AI-Enhanced Telerehabilitation Program Using Automated Video Analysis and Personalized Feedback on Pain, Disability, Mobility, Endurance, for Chronic Non-Specific Low Back Pain in College Students.

Chronic non-specific low back pain (CNSLBP) has emerged as a significant health concern among college students, with international studies reporting prevalence rates between 40-52%. This high incidence is attributed to the modern academic environment, characterized by prolonged static postures during lectures and study sessions, extensive use of laptops and handheld devices leading to poor trunk alignment, and generally low levels of structured physical activity resulting in deconditioning of core and postural muscles.

The impact of CNSLBP in college students extends beyond physical discomfort, affecting academic performance, causing absenteeism, limiting recreational participation, and potentially leading to persistent pain patterns in adulthood. Current evidence-based management guidelines recommend multidisciplinary approaches emphasizing structured exercise therapy, self-management education, and postural retraining, with particular focus on flexibility, core stability, and functional strength exercises.

However, significant barriers prevent college students from accessing optimal care. These include logistical challenges such as academic scheduling conflicts, economic constraints related to repeated physiotherapy visits, and geographical accessibility issues. Consequently, many students resort to unsupervised home exercise programs that, while cost-effective and flexible, lack real-time monitoring and professional guidance, often resulting in incorrect technique, poor adherence, and suboptimal outcomes.

TECHNOLOGICAL INNOVATION

Recent advances in artificial intelligence (AI) and computer vision technology offer promising solutions to bridge this care gap. Markerless motion capture systems, particularly Google's MediaPipe Pose and OpenPose, can analyze human movement using standard cameras to identify skeletal landmarks, track joint angles, assess posture, and detect movement deviations in real-time. These systems demonstrate approximately 85% accuracy for gross movement tracking and exercise repetition counting, making them suitable for clinical rehabilitation applications.

When integrated into telerehabilitation platforms, AI-driven video analysis provides dual benefits: enhancing remote care quality by supplying therapists with quantitative performance feedback, and enabling patients to receive immediate automated correction cues, thereby improving engagement and self-efficacy.

STUDY DESIGN AND METHODOLOGY

This single-blind, three-arm parallel-group randomized controlled trial will compare the effectiveness of AI-enhanced telerehabilitation versus standard telerehabilitation and usual care in college students with CNSLBP. The study design addresses a critical research gap, as no published randomized controlled trials have specifically examined AI-enhanced telerehabilitation in this population.

INTERVENTION GROUPS

Group 1: AI-Enhanced Telerehabilitation Participants will receive personalized exercise programs delivered through a custom platform incorporating AI-based movement analysis. The system uses computer vision algorithms to monitor exercise performance through participants' webcams or smartphones, providing real-time feedback on form, automatically counting repetitions, measuring hold times, and flagging technique errors.

Group 2: Standard Telerehabilitation Participants will receive exercise programs via video instructions without AI monitoring or personalized feedback. This group represents current telerehabilitation practice, relying on pre-recorded exercise videos and periodic therapist consultations without objective movement analysis.

Group 3: Educational Control Group Participants will receive standard medical care as typically provided for CNSLBP, which may include general advice on activity modification, over-the-counter pain medications, and basic exercise recommendations without structured supervision.

PARTICIPANT SELECTION

The study will recruit college students aged 18-30 years with chronic non-specific low back pain (duration >3 months) from university health services and campus recruitment. Inclusion criteria ensure participants have clinically significant symptoms warranting intervention, while exclusion criteria eliminate cases with specific pathologies requiring specialized medical management.

OUTCOME MEASURES

Primary outcomes include pain intensity measured using the Numerical Rating Scale (NRS), functional disability assessed with the Roland-Morris Disability Questionnaire (RMDQ), functional mobility evaluated through the 5STS, and trunk muscular endurance measured via the prone plank test. These validated instruments are sensitive to clinical changes in low back pain populations.

Secondary outcomes encompass adherence rates to prescribed exercises, platform usability assessed through standardized questionnaires, quality of life measures, healthcare utilization patterns, and long-term follow-up assessments at 3 months post-intervention.

STATISTICAL ANALYSIS

The study will employ completers only analysis as the primary approach, with per-protocol analysis as secondary. Power calculations indicate adequate sample size to detect clinically meaningful differences between groups. Mixed-effects models will account for repeated measurements and potential confounding variables.

EXPECTED OUTCOMES AND SIGNIFICANCE

This research aims to establish whether AI-enhanced telerehabilitation can provide superior clinical outcomes compared to standard approaches while maintaining high usability and adherence rates. The findings have potential to inform university health services, influence physiotherapy practice guidelines, and support broader integration of AI technology into telehealth delivery.

The study aligns with the World Health Organization's Global Strategy on Digital Health 2020-2025, which encourages leveraging digital innovation to improve healthcare accessibility and equity. By focusing on a tech-savvy demographic experiencing significant barriers to traditional care, this research addresses both immediate clinical needs and broader healthcare delivery challenges.

INNOVATION AND FUTURE IMPLICATIONS

This study represents a pioneering application of AI technology in rehabilitation for young adults, potentially establishing a scalable model for remote physiotherapy delivery. The integration of objective movement analysis with personalized professional guidance offers a novel approach that maintains therapeutic relationships while leveraging technological capabilities for enhanced monitoring and feedback.

The research contributes to the growing body of evidence supporting digital health interventions while specifically addressing the unique needs and circumstances of college students with chronic low back pain. Success could lead to broader implementation across university health systems and expansion to other musculoskeletal conditions and age groups.

QUALITY ASSURANCE

The study incorporates rigorous methodological standards including randomization procedures, blinding where possible, validated outcome measures, standardized intervention protocols, and comprehensive statistical analysis plans. Regular monitoring ensures protocol adherence and participant safety throughout the study period.