Could Wearables be Orthopedics’ Great Leap Forward?
Could Wearables be Orthopedics’ Great Leap Forward? (Stephen Lyman on LinkedIn)
Success in orthopedics is rarely black and white. In most cases, we’re not treating diseases or completely resolving medical conditions, like a clogged artery. With orthopedic procedures, such as joint replacement surgery, we’re typically working to reduce pain and improve function. Success is making it easier for the patient to live their everyday life.
How do you gauge this type of success? The typical approach is to measure mobility, but that’s easier said than done. Today, we rely mainly on patient-reported outcome measures (PROMs), which are patient surveys and have some inherent limitations. It can be challenging to get patients to complete these surveys, and there are a number of factors that can skew patient feedback. Patients may have difficulty recalling what they did or could do in the past or may subconsciously allow their mood or personal feelings about their physician influence their responses. In some cases, patients simply misunderstand the questions, either due to ambiguous survey wording or limited health literacy.
This all adds up to incomplete and sometimes inaccurate data. But the good news is, we’re about to take a great leap forward in measurement, thanks to wearable technology.
Wearable technology is already helping healthcare providers measure successful patient outcomes. Today, mobile health solutions like Apple HealthKit and the recent generations of FitBits, Misfits, smart watches, and other technologies can provide pulse rate, step counts, and even caloric load, giving physicians a promising lens into their patients’ physical activity. My colleague Deborah Estrin, Professor of Computer Science at Cornell Tech and co-founder of the mobile health data platform Open mHealth, believes even online activity can yield important health insights. Her research has shown that patient moods affect their smartphone usage — what sites they visit and how often — and that particular patterns may indicate mood disorders or depression.
But as useful as smartphones and basic step counters are for tracking activity, we’re still fairly limited in measuring mobility. First, these data points may not tell us the full story. For example, many women carry their phones in their purse, and when they get home, they put their purse down. They may continue to walk around, but we miss those steps, giving us an incomplete picture of their movement. Second, measures like step count can be pretty misleading as a mobility measure. For example, after knee replacement surgery, we may not see an increase in the number of steps a patient takes in a day, but that doesn’t necessarily mean mobility hasn’t improved. The patient may be doing the same things they were doing before surgery — following the same routine — but doing it with much less pain and much more quickly.
Tailoring Wearables for Orthopedics
To gauge the success of orthopedic procedures like knee replacements more accurately, we need a wearable with the ability to measure the bending movement of the knee joint, known as flexion. This might mean placing adhesive sensors above and below the knee to measure the knee in space, using a neoprene brace outfitted with sensors, or using smart clothing (fabrics with embedded sensors) that tracks the full range of motion. Another approach is actually embedding sensors in orthopedic implants, which would send biometric data to the cloud. Thinking even further ahead, if we could develop a way to measure the energy expenditure of a patient’s steps, we may be able to better assess when a patient is experiencing pain.
Advances in data analytics will help extract more value from this data as well. For example, algorithmic analysis of wearable data from many patients could identify specific activity patterns that correlate with particular problems, serving as an early warning system for clinicians. Data from wearables could also be useful in establishing the patient’s baseline mobility prior to surgery, so that we can more accurately track progress in the recovery phase of their treatment. We could benchmark patients against similar patients to motivate them to work harder in their rehabilitation or to slow down if they are trying to do too much too soon on a still vulnerable joint.
Realizing the Benefits of Wearables
Wearable technology has the potential to greatly improve orthopedic patient outcomes by allowing clinicians to monitor rehabilitation remotely, identify potential problems, and ensure patients are following postoperative precautions. Wearables could also encourage patients to follow rehabilitation protocols, simply because they’re aware their progress is being observed (a phenomenon known as the Hawthorne Effect).
There are substantial potential cost savings and efficiency gains as well. If clinicians can monitor a patient’s recovery process remotely, they may be able to reduce the number of physical therapy sessions or postoperative clinic visits. If a patient is complying with their rehabilitation and isn’t experiencing pain, there’s no need for the patient to come in for a checkup. This saves time for both the patient and their clinical team and ultimately reduces costs to the patient and their insurer.
Wearable technology that accurately measures mobility is in development, and it’s only a matter of time before it becomes a meaningful tool to improve patient care. Our biggest challenge may be figuring out how to use this plethora of information available to clinicians in a useful way through the electronic health record. Fortunately, smart people like Dr. Estrin are working on that end of the equation. I imagine a future where data from wearable technology is integrated into orthopedic care and the information is central to the clinical workflow. In the coming years, we will forge ahead meeting the challenges we see today and likely exploring applications of this technology we haven’t even conceived of yet. I’m excited to step into this amazing new era as we continue to strive to improve the quality of life for our patients.