CuffLink: Remotely Monitored Rotator Cuff Repair Rehabilitation at Home

ABSTRACT Rotator cuff tears are the primary cause of shoulder disability in adults, generating between $3 and $12 billion in healthcare costs annually. Rotator cuff repair (RCR) surgery results in greater improvement than non-surgical options. However, post-RCR rehabilitation requires a careful balance of movement to prevent shoulder stiffness while keeping the shoulder stable to protect repair integrity. Current early rehabilitation involves passive range of motion exercises performed during out-patient physiotherapy. Together, ēlizur and the University of Pittsburgh propose to develop CuffLink, a telehealth system for post-RCR rehabilitation, by integrating two previous successful developments: the mechanical Strengthening andamp; Stabilization Systems (SSS) and the remote monitoring capabilities of interACTION (iA). CuffLink will aid post- RCR rehabilitation by providing a safe, reliable and at-home means of mobilizing the shoulder, while allowing for remote monitoring. This reduces the need for costly in-patient visits in the early stage of rehabilitation, increases accessibility to care for patients with limited mobility and/or in rural areas, and increases communication and supervision by physicians and their staff through the clinician portal. First, a Delphi survey will be conducted with orthopaedic surgeons and physical therapists to understand their opinions on the current RCR best practices. Concurrently, an integrated movement monitoring application programming interface will be developed and refined according to the consensus established by the expert Delphi panel. This will result in the conversion of raw data signals from quantitative motion sensors in the SSS into clinically acceptable and telehealth ready data streams. Then, a mobile health system based on iA will be developed. This will include an app suite for patients and a clinician portal, which will provide exercise feedback to both patients and clinicians, and allow clinicians to monitor patient data and engage patients. Then, the accuracy and test-retest reliability of CuffLink will be validated using a group of RCR patients recruited primarily through the UPMC Orthopaedic Surgery clinics. Measured readings from CuffLink will be compared to a gold standard optical motion capture system, and participants will return to the testing facility a few days later to repeat the exercises. Finally, the feasibility, usability, and acceptability of CuffLink for use in patients’ homes will be assessed. These will be evaluated both quantitatively and qualitatively, and the results are expected to demonstrate high satisfaction. Successful completion of this project will result in a device that combines the safety of mechanical motion exercise equipment with quantitative motion tracking and remote monitoring to personalize and optimize patient recovery from RCR surgery at lower costs. It is expected that the device, CuffLink, will be ready for clinical evaluation in a Phase II proposal.NARRATIVE Rotator cuff tears are the primary cause of shoulder disability in adults, and are commonly treated surgically. Early post-operative rehabilitation aims to protect the repair and promote healing while safely and progressively restoring motion, primarily through outpatient physical therapy. We propose to develop CuffLink, a telehealth system that will allow post-operative patients to perform remotely monitored rehabilitation exercises safely at home, resulting in cost savings, more efficient use of clinician time, and improved patient adherence and recovery.