Clinical Pathway Designer
Designing a Clinical Pathway From Zero
Situation
Resistance training works, but adherence collapses without supervision.
Resistance training is first-line therapy for sarcopenia (ICFSR 2018, strong recommendation). Supervised adherence runs 72%. Once supervision ends, which insurance won't reimburse long-term, it drops to 43%. Function (gait speed, grip, TUG) responds strongly to progressive loading. Muscle-mass measures don't move.
72→43%
Adherence drop, supervised → unsupervised
0.81–1.28
SMD effect sizes, strength + function
0
Connected strength device studies
3
Shared device data spine
Complication
No connected device closes the loop between provider and patient.
Across 34 digital interventions for adults 60+, none use a connected strength device. Apps coach. Wearables count steps. None of them surface actual session data (load, sets, compliance) to the provider. The bottleneck is the silent eight months between supervised discharge and the next functional decline.
🔍
Screening
SARC-F or gait speed → referral
↓
✎
Prescription
progressive loading, 40–80% 1RM
↓
▢
Assessment
grip, gait, TUG, chair stand
↓
⚙
Active Training
remote monitoring + adjustment triggers
↓
📈
Check-ins
6/12/24-week reassessment
↓
Maintenance
functional targets met · reduced frequency · regression alerts
✉
Referral
direct-to-home device delivery
↓
⚡
Setup
guided onboarding · 95% feasibility
↓
▢
Assessment
device calibration + clinical baseline
↓
⚠
Active Training
72%→43% drop-off risk window
↓
✓
Check-ins
micro-progress before clinical gains
↓
Maintenance
goal refreshing · regression alerts · 67% long-term adherence
Resolution
Three connected pieces solve the supervision gap.
Three pieces, each anchored in the next. The sections below are the proof for each link.
01 Evidence base
Anchor every design decision in published literature. Seven sources (E1–E7) take the pathway from ICFSR guidelines to RCT effect sizes to longitudinal adherence data. Nothing in the design is guessed.
02 Device data spine
Express the answer as three shared signals. Load progression, session compliance, and baseline strength. The same data drives provider decisions and patient engagement at every visit.
03 FHIR CarePlan
Encode the clinical intent in a minimum-viable CarePlan. Five fields (addresses, goal, activity, careTeam, supportingInfo). Ready to ship to an EHR.
7 sources anchoring every design decision on this page.
E1
Strong recommendation, moderate certainty for resistance training as first-line sarcopenia therapy
guideline ICFSR 2018 (Dent et al.) — J Nutr Health Aging 22(10):1148-1161
E2
SMD 0.81–1.28 for strength/function; muscle mass NOT significant (SMM, ASMI, LLM all NS)
efficacy Chen et al. 2021 — Eur Rev Aging Phys Act 18:23. 14 RCTs, n=561
E3
72% → 43% adherence when supervision genuinely removed (longitudinal, n=114)
adherence Winters-Stone 2022; Gomez-Redondo 2024 MA (n=2,830)
E4
Zero connected strength training device studies across 34 digital interventions in 60+
digital Berry et al. 2025 — Front. Aging 6:1516481
E5
Protein supplementation as adjunct: combined nutrition + physical activity intervention
guideline ICFSR 2018, Rec 4A/4C (conditional, low certainty)
E6
Patient barriers: cost, transportation, lack of support
barriers ICFSR 2018, Table 1 + patient barriers section
E7
Unsupervised home-based RT: 67% mean adherence (range 47–97%)
long-term Manas et al. 2021 — Ageing Res Rev. 21 studies, n=4,053
Same data drives clinical decisions and patient engagement.
Load Progression
Session Compliance
Baseline Strength
| Device Data Element |
Provider Workflow |
Patient Journey |
Load progression
weight per exercise, session-over-session |
Plateau detection (< 5% over 4 wks) → prescription adjustment. Longitudinal curves contextualize clinical measures. Regression alerts (> 10% from peak). |
"You're lifting 18% more than week 1." Micro-progress visible between clinical visits. Maintenance tracking vs. personal peak. |
Session compliance
completed / prescribed ratio |
3+ missed sessions → provider alert within 48 hrs. Adherence % reviewed at check-ins. < 50% over 4 wks → escalation. |
Streak tracking and milestone celebrations. Frequency decline triggers PT outreach (system-initiated, not patient-initiated). |
Baseline strength
initial calibration per exercise |
Provider verifies calibrated loads against prescription (40–80% 1RM). Device baseline vs. clinical baseline creates complete picture. |
"Your program is ready" moment. All progress framed as % improvement from your personal baseline. |
The minimum viable care plan — 5 fields that encode the full clinical intent.
addresses
What am I treating? — Sarcopenia (ICD-10: M62.84)
goal
What outcomes am I targeting? — Grip ≥ 27 kg, gait ≥ 0.8 m/s, TUG ≥ 0.9s improvement
activity
What am I prescribing? — Exercise therapy (SNOMED 229065009) + Diet education (11816003)
careTeam
Who is involved? — PCP, Exercise Physiologist/PT, Registered Dietitian
supportingInfo
What device supports this? — Connected resistance trainer with adaptive weight
Why illustrative, not production? This CarePlan demonstrates clinical reasoning. Field selection is justified. Goals are functional, not muscle-mass. Exercise therapy and protein supplementation appear as separate activities because the evidence supports each at a different grade. A production CarePlan would add id, subject, period, author, and fully-expanded resources. Functional goals only.
Key design decisions — grounded in evidence, not assumption
✓ Goals target function (SMD 0.81–1.28) not mass (all NS)
✓ Progressive loading as key moderator (Chen 2021)
✓ TUG MCID = 0.9s for sarcopenic 65+ (not 3.4s)
✓ Adherence anchored to Winters-Stone (not generic)
✓ Every phase maps to ICFSR barriers {cost, transport, support}
✓ Device replaces 3 supervision functions
✓ Nutrition + exercise as separate activities (ICFSR 4C)
What's next
From design pathway to fielded clinical evidence.
Pilot with one geriatric clinic and one connected-strength-device manufacturer to validate the pathway end-to-end. Build the FHIR CarePlan integration into a real EHR so adherence data shows up where the provider already looks.
Where this goes: a closed-loop sarcopenia pathway where the device is part of the medical record, providers see adherence during chart review, and reimbursement follows function-restoration outcomes instead of visit volume.