{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,17]],"date-time":"2026-03-17T22:29:10Z","timestamp":1773786550564,"version":"3.50.1"},"reference-count":82,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2025,6,23]],"date-time":"2025-06-23T00:00:00Z","timestamp":1750636800000},"content-version":"vor","delay-in-days":173,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,1,1]],"date-time":"2025-01-01T00:00:00Z","timestamp":1735689600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100004054","name":"King Abdulaziz University","doi-asserted-by":"publisher","award":["162-612-1443"],"award-info":[{"award-number":["162-612-1443"]}],"id":[{"id":"10.13039\/501100004054","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["International Journal of Telemedicine and Applications"],"published-print":{"date-parts":[[2025,1]]},"abstract":"<jats:p>\n                    Orthotic treatment, particularly for ankle injuries, often relies on devices such as ankle\u2013foot orthoses (AFOs) to support and stabilize the foot and ankle. Given the high prevalence of lower extremity injuries, especially in sports, and the diagnostic challenges faced by clinicians, there is a pressing need for intelligent systems that aid in accurate assessment and personalized management. Misdiagnosis and suboptimal treatment of ankle conditions, including fractures and sprains, can lead to long\u2010term complications and hinder recovery. This study presents\n                    <jats:italic>TeleOrtho<\/jats:italic>\n                    , a knowledge\u2010based expert system designed to provide personalized diagnosis, treatment recommendations, and recovery plans for ankle injuries, integrating transcutaneous electrical nerve stimulation (TENS) therapy to enhance rehabilitation. The system was implemented using Flutter for cross\u2010platform deployment and Python for expert rule modeling, and it features a user\u2010friendly interface for both clinicians and patients. Diagnostic accuracy and treatment pathways were validated through two published case scenarios, confirming the system\u2019s alignment with medical guidelines. Static and dynamic testing demonstrated consistent functionality, and initial usability assessment indicated high user satisfaction (average SUS score: 85.3\/100). The expert system reliably identified injury types based on structured symptom input and suggested individualized recovery plans. These results affirm the potential of TeleOrtho to reduce diagnostic errors, improve therapy adherence, and enhance clinical decision\u2010making. Future work will focus on integrating imaging analysis, expanding the knowledge base to include additional orthopedic conditions, and conducting clinical trials for broader validation.\n                  <\/jats:p>","DOI":"10.1155\/ijta\/5878245","type":"journal-article","created":{"date-parts":[[2025,6,23]],"date-time":"2025-06-23T12:19:18Z","timestamp":1750681158000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Knowledge\u2010Based Expert System for Orthopedic Injury Management With Integrated Transcutaneous Electrical Nerve Simulation Therapy"],"prefix":"10.1155","volume":"2025","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4475-4878","authenticated-orcid":false,"given":"Haneen","family":"Banjar","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shahad","family":"Almalki","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lama","family":"Almehmadi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amjad","family":"Alshahrani","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ali","family":"Chaudhary","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Reda","family":"Ghoname","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,6,23]]},"reference":[{"key":"e_1_2_15_1_2","unstructured":"Prosthetic and Orthotic Services [Internet] International Society for Prosthetics and Orthotics. 2021 [cited 2021 Nov 29]. Available from:https:\/\/www.ispoint.org\/page\/POservices."},{"key":"e_1_2_15_2_2","doi-asserted-by":"publisher","DOI":"10.1177\/0309364611418019"},{"key":"e_1_2_15_3_2","doi-asserted-by":"publisher","DOI":"10.1177\/0309364611413496"},{"key":"e_1_2_15_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cpm.2010.11.003"},{"key":"e_1_2_15_5_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11999-011-1982-z"},{"key":"e_1_2_15_6_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1553-2712.2007.tb01851.x"},{"key":"e_1_2_15_7_2","doi-asserted-by":"publisher","DOI":"10.1097\/00007611-200408000-00009"},{"key":"e_1_2_15_8_2","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.17228"},{"key":"e_1_2_15_9_2","article-title":"Physiotherapy and Clinical Approaches-An Overview","volume":"1","author":"Melnick S.","year":"2016","journal-title":"European Journal of Physical Education and Sport Science"},{"key":"e_1_2_15_10_2","unstructured":"KhalidM. T. SarwarM. F. andSarwarM. H. Current Role of Physiotherapy in Response to Changing Healthcare Needs of the Society In 2015. Available from:https:\/\/api.semanticscholar.org\/CorpusID:39492054."},{"key":"e_1_2_15_11_2","article-title":"Evidence-Based Physical Therapy","volume":"1","author":"Fatima A.","year":"2022","journal-title":"Healer Journal of Physiotherapy and Rehabilitation Sciences"},{"key":"e_1_2_15_12_2","article-title":"The Role of Physiotherapist in Preventive Care","volume":"29","author":"Bainaboina G.","year":"2021","journal-title":"Quality in Primary Care"},{"key":"e_1_2_15_13_2","doi-asserted-by":"publisher","DOI":"10.2522\/ptj.20140271"},{"key":"e_1_2_15_14_2","first-page":"451","article-title":"A Primer on Physical Therapy","volume":"3","author":"Cwynar D. A.","year":"1999","journal-title":"Lippincott\u2032s Primary Care Orthopaedics"},{"key":"e_1_2_15_15_2","first-page":"1661","article-title":"The Physical Therapy Prescription","volume":"76","author":"Rand S. E.","year":"2007","journal-title":"American Family Physician"},{"key":"e_1_2_15_16_2","first-page":"20","article-title":"Exploring the Evidence for Using TENS to Relieve Pain","volume":"108","author":"Wright A.","year":"2012","journal-title":"Nursing Times"},{"key":"e_1_2_15_17_2","doi-asserted-by":"publisher","DOI":"10.2217\/pmt.14.13"},{"key":"e_1_2_15_18_2","doi-asserted-by":"publisher","DOI":"10.1067\/S1526-5900(03)00780-6"},{"key":"e_1_2_15_19_2","doi-asserted-by":"publisher","DOI":"10.1054\/jpai.2003.434"},{"key":"e_1_2_15_20_2","unstructured":"ButtM. N. AkhterF. KashifM. PerveenW. AkhtarM. M. RiazH. andFatimaI. Determination of Factors Influencing Physical Therapy Treatment Compliance Pakistan Journal of Medical and Health Sciences 2020 available from:https:\/\/api.semanticscholar.org\/CorpusID:245441710."},{"key":"e_1_2_15_21_2","doi-asserted-by":"crossref","unstructured":"Bonnech\u00e8reB. JansenB. OmelinaL. andJanS. L. V. S. Do Patients Perform Their Exercises at Home and Why (Not)? A Survey on Patient Habits During Rehabilitation Exercises In 2016. Available from:https:\/\/api.semanticscholar.org\/CorpusID:79089988.","DOI":"10.5455\/umj.20160210060312"},{"key":"e_1_2_15_22_2","unstructured":"SpiteriC. PonsfordJ. L. WilliamsG. KahnM. B. andMcKayA. Factors Impacting Participation in Physical Therapy During Post-Traumatic Amnesia Archives of Physical Medicine and Rehabilitation 2020 available from:https:\/\/api.semanticscholar.org\/CorpusID:225477267."},{"key":"e_1_2_15_23_2","doi-asserted-by":"publisher","DOI":"10.1093\/ptj\/85.3.238"},{"key":"e_1_2_15_24_2","unstructured":"Aetna 2023 Orthotic Devices. Clinical Policy Bulletin: Number 0565https:\/\/www.aetna.com\/cpb\/medical\/data\/500_599\/0565.html."},{"key":"e_1_2_15_25_2","volume-title":"Clinical Procedures in Emergency Medicine","author":"Chanmugam A. S.","year":"2004"},{"key":"e_1_2_15_26_2","volume-title":"Emergency Orthopedics: The Extremities","author":"Simon R.","year":"2007"},{"key":"e_1_2_15_27_2","volume-title":"Fracture Management for Primary Care","author":"Eiff M. P.","year":"2002"},{"key":"e_1_2_15_28_2","doi-asserted-by":"publisher","DOI":"10.1042\/cs0720503"},{"key":"e_1_2_15_29_2","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1097-4598(199808)21:8<1006::AID-MUS4>3.0.CO;2-C"},{"key":"e_1_2_15_30_2","unstructured":"Transcutaneous Electrical Nerve Stimulation (Tens) clevelandClinic. 2023 [cited 2024 Jul 30]. Available from:https:\/\/my.clevelandclinic.org\/health\/treatments\/15840-transcutaneous-electrical-nerve-stimulation-tens."},{"key":"e_1_2_15_31_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.326.7386.405"},{"key":"e_1_2_15_32_2","doi-asserted-by":"publisher","DOI":"10.4103\/2141-9248.133473"},{"key":"e_1_2_15_33_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1994.03510350037034"},{"key":"e_1_2_15_34_2","doi-asserted-by":"publisher","DOI":"10.1007\/978-3-642-25734-6_93"},{"key":"e_1_2_15_35_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.eswa.2004.08.003"},{"key":"e_1_2_15_36_2","volume-title":"Computer-Aided Design and Manufacturing","author":"Narayan K. L.","year":"2008"},{"key":"e_1_2_15_37_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1477-9730.2006.00383.x"},{"key":"e_1_2_15_38_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.procir.2016.04.174"},{"key":"e_1_2_15_39_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.heliyon.2023.e13640"},{"key":"e_1_2_15_40_2","article-title":"Evolution in Casting Techniques: A Narrative Review of Casting Methods, Techniques, and Innovation","volume":"16","author":"Scheinberg M.","year":"2024","journal-title":"Cureus"},{"key":"e_1_2_15_41_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11832-016-0762-4"},{"key":"e_1_2_15_42_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.msard.2015.03.006"},{"key":"e_1_2_15_43_2","doi-asserted-by":"publisher","DOI":"10.2519\/jospt.1996.24.4.208"},{"key":"e_1_2_15_44_2","unstructured":"JohnsonM. I. Transcutaneous Electrical Nerve Stimulation (TENS) In 2012. Available from:https:\/\/api.semanticscholar.org\/CorpusID:70605429."},{"key":"e_1_2_15_45_2","doi-asserted-by":"publisher","DOI":"10.2519\/jospt.2011.3447"},{"key":"e_1_2_15_46_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.pmn.2020.02.057"},{"key":"e_1_2_15_47_2","unstructured":"MainzerK. Systems Become Experts. Artif Intell-When Do Mach Tak over? 2020 Available from:https:\/\/api.semanticscholar.org\/CorpusID:208120298."},{"key":"e_1_2_15_48_2","unstructured":"AhmedA. MasriN. SultanY. S. A. AkkilaA. N. AlmasriA. R. MahmoudA. Y. ZaqoutI. S. andAbu-NaserS. S. Knowledge-Based Systems Survey 2019 Available from:https:\/\/api.semanticscholar.org\/CorpusID:201126371."},{"key":"e_1_2_15_49_2","unstructured":"TorsunI. S. Foundations of Intelligent Knowledge-Based Systems 1995 Available from:https:\/\/api.semanticscholar.org\/CorpusID:40963790."},{"key":"e_1_2_15_50_2","unstructured":"BiondoS. Fundamentals of Expert Systems Technology - Principles and Concepts 1990 Available from:https:\/\/api.semanticscholar.org\/CorpusID:7524999."},{"key":"e_1_2_15_51_2","doi-asserted-by":"publisher","DOI":"10.2478\/aoj-1996-0013"},{"key":"e_1_2_15_52_2","doi-asserted-by":"crossref","unstructured":"DaoT. T.andThoM. C. H. B. Knowledge-Based System for Orthopedic Pediatric Disorders 2011 Available from:https:\/\/api.semanticscholar.org\/CorpusID:61487945.","DOI":"10.1007\/978-3-642-23508-5_34"},{"key":"e_1_2_15_53_2","doi-asserted-by":"publisher","DOI":"10.3390\/app122211864"},{"key":"e_1_2_15_54_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.compbiomed.2008.12.008"},{"key":"e_1_2_15_55_2","doi-asserted-by":"publisher","DOI":"10.47709\/ijmdsa.v2i1.2394"},{"key":"e_1_2_15_56_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0260471"},{"key":"e_1_2_15_57_2","doi-asserted-by":"publisher","DOI":"10.25259\/IJMS_205_2023"},{"key":"e_1_2_15_58_2","doi-asserted-by":"publisher","DOI":"10.1201\/9781003145349-9"},{"key":"e_1_2_15_59_2","unstructured":"IliescuM. Finite Element Method Simulation and Rapid Prototyping 2008 Available from:https:\/\/api.semanticscholar.org\/CorpusID:8377669."},{"key":"e_1_2_15_60_2","doi-asserted-by":"crossref","unstructured":"CoulentianosM. J. Rodriguez-CaleroI. DalyS. R. andSienkoK. H. Stakeholder Engagement With Prototypes During Front-End Medical Device Design: Who Is Engaged With What Prototype? 2020 Available from:https:\/\/api.semanticscholar.org\/CorpusID:226002861.","DOI":"10.1115\/DMD2020-9020"},{"key":"e_1_2_15_61_2","doi-asserted-by":"publisher","DOI":"10.1080\/0951192X.2014.951531"},{"key":"e_1_2_15_62_2","unstructured":"Best Online Orthopedic Telemedicine Service: Moonlight Ortho Moonlight Ortho. 2019 [cited 2021 Nov 29]. Available from:https:\/\/www.moonlightortho.com."},{"key":"e_1_2_15_63_2","unstructured":"DesaiP. Implant Identifier [Internet] Implant Identifier. [cited 2021 Nov 29]. Available from:https:\/\/implantidentifier.app."},{"key":"e_1_2_15_64_2","unstructured":"OrthoLive 2021 [cited 2021 Nov 29]. Available from:https:\/\/www.ortholive.com."},{"key":"e_1_2_15_65_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2018.8565"},{"key":"e_1_2_15_66_2","volume-title":"Physical Therapy Guidelines for Lateral Ankle Sprain","author":"Massachusetts General Hospital","year":"2021"},{"key":"e_1_2_15_67_2","volume-title":"Ankle Fracture Weber C","author":"Doncaster Royal Infirmary","year":"2019"},{"key":"e_1_2_15_68_2","unstructured":"Virtual Fracture Clinic Weber B Fracture https:\/\/www.fracturecare.co.uk\/care-plans\/ankle\/weber-b-fracture\/ankle-fracture-weber-b\/."},{"key":"e_1_2_15_69_2","unstructured":"NHS Foundation Trust A Guide to Understanding TENS https:\/\/www.yorkhospitals.nhs.uk\/seecmsfile\/?id=5107."},{"key":"e_1_2_15_70_2","volume-title":"Principles of Expert Systems","author":"Lucas P. J.","year":"1991"},{"key":"e_1_2_15_71_2","unstructured":"Lars BakK. L. Dart Overview Dart 2011 Available from:https:\/\/dart.dev\/."},{"key":"e_1_2_15_72_2","unstructured":"Google and Community Flutter Framework Flutter 2017 Available from:https:\/\/flutter.dev\/."},{"key":"e_1_2_15_73_2","unstructured":"James TamplinA. L. Firebase 2011 Available from:https:\/\/firebase.google.com\/."},{"key":"e_1_2_15_74_2","unstructured":"van RossumG. python Python Software Foundation 1991 Available from:https:\/\/www.python.org\/."},{"key":"e_1_2_15_75_2","unstructured":"Richard HippD. SQLite https:\/\/sqlite.org\/crew.html."},{"key":"e_1_2_15_76_2","unstructured":"JetBrains PyCharm 2000 Available from:https:\/\/www.jetbrains.com\/pycharm\/."},{"key":"e_1_2_15_77_2","unstructured":"BanziM. CuartiellesD. IgoeT. andMellisD. Arduino IDE Available from:https:\/\/www.arduino.cc\/en\/software."},{"key":"e_1_2_15_78_2","unstructured":"BackmanK.andMononenM. Autodesk Tinkercad Autodesk 2011 Available from:https:\/\/www.tinkercad.com\/."},{"key":"e_1_2_15_79_2","volume-title":"Medartis Ankle Fracture Case Study","author":"Sebag J. A.","year":"2021"},{"key":"e_1_2_15_80_2","article-title":"Physical Therapy Management of 44-Year-Old Female With Lateral Ankle Sprain and Multiple Sclerosis in the Outpatient Setting: A Retrospective Case Report","volume":"119","author":"Gassett M.","year":"2015","journal-title":"All Capstone Projects"},{"key":"e_1_2_15_81_2","article-title":"Resolving Long-Standing Uncertainty About the Clinical Efficacy of Transcutaneous Electrical Nerve Stimulation (TENS) to Relieve Pain: A Comprehensive Review of Factors Influencing Outcome","volume":"57","author":"Johnson M. I.","year":"2021","journal-title":"Medicina (B Aires)"},{"key":"e_1_2_15_82_2","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD003008.pub3"}],"container-title":["International Journal of Telemedicine and Applications"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1155\/ijta\/5878245","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1155\/ijta\/5878245","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1155\/ijta\/5878245","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,17]],"date-time":"2026-03-17T18:53:08Z","timestamp":1773773588000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1155\/ijta\/5878245"}},"subtitle":[],"editor":[{"given":"Fei","family":"Hu","sequence":"additional","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2025,1]]},"references-count":82,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2025,1]]}},"alternative-id":["10.1155\/ijta\/5878245"],"URL":"https:\/\/doi.org\/10.1155\/ijta\/5878245","archive":["Portico"],"relation":{},"ISSN":["1687-6415","1687-6423"],"issn-type":[{"value":"1687-6415","type":"print"},{"value":"1687-6423","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1]]},"assertion":[{"value":"2024-12-30","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-05-16","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-06-23","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"5878245"}}