“It’s a black box”: Physiotherapists’ perspectives on sensorimotor control and the use of technology in this context to improve rehabilitation following ACL injury

Abstract Background Anterior cruciate ligament (ACL) injuries commonly occur in non-contact situations, implicating that underlying deficits in sensorimotor control may contribute to both primary and secondary injury risk. Physiotherapists play a central role in rehabilitation and have opportunities to advance recovery by use of technology targeting sensorimotor control. The integration of technologies such as wearable sensors, virtual reality, and artificial intelligence methods may support more objective assessment and context-related training after ACL injury, but clinical implementation remains limited. This study explored physiotherapists’ perspectives on sensorimotor control, including their view on how technology may support its assessment and rehabilitation following ACL injury. Methods A qualitative design was used, comprising six digital focus group discussions with 22 physiotherapists experienced in ACL rehabilitation (median experience 7 years, range 3–27), with current positions including generalist physiotherapists, clinical specialists and researchers. Discussions were recorded, transcribed, and analysed using an inductive approach and reflexive thematic analysis (Braun and Clarke). Results The analysis generated three themes: (1) Calling for measurable indicators of movement quality (2), Integrating technology as a meaningful complement to clinical assessment, and (3) Extending rehabilitation beyond the clinical walls. The physiotherapists called for methods to assess movement quality with outcome measures relevant to functional recovery and ACL re-injury risk. Although technologies were viewed as potentially supportive for assessment and rehabilitation, their added clinical value remained somewhat unclear. Adoption of technology was perceived to depend on the demonstration of clear clinical benefits, integration with clinical reasoning, and adaptation to emerging shifts in rehabilitation structures. Conclusions The physiotherapists expressed interest in technology to support sensorimotor assessment and rehabilitation after ACL injury. However, implementation was limited by uncertainty regarding the clinical value of sensorimotor outcomes. Future research needs to establish sensorimotor outcomes that are relevant for functional performance and/or re-injury risk and investigate whether educating physiotherapists in emerging technologies will improve the understanding of their potential and limitations as well as stimulate increased use. Co-creation between physiotherapists, researchers, and technology developers may help align emerging technologies with clinical workflows and reasoning.