JMIR Rehabilitation and Assistive Technologies

Leveraging AI and Machine Vision in Telephysiotherapy for Promoting Physical Activity and Reducing Sedentary Behavior: Scoping Review

2026-10-15T16:00:05-04:00

Background: Globally, sedentary behavior is a leading risk factor for noncommunicable diseases and premature death. Although telerehabilitation has emerged as a promising method to increase access to physical therapy, the potential of artificial intelligence (AI) and machine vision technologies to objectively monitor and promote physical activity (PA) in home settings remains underexplored. Objective: This scoping review aimed to map and systematize current evidence on the use of AI and machine vision in telephysiotherapy to promote PA and reduce sedentary behavior among healthy adults. Methods: The review followed the Joanna Briggs Institute scoping review methodology and was reported according to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. The PCC (population, concepts, and context) framework defined participants as healthy adults, the concept as AI or machine learning (ML) and machine vision technologies, and the context as remote, home-based telephysiotherapy for objective PA monitoring and/or outcome measurement in interventions aimed at promoting daily activity. Searches were conducted in PubMed, ProQuest, Science Direct, and Wiley Online Library for peer-reviewed primary studies published between 2016 and 2024. Inclusion and exclusion criteria were applied systematically using the Rayyan platform. Results: Of 7253 initial records, 4 studies met the inclusion criteria. Identified digital solutions comprised ML algorithms (eg, extreme gradient boosting and hybrid classifiers), deep learning models such as graph convolutional networks, video-based center-of-pressure assessments using RGB cameras, and ontology-driven semantic data structuring for personalization. The most frequently studied technologies combined wearable sensors with ML-based behavior change frameworks to assess usability and prototype feasibility. However, none of the studies demonstrated statistically significant improvements in reducing sedentary time or increasing PA levels among participants. The studies predominantly used exploratory or pilot designs, with small sample sizes (range: 10‐32 participants) and short follow-up periods (≤12 wk), limiting the strength of the conclusions. Conclusions: Current evidence on the application of AI and machine vision in telephysiotherapy remains scarce and largely exploratory. Although the integration of wearable technology and ML algorithms shows technical feasibility and personalization potential, there is insufficient evidence to confirm improvements in PA outcomes. Future research should prioritize longitudinal clinical trials, ensure the inclusion of diverse populations, and evaluate behavioral outcomes to determine the real-world impact of these technologies in telerehabilitation. Trial Registration: OSF Registries OSF.IO/SFC97; https://doi.org/10.17605/OSF.IO/SFC97

Ankle-Foot Orthosis and Footwear Interactions in Adult Healthy and Patient Populations: Systematic Review of Biomechanical Outcomes

2026-10-13T17:00:03-04:00

Background: Both ankle-foot orthoses (AFOs) and footwear adaptations are used to improve gait across a broad range of neuromuscular disorders. AFOs and footwear can each independently influence gait through the manipulation of certain design parameters, such as AFO footplate stiffness or the use of a forefoot rocker. While the effects of design parameters from AFOs and footwear on gait have been investigated independently, how these parameters interact to influence walking biomechanics remains poorly understood. Objective: This systematic literature review aims to provide an overview of the interacting effects between AFOs and footwear on gait biomechanics from both a theoretical standpoint and through the synthesis of existing literature. Methods: A search of existing literature was conducted across 4 major databases. Studies were eligible if they included adult participants from healthy or patient populations. Studies included should have investigated biomechanical gait outcomes recorded during walking with an AFO and at least two different footwear conditions. Quality assessment was performed using the Downs and Black checklist and AFO reporting guidelines. Results: A total of 14 studies were included in this review. Across these 14 studies, a total of 204 participants (108 healthy, 84 patients after stroke, and 12 unilateral ankle weakness or pain) were included. The majority of these studies were within-subjects designs. Footwear adaptations were primarily changes to the heel-sole differential (HSD; 7/14), followed by forefoot rockers (5/14), with some studies on changes to heel shape and hardness (3/14), and a study on mediolateral wedging. These adaptations were used in combination with primarily rigid AFOs (10/14), with studies also using dorsiflexion-free and frontal plane restrictive AFOs. Conclusions: Increasing the HSD can be used to increase knee flexion across the stance phase in rigid AFO users, including in the third rocker when HSD is manipulated between the shoe and AFO. Beyond changing the HSD, there is a lack of well-designed experimental studies exploring footwear adaptations. Detailed reporting of both AFO and footwear design choices is necessary for future work in order to make informed statements on biomechanics.

Concurrent Validity of Isokinetic Hip and Knee Strength Measurements Using the UGO Exoskeleton in Healthy Young Adults: Cross-Sectional Validation Study

2026-10-05T16:00:03-04:00

Background: The UGO lower limb exoskeleton rehabilitation robot is designed for patients with lower limb motor dysfunction, and it can be used to assess the peak torque of hip and knee flexors and extensors. Objective: The primary aim of this study was to establish the concurrent validity of peak isokinetic torque using the UGO exoskeleton and Humac Norm dynamometers in healthy young adults. Methods: Twenty healthy young adults were enrolled in this study. All participants underwent isokinetic muscle strength tests using both the UGO exoskeleton and the Humac Norm dynamometers. Peak torque (Nm) of the hip and knee flexors and extensors was measured. The Pearson correlation coefficient was used to determine concurrent validity. Bland-Altman analysis was used to assess the agreement between the 2 devices. Results: At the knee, peak torque of the extensors measured by the UGO exoskeleton correlated strongly with that measured by the Humac Norm dynamometer (right: r=0.662; P=.001; left: r=0.768; P<.001), with 95% limits of agreement (LoA) ranging from −22.89 to 82.21 Nm and from −24.60 to 75.65 Nm, respectively; the right knee flexors showed a moderate correlation (r=0.547; P=.01), with 95% LoA ranging from −26.27 to 36.01 Nm, whereas the left knee flexors showed no significant association (r=0.347; P=.12), with 95% LoA ranging from −2.40 to 75.02 Nm. At the hip, peak torque of the flexors correlated strongly on the right (r=0.615; P=.003) and moderately on the left (r=0.443; P=.04), with 95% LoA ranging from −15.52 to 86.57 Nm and from −12.53 to 98.50 Nm, respectively, whereas the bilateral hip extensors showed no significant association (right: r=0.337; P=.14; left: r=0.391; P=.20), with 95% LoA ranging from −51.57 to 76.80 Nm and from −28.19 to 79.59 Nm, respectively. Conclusions: In healthy young adults, the UGO exoskeleton demonstrated moderate to strong concurrent validity for peak torque of the bilateral knee extensors and hip flexors, but not for the nondominant knee flexors or bilateral hip extensors. The device may serve as a convenient torque assessment tool for selected muscle actions, but systematic overestimation and posture-related differences must be considered, and validation in the intended clinical population of patients with neurological conditions is required in further studies.

Crossover Analysis Is Needed in Smartphone-Supported Vestibular Rehabilitation

2026-09-30T13:30:13-04:00

Kaplan et al evaluated smartphone-supported vestibular rehabilitation using a randomized 2-period crossover design. We argue that the reported between-sequence and within-sequence tests do not directly estimate the incremental effect of app support or adequately preserve the paired participant-level structure. We also identify limitations in the interpretation of the iTUG and DHI responder analyses. Period-specific participant-level analyses accounting for treatment, period, sequence, and possible carryover effects are needed before concluding that smartphone support provides additional benefit.

Clarifying Methodological Principles and Preliminary Trends in Digital Vestibular Rehabilitation: Authors’ Reply

2026-09-30T13:00:17-04:00

Letter to editor

Measurement Properties of the European Portuguese Michigan Hand Outcomes Questionnaire (MHQ) in Paper and Electronic Formats: Instrument Validation Study

2026-09-30T11:45:03-04:00

Background: The Michigan Hand Outcomes Questionnaire (MHQ) is a key instrument for assessing hand and wrist conditions, but a validated version for European Portuguese speakers is unavailable. Furthermore, the potential of an electronic format to improve data collection and clinical workflows has not been formally evaluated. Objective: This study aimed to translate and culturally adapt the MHQ for European Portuguese and to evaluate the measurement properties and comparability of its paper and electronic formats. Methods: An observational study was conducted in three phases: (1) translation and expert review, (2) content validation through cognitive interviews, and (3) psychometric evaluation in a cohort of 81 adult patients with hand or wrist conditions. Exploratory known-groups analyses were performed according to clinical, sociodemographic, and digital-access variables. Analysis also included internal consistency (Cronbach α and McDonald ω), measurement error (standard error of measurement [SEM]), relative and absolute reliability (intraclass correlation coefficient [ICC], Spearman correlation coefficient [ρ], and Bland-Altman analysis). The electronic format’s usability was assessed with the System Usability Scale (SUS). Results: The translation and cognitive interviews confirmed the content validity and conceptual equivalence of the European Portuguese MHQ. The instrument demonstrated excellent internal consistency (Cronbach α=0.85-0.98; McDonald ω=0.88-0.99). Exploratory known-groups analyses showed significant gender-related differences and suggested side-specific clinical discrimination in fracture cases. While group-level relative reliability between formats was strong (ρ=0.68-0.91; ICC=0.76-0.95), individual-level absolute reliability was poor, with wide 95% limits of agreement spanning a 32.83-point interval. Format-related score discrepancies were most pronounced among older participants, those with lower educational attainment, and those with low digital literacy. The electronic MHQ was the preferred format (43 out of 74, 58%), showed acceptable usability (median SUS score 70, IQR 66-88), and had lower SEM in pain and function domains. Conclusions: The European Portuguese MHQ is a relevant and reliable instrument with adequate measurement properties for both clinical practice and research. The electronic version demonstrated superior precision and user preference. However, maintaining the paper format as a viable alternative is essential to ensure equitable access for patients with digital barriers. Due to the overall low absolute reliability between formats, once a patient-preferred format is adopted, it should be used consistently for longitudinal patient monitoring.

User Satisfaction With Assistive, Rehabilitation, and Training Technologies: Questionnaire Development and Content Validation Study

2026-09-25T15:15:11-04:00

Background: According to human-centered design principles, user experience and user satisfaction are key aspects when developing or providing patients and clients with assistive, rehabilitation, or training technologies. Existing tools for assessing user experience and satisfaction are often either too narrow (developed for specific technologies) or too broad, failing to capture all relevant aspects of the technology being evaluated. Objective: The main objective of this study was to present the development process and content validation of a questionnaire that, following further validation steps, could be useful for researchers and developers in assessing the satisfaction of direct end users with assistive, rehabilitation, and training technologies. Methods: The development of the User Satisfaction Questionnaire for Assistive, Rehabilitation, and Training Technologies (U-ART-Q) followed a multistep process: (1) literature review, (2) domain definition and item generation, (3) expert consultation, (4) linguistic validation, and (5) content validation. Initially, 72 items were generated and organized into 7 domains. After expert review and linguistic validation, the questionnaire underwent content validation by 8 experts in physiotherapy, kinesiology, and ergonomics. Each item was rated for relevance using a 4-point Likert-type scale. The content validity ratio (CVR) and item-level content validity index (I-CVI) were calculated, and items below the accepted thresholds were removed or further revised. Results: Expert consultation resulted in the removal or merging of 20 items to improve clarity and reduce redundancy. Of the 52 items evaluated during content validation, 44 met the CVR and I-CVI criteria (CVR >0.75 and I-CVI >0.78). Eight items required additional review, and 2 items were ultimately removed. The final questionnaire comprises 10 initial screening questions and 50 content-valid items across 7 domains: design, comfort, effectiveness and usefulness, service, treatment or exercise, overall impressions, and safety. The overall average content validity index was 0.915, providing evidence of strong content validity. A macro-enabled Excel tool was developed to automate item selection and generate a PDF version of the questionnaire based on initial screening responses. Conclusions: The U-ART-Q is a newly developed instrument for assessing user satisfaction with assistive, rehabilitation, and training technologies. Further research will focus on psychometric evaluation, reliability testing, and multilingual validation to determine whether the U-ART-Q can provide a standardized method for assessing user satisfaction. Once fully evaluated, the questionnaire could support both developmental usability testing and postmarket evaluation, facilitating evidence-based decision-making and guiding future product improvement.

Participant-Reported Reductions in Falls and Fall-Related Injuries Associated With Variable-Friction Footwear: Retrospective Pre-Post Survey Study

2026-09-22T14:45:10-04:00

Background: Falls represent a critical public health burden in older adults and individuals with neurological disabilities, but evidence for passive footwear-based fall prevention strategies remains limited. Objective: This study aimed to evaluate changes in fall frequency and fall-related outcomes following adoption of variable-friction (VF) footwear. Methods: This retrospective pre-post observational study used self-reported survey data collected from community-dwelling adults aged 18 years or older who had worn VF footwear for 3 months or longer. Participants were recruited from a convenience sample of 14,570 invited customers who purchased the device through an electronic survey platform. Outcomes included self-reported fall frequency, injurious falls, fall mechanisms, fall-related health care use (including medical visits, urgent care, and hospitalization), and assistive device use, assessed before and during VF footwear use. Results: A total of 706 participants completed the survey, yielding 705 participants with usable data for analysis (4.8% response rate). Mean monthly participant-reported falls decreased from 2.4 (SD 4.3) before VF use to 0.3 (SD 1.9) during VF use (87.1% reduction; Wilcoxon signed-rank test, <.001). The proportion reporting zero falls increased from 22.7% to 84.4%. Among participants with at least 1 fall before VF use (n=545), 95.4% (n=520) reported a reduction, including 80.7% (n=440) reporting zero falls during VF use. Injurious falls decreased by 93.2% (<.001). Participants requiring medical attention decreased from 192 (27.2%) to 12 (1.7%; 93.8% reduction; <.001), and hospital or urgent care visits decreased from 131 (18.6%) to 10 (1.4%; 92.4% reduction; <.001). Trip-related falls decreased from 52.3% to 31.5% of reported mechanisms among participants who reported a fall mechanism in both periods (<.001). Assistive device use decreased from 70.8% to 16.6% (<.001). Mean annualized insurance-related fall costs decreased from US $5946.2 to US $45.7 per person-year (99.2% reduction) across the full cohort. Conclusions: VF footwear use was associated with substantial reductions in self-reported falls, injurious falls, and fall-related health care use. Reductions in trip-related falls are consistent with the proposed biomechanical mechanism of the device. Given the low survey response rate and potential for self-selection bias, these findings should be considered preliminary. Prospective controlled studies are needed to confirm these findings.

Leisure-Time Physical Activity Interventions for Health Promotion in Individuals With Rett Syndrome: Scoping Review

2026-09-21T17:30:02-04:00

Background: While half of individuals with Rett syndrome (RTT) are older than 50 years, research shows that they have low levels of physical activity, especially for those of advanced age and poor ambulation. Despite this evidence, recent studies underscore the potential of leisure-time physical activity interventions to improve health outcomes and quality of life for individuals with RTT. Objective: This scoping review aimed to summarize the state of the science regarding physical activity interventions for individuals with RTT and their families across the life span; map the extent, range, and nature of research activity in telehealth; and describe outcomes targeted by interventions with a focus on health-related fitness. Methods: Systematic searches were performed in the MEDLINE, Scopus, Google Scholar, and CINAHL Plus databases. The data charted from eligible studies included specific details about the participants, study design, setting, intervention characteristics, outcomes, and relevant key findings. Inclusion criteria were (1) original, peer-reviewed research; (2) full-text articles in English; (3) studies reporting a leisure-time physical activity intervention; and (4) a sample of individuals with RTT and/or caregivers. Results: A total of 23 studies enrolled 200 participants in total (mean age 13, SD 7, range 2-48 years). Participants were all female individuals, and studies included mostly those who were ambulatory. RTT severity was reported in less than half (9/23, 39%) of the studies; however, participants with mild to severe scores were represented. Most of the studies (20/23, 87%) used a case study design or single-group repeated measures, and only 13% (3/23) were randomized trials. The focus was primarily on gross motor function, walking ability, and physical activity outcomes. In total, 39% (9/23) of the interventions implemented telehealth into their design, primarily using remote video calls between a physical therapist and the participants’ parents. Conclusions: The findings of this review provide a foundation for designing evidence-based, scalable physical activity programs tailored to the unique needs of individuals with RTT. The integration of telehealth strategies offers a promising avenue for enhancing accessibility and caregiver engagement. Trial Registration:

Remote Therapeutic Monitoring Use Among Commercially Insured and Medicare Advantage Patients

2026-09-21T16:45:10-04:00

This national study found that remote therapeutic monitoring use increased rapidly between 2022 and 2024 but remained low overall, varied by insurance type and clinician specialty, and was concentrated among patients with musculoskeletal conditions.