Chatbot Based on Large Language Model to Improve Adherence to Exercise-Based Treatment in People with Knee Osteoarthritis: System Development

Knee osteoarthritis (KOA) is a prevalent condition globally, leading to significant pain and disability, particularly in individuals over the age of 40. While exercise has been shown to reduce symptoms and improve physical function and quality of life in patients with KOA, long-term adherence to exercise programs remains a challenge due to the lack of ongoing support. To address this, a chatbot was developed using large language models (LLMs) to provide evidence-based guidance and promote adherence to treatment. A systematic review conducted under the PRISMA framework identified relevant clinical guidelines that served as the foundational knowledge base for the chatbot. The Mistral 7B model, optimized with Parameter-Efficient Fine-Tuning (PEFT) and Mixture-of-Experts (MoE) techniques, was integrated to ensure computational efficiency and mitigate hallucinations, a critical concern in medical applications. Additionally, the chatbot employs Self-Reflective Retrieval-Augmented Generation (SELF-RAG) combined with Chain of Thought (CoT) reasoning, enabling dynamic query reformulation and the generation of accurate, evidence-based responses tailored to patient needs. The chatbot was evaluated by comparing pre- and post-improvement versions and against a reference model (ChatGPT), using metrics of accuracy, relevance, and consistency. The results demonstrated significant improvements in response quality and conversational coherence, emphasizing the potential of integrating advanced LLMs with retrieval and reasoning methods to address critical challenges in healthcare. This approach not only enhances treatment adherence but also strengthens patient–provider interactions in managing chronic conditions like KOA.