Research Dossier: Telerehabilitation

Dossier Introduction
The topic I chose to research for my project this semester is the impact of technology on physical
therapy. The reason I chose this subject is that I spent an insane amount of my childhood in
physical therapy, due to injuries I sustained during my athletic days. Weirdly enough, I enjoyed
everything about it and realized I found my future career interest. Years later, I am majoring in
Kinesiology, on the track to being a physical therapist. I was excited to learn about the
implementation of technology in an environment that has been conditioned to be physical and
traditional.
Technology has had a major impact on physical therapy, and this impact is only expected to
grow in the years to come. Physical therapists are now able to use a variety of technological
tools to help their patients recover from injuries and illnesses. These tools range from virtual
reality systems to robotic devices that can help with rehabilitation, Carlow University (2022).
Technology has also had an impact on the way physical therapists communicate with their
patients. For example, physical therapists can now use telehealth services to communicate with
their patients remotely, Crawford (2020).
Telerehabilitation is a form of physical therapy that is delivered remotely, usually through video
conferencing or other digital means. Suso-Marti et el. (2021) this type of therapy has been
gaining popularity in recent years due to its convenience and cost-effectiveness.
Telerehabilitation has enabled physical therapists to provide care to patients who may not be able
to access traditional physical therapy services due to geographic, financial, or other barriers. By
using telerehabilitation, physical therapists can provide care to multiple patients at once, which
can help reduce wait times and improve access to care. Fioratti et al. (2020) physical therapists
can provide a wider range of services, such as virtual exercise programs, video conferencing, and
remote monitoring.
However, one of the main drawbacks of telerehabilitation is that it can be difficult to accurately
assess a patient’s condition and progress without being able to physically examine them, Cox
(2019). Physical therapists rely on their hands-on assessment skills to accurately diagnose and
treat a patient’s condition, and this can be difficult to do remotely. Additionally, telerehabilitation
can be difficult to use for certain types of physical therapy, such as manual therapy or aquatic
therapy, which require the physical presence of the therapist. Saaei and Klappa (2021) overall,
while telerehabilitation can be a great way to provide physical therapy services to those who
may not have access to traditional in-person services, there are some potentially negative
impacts that should be considered.
Telerehabilitation is not a replacement for traditional physical therapy, but rather an additional
tool that physical therapists can use to provide care to their patients. Telerehabilitation is also
creating new job opportunities for physical therapists. As telerehabilitation becomes more
popular, physical therapists are needed to provide remote care to patients. On the other hand,
traditional physical therapy is still the preferred method of treatment for many patients, as it
offers a few advantages that telerehabilitation cannot. It allows for a more personal experience,
more hands-on treatment, more accurate assessment of the patient’s condition, and more
accountability. It is important to weigh the pros and cons of telerehabilitation before deciding if
it is the right option for a particular patient.

Research Proposal

Subject: Research Proposal: How is technology impacting the world of Kinesiology?

Topic description: Kinesiology research has been substantially impacted by technology. Recent
technological developments have significantly improved our capacity to noninvasively quantify
changes in the human body caused by activities. Unfortunately, getting such data and being able
to understand it both require substantial effort inputs. The promise of technology in kinesiology
is significantly constrained by the escalating expenses of developing technologies. Chatbots have
been used extensively for a while, and while they can occasionally be helpful, it is well known
that they have several limits. They use artificial intelligence (AI) and rely on data gathered from
a variety of internet sources, some of questionable validity and bias, such as those based on
variations in gender, class, race/ethnicity, and age. Online content is sometimes "personalized"
algorithm-driven advertising that aims to interest users. These individually written words are
designed to "emotionally resonate." The use of ChatGPT and comparable tools for ordinary
medical operations, including self-diagnosis, worries me tremendously. IBM Watson provides
rapid, simple responses in understandable natural language to common questions regarding
complicated health plan benefits. There is a lot of controversies regarding the need and success
of IBM Watson, so I will research the pros and cons. All this research led me to find so much
information about telerehabilitation in physical therapy, or should I say, “technology takeover”?

Documentation Style: I will write my paper in APA format because that is what's primarily
used for writing in social science fields. Writing in APA format lays the groundwork for
successful and transparent scientific communication. Researchers and students who write on
psychology and other scientific fields (like kinesiology) can present their ideas, research, and
conclusions in a uniform format by following the APA style guidelines. This makes it easier for
readers to quickly search for key details and sources while scanning scientific literature.

Purpose: My major is Kinesiology, specializing in sports medicine/physical therapy, and my

minor is Sports Psychology. My research question asks if technology will have a significant
impact on the future of sports medicine therapy and the jobs that come from it. I will be writing
from the POV of a physical therapist in the athletic field. My minor ties into this topic when
asking about ChatGPT and people self-diagnosing their illnesses instead of relying on physical
doctors to recommend options. These diagnoses can be physical or mental. Telerehabilitation
will be analyzed throughout my paper as well.

Intended audience: Since the intended audience is my class, and I don't believe anyone else is
majoring in the sports medicine field, I will have to explain a lot of medical/health terminology.
Nevertheless, my audience will benefit from reading my paper because they will understand that
physical/mental health treatment should be left to professionals with real degrees, not some AI-
generated robot with general information.
Research Question / Preliminary Thesis / Argument: How is technology impacting the world
of Kinesiology?

Types of research areas: I won't be able to do field research because I don't have access to
interview a physical therapist or doctor right now, but I will perform scholarly and internet
research. I will research within the kinesiology field and gain information from
professionals/scholars in my major. I will do this by reading professional articles, and journals,
or even viewing video lectures. I will provide internet research by going through general
resources on search sites.

Keywords: Kinesiology, technology, IBM Watson, telerehabilitation, physical therapy

Annotated Bibliography

Schweikart, S. J. (n.d.). Minnesota Journal of Law, Science & Technology. Retrieved

March 8, 2023, from https://scholarship.law.umn.edu/cgi/viewcontent.cgi?
article=1497&context=mjlst Content: Abstract: Artificial intelligence (AI) is a
powerful technology that can assist physicians with the practice of medicine. The use of
the technology has grown in recent years and has powerful potential. Medical AI
typically functions as a type of “machine learning” that relies on deep neural networks to
sift through vast amounts of data to give recommendations or draw conclusions for
clinicians. This Article begins by outlining key characteristics of medical AI (e.g., AI’s
opacity and “black-box,” and how and with what data the AI was developed) that make
an assessment of liability under traditional tort paradigms (like negligence) difficult. This
Article then highlights several tort paradigms (e.g., medical malpractice, product liability,
vicarious liability, and informed consent) and how they might function in the context of
medical AI. In conclusion, this Article offers an analysis of how tort law may evolve in
the future in response to the challenges created by medical AI today (e.g., legal
evolutions that may take the form of new solutions like AI personhood, common
enterprise liability, and a new standard of care).
Author: Scott J. Schweikart is a Senior Research Associate at the American Medical
Association and Legal Editor of the AMA Journal of Ethics. M.B.E., University of
Pennsylvania; J.D., Case Western Reserve University; B.A., Washington University in
St. Louis.
BEAM: The research article indicates the perspective of AI and its liability in the
medical field of work. There is some bias because using AI will have liabilities. This
source can be used to show the legal background before trusting AI.
Gerke, S. (n.d.). Health AI for good rather than evil? the need for a new regulatory ...
Retrieved March 8, 2023, from https://ideas.dickinsonlaw.psu.edu/cgi/viewcontent.cgi?
article=1286&context=fac-works Content: Abstract: Artificial intelligence (AI),
especially its subset machine learning, has tremendous potential to improve health care.
However, health AI also raises new regulatory challenges. In this Article, I argue that
there is a need for a new regulatory framework for AI-based medical devices in the U.S.
that ensures that such devices are reasonably safe and effective when placed on the
market and will remain so throughout their life cycle. I advocate for U.S. Food and Drug
Administration (FDA) and congressional actions. I focus on how the FDA could— with
additional statutory authority—regulate AI-based medical devices. I show that the FDA
incompletely regulates health AI-based products, which may jeopardize patient safety
and undermine public trust. For example, the medical device definition is too narrow, and
several risky health AI-based products are not subject to FDA regulation. Moreover, I
show that most AI-based medical devices available on the U.S. market are 510(k)-
cleared. However, the 510(k) pathway raises significant safety and effectiveness
concerns. I thus propose a future regulatory framework for premarket review of medical
devices, including AIbased ones. Further, I discuss two problems that are related to
specific AI-based medical devices, namely opaque (“black-box”) algorithms and adaptive
algorithms that can continuously learn, and I make suggestions on how to address them.
Finally, I encourage the FDA to broaden its view and consider AI-based medical devices
as systems, not just devices, and focus more on the environment in which they are
deployed. Author: In this article, Sara Gerke makes the case that a new
regulatory framework is required in the United States for medical devices based on AI.
This framework must guarantee that these devices are reasonably safe and effective when
they are first put on the market and will remain so throughout their entire life cycle. She
supports legislative and U.S. Food and Drug Administration (FDA) action. She wants to
concentrate on how the FDA might regulate AI-based medical devices if given more
legislative authority. BEAM: There is a bias towards new framework when using AI for
medical devices. The perspective is from Sara and the FDA regulating these AI-based
devices.

Price II, W. N. (2018, April 3). Artificial Intelligence in health care: Applications and
legal issues. SSRN. Retrieved March 8, 2023, from
https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3078704
Content: Abstract: Artificial intelligence (AI) is rapidly moving to change the
healthcare system. Driven by the juxtaposition of big data and powerful machine learning
techniques, innovators have begun to develop tools to improve the process of clinical
care, to advance medical research, and to improve efficiency. These tools rely on
algorithms, programs created from health-care data that can make predictions or
recommendations. However, the algorithms themselves are often too complex for their
reasoning to be understood or even stated explicitly. Such algorithms may be best
described as “black-box.” This article briefly describes the concept of AI in medicine,
including several possible applications, then considers its legal implications in four areas
of law: regulation, tort, intellectual property, and privacy. Author: At the
University of Michigan Law School, Nicholson Price teaches as an assistant professor of
law. He graduated from Columbia University with a JD and a PhD in biological sciences.
His work primarily focuses on the application of big data and
artificial intelligence in the field of health care, with a strong emphasis on innovation in
the life sciences.
BEAM: This article is from the perspective of legal ramifications relating AI use in
medicine. There are four legal areas: regulation, tort, intellectual property, and privacy.
This article will cause bias towards the application of AI in the healthcare field.

Chung, J. (2018, February 13). What should we do about Artificial Intelligence in health
care? SSRN. Retrieved March 8, 2023, from
https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3113655
Content: Abstract: Artificial intelligence (AI) has become an important driver of growth
and investment in the health care industry. In perhaps the most eye-catching example,
industry heavyweights such as IBM are leveraging the promise of AI to market
diagnostic systems such as Watson for Oncology that offer personalized treatment advice.
But can machines really perform the services promised by IBM? What legal principles
should underpin decisions made by AI systems?
Author: At NYU Sports and Society, Jason Chung, a senior researcher and attorney,
writes about legal and governmental issues pertaining to healthcare and sports.
BEAM: This essay explores these issues and makes the argument that giving AI legal
personhood would give the tumultuous legal and regulatory environment the
predictability and stability it needs. This creates a bias toward regulating AI’s legal
stability.

Croteau, A.-M., & Vieru, D. (n.d.). Telemedicine adoption by different groups of

Physicians (PDF). Retrieved March 8, 2023, from
https://www.researchgate.net/publication/232633571_Telemedicine_Adoption_by_Differ
ent_Groups_of_Physicians_PDF
Content: Abstract: This study addresses the factors that could affect the intention of
physicians to adopt telemedicine technology. Based on the theoretical foundations of
technology adoption models, a revised model is proposed and tested via a questionnaire
with two groups of physicians that were, at the time of the survey, just about to use
telemedicine technology.
Authors: Anne-Marie Croteau has a Ph.D. from Concordia University in Canada, and
Dragos Vieru has a Ph.D. from Concordia as well. Dragos then got his M.Sc. at McGill
University Health Center in Canada.
BEAM: This study looks at the variables that can influence doctors' decision to use
telemedicine. This article is from the perspective of doctors being asked if they are for or
against the use of telemedicine. This will add bias throughout the article because there are
opposing sides.
 de Grood, C., Raissi, A., Kwon, Y., & Santana, M. J. (n.d.). Adoption of e-health
technology by physicians: a scoping review. Retrieved March 8, 2023, from
https://www.tandfonline.com/doi/epdf/10.2147/JMDH.S103881?needAccess=true&role=
button
Content: The objective of this scoping study was to compile the available information on
possibilities and barriers that support physicians' adoption of e-health technology.
Authors: Chloe de Grood and Aida Raissi selected the full-text papers, abstracts, and
titles for the review; she also wrote and edited the final product. Yoojin Kwon did the
search, created the search plan, and helped with the writing and editing of the book. The
project's concept was established by Maria Jose Santana, who also helped with the search
strategy, supported the article screening procedure, and wrote and edited the paper.
BEAM: This article is from the perspective of physicians and their bias on the
implementation of e-health technology.

Petersen, A. (2023, January 31). More debate needed over Generative AI's Health Care
Impacts: Chatgpt. Medical Xpress - medical research advances and health news.
Retrieved March 8, 2023, from https://medicalxpress.com/news/2023-01-
debategenerative-ai-health-impacts.html
Content: IBM Watson has been used extensively for a while, and while it can
occasionally be helpful, it is well-known that they have several limits. Watson uses
artificial intelligence (AI) and relies on data gathered from a variety of internet sources,
some of questionable trustworthiness and bias, such as those based on variations in
gender, class, race/ethnicity, and age.
Author: Alan Petersen is a health sociologist interested in new and emerging health
technologies.
BEAM: There is a lot of bias in this article, such as the variations of gender, race, and
age. This is written from the perspective of a health sociologist.

McCully, K. K. (n.d.). Technology to advance research in kinesiology: The case for light,
sound, and radiofrequencies. Taylor & Francis. Retrieved March 8, 2023, from
https://www.tandfonline.com/doi/abs/10.1080/00336297.2009.10483605 Content:
Abstract: Technology has strongly impacted research in kinesiology. Recent
technological advances have greatly enhanced our ability to noninvasively quantify
activity-related changes in skeletal muscles and peripheral arteries. In people with spinal
cord injuries, we can track changes in muscle size, composition, and the presence of
injury. We can also measure changes in artery size, health, and the ability to deliver
oxygen. However, large investments in time are needed to both obtain these
measurements and to be able to interpret them. The monetary costs of advancing
technology are rising as well, serving as a major limitation to the promise of technology
in kinesiology.
Author: Kevin K. McCully is with the Department of Kinesiology at the University of
Georgia.
BEAM: The promise of innovation in kinesiology is significantly constrained by the
escalating expenses of developing technologies.
 Cox, E. (n.d.). Pros and cons of technology in Health Care - US News & World Report.
Is Technology the Health-Care Wave or Tsunami of the Future? Retrieved March 8, 2023,
from https://health.usnews.com/health-care/for-better/articles/pros-and-cons-of-
technology-in-health-care
Content: This article speaks about the Pros and Cons of technology in healthcare. They
start off with saying technology cannot replace human interaction and empathy. In-person
medical encounters are crucial for medical attention. Small indicators that anything is
wrong are frequently noticed by the people working at the front desk. A site or streaming
service is unlikely to have such insight or body language. Author: Riley
Children's Health in Indianapolis is led by chief medical officer Elaine Cox, M.D. She
serves as Riley's clinical safety officer as well. Dr. Cox has been a contributor to the U.S.
News For Better blog since 2015 and has more than 25 years of experience. Dr. Cox is an
expert in pediatric infectious diseases. BEAM: The bias come from
the doctors saying technology can’t replace human empathy or physical interaction
between doctor and patient. This will help me in my argument about the pros and cons of
technology in the healthcare world.

Suso-Martí, L., La Touche, R., Herranz-Gómez, A., Angulo-Díaz-Parreño, S., Paris-

Alemany, A., & Cuenca-Martínez, F. (n.d.). Effectiveness of Telerehabilitation in
Physical Therapist Practice: An Umbrella and Mapping Review With Meta–
MetaAnalysis. Academic.oup.com. Retrieved March 8, 2023, from
https://academic.oup.com/ptj/article/101/5/pzab075/6145901
Content: Abstract: Telerehabilitation is an option that should be adapted as soon as
possible to face the crisis caused by coronavirus disease 2019. An umbrella and mapping
review with meta–meta-analysis (MMA) of the available scientific evidence was
performed to determine whether telerehabilitation could be an effective alternative to
conventional rehabilitation in physical therapist practice.
Authors: There are more than 5 authors that contributed to this article. Each of them
gave concepts, data analysis, management, and wrote the article. They all have their
Master’s.
BEAM: There is a bias towards telerehabilitation, which enforces the use of it after
Covid19. The article is from the perspective of doctors and why they agree
telerehabilitation should be implemented.

Fioratti, L., Fernandes, L. G., Reis, F. J., & Saragiotto, B. T. (2021). Strategies for a safe
and assertive telerehabilitation practice. Brazilian journal of physical therapy. Retrieved
March 8, 2023, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7410814/
Content: A set of useful suggestions that can help physical therapists when they employ
technology to treat their patients have been acquired in this article. For forward, physical
therapists will refer to remotely administered interventions as "telerehabilitation."
Examples will center on musculoskeletal pain disorders including osteoarthritis and low
back pain, but advice may be used in a variety of physical therapy settings and diseases.
Authors: The four authors have their master’s in physical therapy.
BEAM: The article is written from the perspective of doctors who specialize in physical
therapy, and their recommendation on how to use telerehabilitation effectively.
Saaei, F., & Klappa, S. G. (n.d.). Rethinking Telerehabilitation: Attitudes of Physical
Therapists and Patients. Retrieved March 8, 2023, from
https://journals.sagepub.com/doi/pdf/10.1177/23743735211034335
Content: Abstract: COVID-19 has accelerated the adoption of telehealth among various
specialties, including rehabilitation. The fast-paced implementation of telerehabilitation
has laid bare its challenges, providing an opportunity for innovation in order to enhance
the experience of remote care. The purpose of this study sought to understand the
attitudes toward tele rehabilitation from physical therapist (PT) and patient perspectives.
Two surveys administered to PTs, and the general patient population explored beliefs
regarding telerehabilitation. There were a total of 289 participant responses in this study.
There were 228 PT respondents and 61 patients who responded to the patient survey.
Qualitative results describe current attitudes toward telerehabilitation. Results indicated
both groups were receptive to virtual therapy sessions; however, some challenges were
also reported. Current challenges and trends in utilizing telerehabilitation are further
discussed.
Authors: Saaei and Klappa are physical therapists.
BEAM: There is a lot of information about telerehabilitation in physical therapy in this
article, so I will use most of my examples from here. This article is written from the
perspective of physical therapists trying to implement telerehabilitation after Covid19.