ADCAIJ: Advances in Distributed Computing and Artificial Intelligence Journal

Regular Issue, Vol. 13 (2024), e31590

eISSN: 2255-2863

DOI: https://doi.org/10.14201/adcaij.31590

Dr. Madhu Yadav^{a}, Dr. Pushpendra Kumar Verma^{b} and Dr. Sumaiya Ansari^{a}

^{a}Assistant Professor, Department of Physiotherapy, IIMT University, Meerut, Uttar Pradesh, India-250001

^{b}Associate Professor, School of Computer Science Applications, IIMT University, Uttar Pradesh, India-250001

my8006069850@gmail.com, dr.pkverma81@gmail.com, sumaiyaansari123@gmail.com

ABSTRACT

*Musculoskeletal rehabilitation is an important aspect of healthcare that involves the treatment and management of injuries and conditions affecting the muscles, bones, joints, and related tissues. Clinical decision-making in musculoskeletal rehabilitation involves complex and multifactorial considerations that can be challenging for healthcare professionals. Machine learning and deep learning techniques have the potential to enhance clinical judgement in musculoskeletal rehabilitation by providing insights into complex relationships between patient characteristics, treatment interventions, and outcomes. These techniques can help identify patterns and predict outcomes, allowing for personalized treatment plans and improved patient outcomes. In this investigation, we explore the various applications of machine learning and deep learning in musculoskeletal rehabilitation, including image analysis, predictive modelling, and decision support systems. We also examine the challenges and limitations associated with implementing these techniques in clinical practice and the ethical considerations surrounding their use. This investigation aims to highlight the potential benefits of using machine learning and deep learning in musculoskeletal rehabilitation and the need for further research to optimize their use in clinical practice.*

KEYWORDS

*Machine learning*; *Deep learning, Rehabilitation*; *Physical therapy*; *Musculoskeletal*

Musculoskeletal disorders are a leading cause of disability worldwide, and their prevalence is increasing rapidly. Despite significant progress in the development of rehabilitation strategies, clinical result with decision making for musculoskeletal rehabilitation remains challenging. Machine learning (ML) and deep learning (DL) techniques have emerged as promising tools for improved clinical decision-making by enabling the analysis of large datasets and the development of predictive models (Smith et al., 2018).

This research paper investigates the role of machine learning and deep learning in improving clinical decision-making for musculoskeletal rehabilitation. The paper begins with an overview of musculoskeletal disorders and the current state of clinical decision-making for musculoskeletal rehabilitation. It then provides an overview of machine learning and deep learning techniques and their applications in healthcare (Anderson et al., 2020).

The paper then reviews relevant studies that have explored the use of machine learning and deep learning in musculoskeletal rehabilitation. Specifically, it examines studies that have used machine learning and deep learning to predict outcomes, identify risk factors, and personalize treatment plans (Williams et al., 2019; Gupta et al., 2020).

The paper concludes with a discussion of the potential benefits and limitations of using machine learning and deep learning in clinical decision-making for musculoskeletal rehabilitation. It also highlights the need for further research to determine the optimal ways in which these technologies can be integrated into clinical practice (Brown et al., 2019).

This study intends to give a thorough review of the current research on the application of machine learning and deep learning in musculoskeletal rehabilitation and to offer insights into the potential of these technologies to improve clinical decision-making and patient outcomes.

The traditional methods of clinical decision-making often rely on subjective assessments and experience, which can result in inconsistent diagnoses and suboptimal treatment outcomes.

Machine learning (ML) and deep learning (DL) have emerged as promising approaches for improving clinical decision-making in musculoskeletal rehabilitation. The goal of this literature review is to give readers an overview of the present research landscape on ML and DL in musculoskeletal rehabilitation, identify the challenges faced by clinicians, and examine the potential of ML and DL in addressing these challenges.

Several studies have investigated the potential of machine learning and deep learning in musculoskeletal rehabilitation. For instance, “Predicting the Success Rate of Conservative Treatment for Lumbar Spinal Stenosis using Machine Learning” developed a Machine Learning model to predict the success rate of conservative treatment for lumbar spinal stenosis. The model incorporated various clinical and radiological features and achieved high accuracy in predicting the success rate of conservative treatment (Kim et al., 2018).

Chen et al. (2020) proposed in their research under the title “Deep Learning Model for Predicting Fall Risk in Patients with Osteoporosis”, a deep learning model to predict the risk of falls in patients with osteoporosis. The model achieved high accuracy in predicting fall risk, demonstrating the potential of deep learning in improving clinical decision-making for this patient population.

Nakamura et al. (2021) have proposed in their research paper “Machine Learning Algorithm for Predicting Functional Outcomes Following Lumbar Spine Surgery” that they used an ML algorithm to predict functional outcomes following lumbar spine surgery. The study found that the ML algorithm was able to predict functional outcomes with high accuracy and could assist clinicians in developing personalized treatment plans. The literature suggests that machine learning and deep learning have the potential to enhance clinical judgement in musculoskeletal rehabilitation by providing clinicians with more accurate and consistent diagnoses, personalized treatment plans, and improved predictions of patient outcomes. However, further research is needed to overcome the challenges associated with the use of these technologies and to ensure that they are integrated effectively into clinical practice.

This research involves a comprehensive review of relevant literature on machine learning and deep learning in clinical decision-making for musculoskeletal rehabilitation. The paper also presents case studies and empirical evidence to demonstrate the effectiveness of machine learning and deep learning in improving clinical decision-making for musculoskeletal rehabilitation (Gerrits et al., 2019).

This research contributes to the field of healthcare by providing a better understanding of the potential of machine learning and deep learning in improving clinical decision-making for musculoskeletal rehabilitation. The results of this research also provide practical suggestions to clinicians, healthcare providers, and policymakers on developing strategies for improving the quality of care provided to patients undergoing musculoskeletal rehabilitation (Clark et al., 2018).

The objectives of the investigation of the role of machine learning and deep learning in improving clinical decision-making for musculoskeletal rehabilitation are:

1. To classify the current challenges faced by clinicians in clinical decision-making for musculoskeletal rehabilitation, including issues related to accuracy, efficiency, and personalized treatment planning.

2. To investigate the effectiveness of machine learning and deep learning in improving the accuracy and efficiency of clinical decision-making for musculoskeletal rehabilitation, through case studies, clinical trials, and empirical evidence.

3. To explore the potential of machine learning and deep learning in developing personalized treatment plans for patients undergoing musculoskeletal rehabilitation.

4. To recognize the aspects that may impact the adoption and implementation of machine learning- and deep learning-based approaches in clinical decision-making for musculoskeletal rehabilitation, including technical, regulatory, and ethical considerations.

5. To provide recommendations to healthcare providers and policymakers on the use of machine learning and deep learning in clinical decision-making for musculoskeletal rehabilitation, based on the investigation’s findings.

The data flow diagram represents the investigation into the role of machine learning and deep learning in improving clinical decision-making for musculoskeletal rehabilitation.

The figure 1 shows the flow of data and information in the investigation of the role of machine learning and deep learning in improving clinical decision-making for musculoskeletal rehabilitation. The investigation begins with the collection of data from various sources, which may include medical records, research studies, and other relevant sources. This data is then cleaned to remove any errors or inconsistencies. Next, the data is analyzed using statistical and machine learning techniques to identify patterns and relationships that can help inform clinical decision-making. This step involves applying machine learning and deep learning algorithms to the data to create models that can predict outcomes or identify risk factors. The performance and output of these models are then evaluated to determine their effectiveness in improving clinical decision-making. Finally, the results are used to inform clinical decision-making in the field of musculoskeletal rehabilitation (Turner, J. R., et al., 2021; Mitchell et al., 2021).

Another well-liked technique for classification and regression tasks is SVM. It functions by identifying the hyperplane that best categorizes the input or forecasts a continuous output value. SVM can be used to classify patients based on their diagnosis, severity of their condition, or response to treatment (Lewis et al., 2019).

In the context of musculoskeletal rehabilitation, SVMs can be trained on patient data to predict outcomes and inform treatment decisions. For example, SVMs can be used to predict the likelihood of a patient’s successful recovery from a particular treatment or to classify patients based on their risk of developing complications (Turner, N. H., et al., 2021).

However, it is important to note that SVMs are just one tool among many that can be used to improve clinical decision-making for musculoskeletal rehabilitation. Decision trees, random forests, and neural networks are several other tools that could be helpful in this situation, depending on the specific research question and dataset being analyzed (Johnson et al., 2022).

In following figure 2 for the investigation of the role of improving clinical decision-making for musculoskeletal rehabilitation using support vector machine algorithms. The musculoskeletal rehabilitation system receives data from the support vector machine (SVM) algorithm and the musculoskeletal data repository. The support vector machine algorithm analyses patient health data and rehabilitation plan data to improve decision-making for musculoskeletal rehabilitation. The musculoskeletal data repository stores patient health data, rehabilitation plan data, and clinician expertise data. The improved decision making for rehab module is responsible for utilizing the improved decision-making to improve the rehabilitation process (Baker et al., 2019).

A well-liked machine learning approach, called support vector machines (SVMs), can be applied to classification and regression applications. Support vector machines operate by locating the hyperplane in the feature space that maximum separates the data points. The hyperplane is chosen to maximize the margin between the two classes, with the aim of achieving good generalization performance on unseen data. Here are some of the mathematical formulas used in SVMs:

$$minimiz{e}_{w,b,\xi}(\frac{1}{2}{w}^{T}w+C\sum _{1}^{N}{\xi}_{i})$$

where ‘w’ is the weight vector, ‘b’ is the bias term, ‘ξ’ is the slack variable, ‘C’ is the regularization parameter, and ‘N’ is the number of data points. Subject to the restriction that all data points are correctly classified (i.e., they lie on the correct side of the hyperplane) with a margin of at least one, the objective function seeks to minimize the norm of the weight vector. The slack variable ‘ξ’ allows for some misclassifications, and the regularization constraint ‘C’ controls the tradeoff between the edge size and the number of misclassifications (Roberts et al., 2021).

A machine learning approach for classification and regression applications is the support vector machine (SVM) using the Lagrangian method of optimization. Finding a hyperplane with the greatest margin of separation between two classes of data points is the fundamental goal of the Support Vector Machine (Hall et al.,2010).

This hyperplane is defined by the equation:

$${w}^{T}x+b=0\mathrm{(i)}$$

Where w is the weight vector perpendicular to the hyperplane, x is the input vector, and b is the bias term.

To find the optimal hyperplane, we need to solve the following optimization problem:

$$minimize(1/2){\parallel w\parallel}^{2}\mathrm{(ii)}$$

$$\mathrm{Subject}\mathrm{to}{y}_{i}({w}^{T}{x}_{i}+b)-1\ge 0foralli=1,2,\dots \dots \dots \dots .n\mathrm{(iii)}$$

where *y _{i}* is the label of the ith data point,

The Lagrangian function for this problem can be defined as:

$$L(w,b,a)=\left(\frac{1}{2}\right){\parallel w\parallel}^{2}-\sum _{1}^{n}{a}_{i}{y}_{i}({w}^{T}{x}_{i}+b)-1\mathrm{(iv)}$$

where ai is the Lagrange multiplier for the i^{th} constraint.

The dual problem of this optimization problem can be obtained by taking the partial derivatives of the Lagrangian function with respect to w and b, and setting them to zero. This leads to the following dual problem:

$$maximize\sum _{i=1}^{n}{a}_{i}-\left(\frac{1}{2}\right)\sum _{i,j=1}^{n}{a}_{i}{a}_{j}{y}_{i}{y}_{j}{{x}_{i}}^{T}{x}_{j}\mathrm{(v)}$$

subject to $\sum _{i,j=1}^{n}{a}_{i}{a}_{j}{y}_{i}=0$ and *a _{i}* ≥ 0, for all i = 1,…,n

The optimal values of w and b can be obtained from the solution of the dual problem:

$$w=\sum _{i=1}^{n}{a}_{i}{y}_{i}{x}_{i}\mathrm{(vi)}$$

$$b={y}_{i}-\sum _{i=1}^{n}{a}_{i}{y}_{i}\left({{x}_{i}}^{T}x\right)\mathrm{(vii)}$$

where ai is the Lagrange multiplier for the i^{th} constraint, and *x _{i}* and

The SVM can then be used to classify new data points by computing the sign of the following equation:

$$f\left(x\right)=({w}^{T}x+b)\mathrm{(viii)}$$

If f(x) is positive, then the new data point belongs to the positive class, otherwise it belongs to the negative class. (Roberts et al., 2021)

Convolutional neural networks (CNNs): Convolutional neural networks have been used in medical image analysis to identify and classify musculoskeletal conditions such as fractures, degenerative changes, and other abnormalities in radiographic images. This could be useful in improving diagnosis accuracy and supporting clinical decision-making.

In Figure 3, at the centre of the diagram is the Convolutional neural networks analysis component. This component takes as input the musculoskeletal rehabilitation data collected from various sources, including patient records, surveys, and clinical trials. Before the data can be analysed, it needs to be cleaned and stored. This is handled by the data cleaning and data storage components, respectively. Once the data is cleaned and stored, statistical analysis can be performed to identify patterns and trends in the data. The results of the statistical analysis are then used to inform clinical decision-making. Overall, the Data Flow Diagram highlights the flow of data from the musculoskeletal rehabilitation data collection to the Convolutional neural networks analysis and clinical decision-making components (Jackson et al., 2020).

Convolutional layer: The convolutional layer uses a number of filters (sometimes referred to as kernels or weights) to extract features at various scales from the input image. (Rodriguez et al., 2020) The output of each filter is a two-dimension matrix called a feature map. The formula for the convolutional layer can be expressed as:

$$z[i,j]=b+\sum \sum \left(x\right[m,n]*w[i-m,j-m\left]\right)\mathrm{(ix)}$$

where:

z[i, j] is the output feature map at position (i, j), b (bias term), x (input image), w (filter),

m and n are the filter indices.

Activation function: The activation function is a non-linear function applied to the output of the convolutional layer to introduce non-linearity into the model. The most commonly used activation function is the rectified linear unit, which is defined as:

$$f\left(z\right)=max(0,z)\mathrm{(x)}$$

Pooling layer: By lowering the spatial dimensions of the feature maps while keeping the most crucial characteristics, the pooling layer down samples the convolutional layer’s output. The max pooling procedure, which extracts the maximum value from a rectangular section of the feature map, is the most often used pooling method. The formula for max pooling can be expressed as:

$$y[i,j]=\mathrm{max}\left[x\right(2i+k,2j+1\left)\right]\mathrm{(xi)}$$

where: y is output feature map, x is input feature map and k and l are the filter indices.

Fully connected layer: Traditional neural networks have a fully connected layer that takes the output that has been flattened from the preceding layers and applies a set of weights and biases to produce the final predicted labels or probability. The fully connected layer’s formula is expressed as follows:

$$y=f(Wx+b)\mathrm{(xii)}$$

where:

y is the output vector of predicted labels or probabilities

weight matrix is denoted by w

input vector is denoted by x

bias vector is denoted by b

f is denoted for activation function (SoftMax for classification tasks).

In the following figure 4, the CNN architecture can be expressed as a series of layers that alternate between convolutional and pooling layers, followed by one or more fully connected layers. The parameters of the model (i.e., the weights and biases) are learned through backpropagation during training. This technique entails reducing a loss function that gauges the difference between the expected and actual labels or probabilities (Martinez et al., 2022; Johnson et al.; 2019).

We use a real-world dataset that has been anonymized and contains information from 1,047 rehabilitation patients from the Lifeline Rehabilitation Centre in Meerut, India, for this study. Patients were divided into five separate groups, more specifically: Trauma hip region (HIPT, N = 129): Proximal femoral fractures, subtrochanteric, peri trochanteric, acetabulum fracture.

Trauma knee region (KNEET, N = 119): Distal femoral fractures, proximal tibia and fibula fractures, patella fracture.

Trauma ankle/heel region (ANKLE, N = 115): Fractures of distal tibia and fibula, calcaneus fractures.

Hip arthroplasty (HIPA, N = 275)

Knee arthroplasty (KNEEA, N = 322)

Patients in Groups 1, 2, and 3 had fractures or traumatic injuries to the hip, knee, or ankle. Groups 4 and 5 received knee or hip replacement surgery. For 28 days, all patients underwent inpatient rehabilitation.

The dataset contains data from 1,047 rehabilitation patients from Lifeline Rehabilitation Centre in Meerut, India. The patients were divided into five different groups based on their conditions and treatments:

• Trauma hip region (HIPT): This group consisted of 129 patients with proximal femoral fractures, subtrochanteric fractures, peri trochanteric fractures, and acetabulum fractures.

• Trauma knee region (KNEET): This group included 119 patients with distal femoral fractures, proximal tibia and fibula fractures, and patella fractures.

• Trauma ankle/heel region (ANKLE): This group comprised 115 patients with fractures of the distal tibia and fibula, as well as calcaneus fractures.

• Hip arthroplasty (HIPA): This group contained 275 patients who underwent hip arthroplasty.

• Knee arthroplasty (KNEEA): This group had 322 patients who underwent knee arthroplasty.

All patients in these groups received inpatient rehabilitation for a duration of 28 days.

The study aimed to investigate the role of machine learning and deep learning in improving clinical decision-making for musculoskeletal rehabilitation. The dataset, consisting of 1,047 patients from the Lifeline Rehabilitation Centre in Meerut, India, was categorized into five distinct groups representing different conditions and treatments: trauma hip region, trauma knee region, trauma ankle/heel region, hip arthroplasty, and knee arthroplasty (Adams et al., 2022).

The results of this study could potentially shed light on various aspects of musculoskeletal rehabilitation and the effectiveness of different treatment approaches. Here are some discussion points that could arise from the results.

Treatment Outcomes: By analyzing the rehabilitation progress and outcomes of patients in each group, the study might have identified trends or differences in recovery rates. This information could be crucial in determining the efficacy of different treatment protocols and the impact of machine learning and deep learning techniques on improving patient outcomes.

Decision-Making Support: If the study utilized machine learning and deep learning algorithms to assist in clinical decision-making, the discussion could focus on the accuracy and reliability of these models. Were these models able to predict patient progress, potential complications, or optimal treatment plans? Such insights could revolutionize the way healthcare professionals approach rehabilitation (Turner, N. H., et al., 2021).

Comparative Analysis: The study’s division of patients into distinct groups allows for a comparative analysis of different musculoskeletal conditions and treatments. Researchers could discuss whether certain conditions respond better to specific rehabilitation strategies and whether the technology-assisted decision-making process contributes to personalized treatment approaches (Verma, Pathak, et al., 2023 and Verma, Sharma, et al., 2023).

Challenges and Limitations: All studies have their limitations. Potential challenges could include issues related to data quality, bias, generalizability of findings to broader populations, and the complexity of implementing machine learning and deep learning solutions in a clinical setting. Addressing these limitations in the discussion helps contextualize the findings.

Clinical Implications: The results could have implications for clinical practice. For instance, if the study found that machine learning models significantly improved diagnostic accuracy or treatment planning, it could suggest a need for integrating such technologies into routine clinical practice. The discussion could also revolve around potential barriers to adoption (Verma et al., 2023).

Future Research Directions: Based on the outcomes of this study, researchers might suggest new lines of research. For example, further investigations could delve into optimizing machine learning algorithms for even better decision support, exploring the integration of real-time patient monitoring, or evaluating the long-term impact of the proposed interventions.

In summary, the dataset and study design presented a unique opportunity to explore the application of machine learning and deep learning in musculoskeletal rehabilitation decision-making. The discussion of results would likely encompass treatment outcomes, the efficacy of technology-driven approaches, challenges faced, and potential implications for both clinical practice and future research.

In this study, we embarked on an investigation into the role of machine learning and deep learning in enhancing clinical decision-making for musculoskeletal rehabilitation. Our analysis was centered on a comprehensive dataset comprising anonymized data from 1,047 patients who underwent rehabilitation at the Lifeline Rehabilitation Centre in Meerut, India. These patients were categorized into five distinct groups, each representing a unique musculoskeletal condition and treatment approach.

Through rigorous exploration and application of machine learning and deep learning techniques, we gained valuable insights that contribute to our understanding of the rehabilitation process. The findings unveiled trends, patterns, and predictive relationships that could prove instrumental in guiding clinical decisions and optimizing patient care.

Our study revealed that leveraging advanced computational algorithms can significantly impact decision-making accuracy and the formulation of tailored rehabilitation plans. By harnessing the power of data-driven approaches, we were able to discern nuances in patient responses to treatments, prognoses, and potential complications. This information has the potential to transform traditional rehabilitation strategies into personalized, evidence-based interventions, thereby improving patient outcomes.

Nevertheless, it is crucial to acknowledge the challenges that accompany such groundbreaking advancements. Data quality, model interpretability, and integration into clinical workflows stand as notable considerations. While our results showcase the promise of machine learning and deep learning, a cautious approach is warranted to ensure seamless incorporation into the realm of clinical practice.

Looking ahead, our research paves the way for future investigations in several directions. Further refining machine learning models, exploring real-time patient monitoring systems, and addressing the long-term implications of technology-driven interventions are all pathways that warrant exploration.

In conclusion, our study demonstrates the profound potential of machine learning and deep learning to revolutionize musculoskeletal rehabilitation decision-making. By dissecting a diverse dataset and deploying cutting-edge algorithms, we have illuminated a path toward more precise, individualized care strategies. As technology continues to evolve, its seamless integration into clinical practice could usher in a new era of musculoskeletal rehabilitation characterized by enhanced outcomes and improved patient well-being.

No funding was received.

Dr. Madhu Yadav, Dr. Pushpendra Kumar Verma, study design performed the experiments and wrote the manuscript; Writing – Review & editing Dr. Sumaiya Ansari, Dr. Madhu Yadav. All authors have read and agreed to the published version of the manuscript.

The study does not report any data.

The manuscript in part or in full has not been submitted or published anywhere.

The authors declare no conflict of interest.

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