are caught and accounted for in their plan of care. Technology is an impressive asset, but only when leveraged by an actual physical therapist.

Physical therapy: a historically hands-on profession

Physical therapy is a traditionally in-person profession, with the delivery of hands-on assessment and treatment as a component of the patient plan of care. Physical therapists’ refined sense of touch used to evaluate movement, identify impairments, and facilitate interventions certainly has demonstrated value. However, the foundation of physical therapy is rooted in optimizing human movement to improve the lives of others. Physical therapists also rely on their knowledge base and professional judgment to analyze a patient’s movement, medical history, clinical presentation, and personal feedback. This skill set allows them to form a hypothesis about the underlying impairments that are impacting the patient’s mobility, comfort and quality of life so that they can formulate an appropriate plan of care.

Unfortunately, decreasing reimbursement rates and high productivity standards make it difficult for physical therapists to provide patients with the best care possible. There is a growing burden to be more efficient while maintaining high caseloads that leads to provider burnout and insufficient patient care. Additionally, patients are only able to be seen 1-2 times per week in traditional therapy models, leaving them on their own for a majority of their plan of care – oftentimes without accessible lines of communication for guidance between visits. 

These challenges can be mitigated with AI technology. Physical therapy assessment and treatment can be done, and done well, completely virtual with the proper tools and training. Some therapists might be skeptical about going digital and concerned about the inability to provide manual therapy or use certain modalities. It’s a natural tendency to feel hesitant when going digital. However, it’s important to remember that hands-on interventions are only a piece of the puzzle that can be incorporated into the overall treatment plan. In most cases, creating a personalized plan of care with effective exercises, ongoing patient education and lifestyle modifications that the patient actually engages in consistently is what drives meaningful change and long-term results. Movement is medicine, and now with advances in AI technology physical therapists can analyze patient movement and prescribe exercise programs directly to patients in their own environment. Furthermore, AI technology can make clinicians more efficient by removing the burden of certain daily tasks – such as collecting outcome measures, tracking patient adherence, and documenting.

The issue in leveraging AI technology partly lies in determining what constitutes receiving actual “physical therapy” services when these solutions are involved. The American Physical Therapy Association (APTA) takes a strong stance on The Importance of Term and Title Protection in regard to delivering true physical therapy services, performed by a qualified, licensed physical therapist. Physical therapy should not be used as a general term and is reserved only for professionals with the appropriate education, credentials, and licensing requirements. When a physical therapist is not involved, the service cannot be classified as physical therapy.

AI can provide tremendous benefits to many aspects of physical therapy when implemented appropriately, and the APTA also “recognizes and supports the potential for technology to augment physical therapist practice.” There has been significant innovation in motion analysis technology that allows for a more accurate and objective collection of outcome measures – enabling physical therapists to work in a truly evidence-based model that’s specific to each patient. The introduction of billable remote therapeutic monitoring (RTM) codes means digital solutions can increase revenue streams and improve efficiency without compromising the quality of care – a struggle well-known to the physical therapy community as discussed. Remote monitoring technology and predictive analytics can help clinicians observe patients for changes in functional mobility and fall risk status so that they can intervene proactively or triage them to the appropriate level of care. Additionally, the ability to automatically transmit data within care teams as well as between providers and patients enhances interdisciplinary communication and improves the continuity of care. It also saves valuable time, increases personalized treatment plans, and offers better avenues for patient guidance outside of the clinic. Streamlining workflows with AI technology enables physical therapists more time to focus on patient treatment and ensure optimal clinical decision-making for their patients.

On a larger scale, AI is extremely useful at producing population-level data that allows physical therapists to not only view an individual patient’s data, but also various populations based on specific demographics. This can be used to quickly understand how a patient is progressing in comparison to others of similar demographics and tailor their treatment as necessary. Population-level data also offers insight into overarching trends in various populations, which can then be used to implement population health strategies or new treatment protocols and monitor intervention efficacy. The future of AI in the physical rehabilitation space is impressive, but it is most powerful when combined with the human touch and critical analysis of a physical therapist.

AI should enhance human interaction in physical therapy

“Why see a clinician when an app can do everything” is a general impression, but such thinking is a bit short-sighted. Yes – AI technologies are incredibly smart and can make things more efficient and perform many tasks automatically with greater precision. However, we should look at exactly what is being automated and what is being made more efficient. Is it the decision-making power of a clinician? No. It is the mundane tasks; the tasks that take little to no cognitive power. The processing power of AI takes care of all that, leaving more emphasis on clinical judgment, patient rapport, and empathy with patients. Perhaps, instead of looking at AI as something that takes away, what if we look at what it can give back? Time. As renowned digital health physician, Eric Topol, expressed as a core principle in the deployment of digital healthcare technologies:

“The gift of time: wherever possible the adoption of new technologies should enable staff to gain more time to care, promoting deeper interactions with patients.”

AI cannot offer true human connection throughout a patient’s plan of care. Physical therapists are empathetic clinicians who understand the complexities of human emotion, having the ability to experience these emotions themselves. Patient care is substantially more than algorithms and numerical outcomes. In fact, research shows that the patient-doctor relationship is crucial and directly impacts the entire treatment experience. Implementing a patient-centered approach built on trust and effective communication has been shown to foster improved patient satisfaction, greater adherence, and better outcomes. The best patient care considers the entirety of the patient and encourages personal, two-way conversation. Physical therapists receive not only extensive schooling to become movement experts, but they are taught the importance of empathy, patient-centered care, and effective communication strategies to both understand and educate their patients. Successful use of AI should enable more frequent – and convenient – touchpoints between the patient and the provider, not less.

Combining AI with human touch will change patients’ lives.

AI remains only able to complete particular and narrow tasks. It isn’t smart enough for us to put the entirety of our health in its control – AI can enhance care, but we still need qualified providers to facilitate a truly effective healthcare ecosystem as humans are complex beings. 
However, providers and patients will absolutely benefit from the integration of new technology that is optimizing patient care – so providers can do their jobs more efficiently and patients reap the benefits of convenient, personalized, engaging plans of care. While AI will never replace a physical therapist, Justin Moore, CEO of the APTA, said it best at the APTA Summit on Digital Physical Therapy – “A digitally enabled PT will absolutely replace a PT who is not digitally enabled.”

About Alaina Victoria

Alaina Victoria, PT, DPT, is a Clinical Content Manager for OneStep, and a doctor of Physical Therapy with a passion for digital health technology. Her prior experience includes working within the rehabilitation and orthopedic settings as both a permanent and travel therapist. She is a member of the American Physical Therapy Association (APTA) including the APTA Academy of Geriatrics Physical Therapy, APTA Frontiers in Rehabilitation, Science and Technology Council, and APTA Health Promotion and Wellness Council.