Clinical Pathway Designer
Bridge clinical evidence
to connected device pathways
Zero connected strength training device studies in the literature. Here's the pathway design that fills the gap.
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
Evidence → Pathway → Product.
Provider workflow + patient journey, connected by the same device data spine.
Provider workflow + patient journey, connected by the same device data spine.
★ samd-os/skills
Provider Workflow
6 phases
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
Patient Journey
6 phases
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
Shared Device Data Spine — connects both workflows
Load Progression
Session Compliance
Baseline Strength
The data spine — same data drives clinical decisions and patient engagement
| 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. |
E1–E7
Evidence anchors — every claim traces here
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
FHIR CAREPLAN
5 fields — the minimum clinical information
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 rationale, functional goals only (not muscle mass), and the evidence-driven decision to separate exercise therapy from protein supplementation as distinct activities with different evidence grades. A production CarePlan would add id, subject, period, author, and fully expanded resources. Functional goals only — not muscle mass.
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)