Clinicians can use digital health systems to inform them when a patient needs insulin shots for type 2 diabetes or medication to decrease cholesterol based on their risk of heart disease.
Ohio State University engineering and medical researchers are developing a digital health system approach designed to enhance back-pain clinical decision-making. Image Credit: Getty Images
For the millions of people who suffer from lower back pain, care decisions are frequently based on subjective assessments of patient discomfort, which frequently results in costly tests and treatments that do not always provide a long-term fix (back pain accounts for the third-highest share of U.S. health care spending, behind diabetes and heart disease).
Engineering and medical researchers at Ohio State University set out to improve back pain clinical decision-making by developing a digital health system strategy. The team hopes to use data-driven practices to assess and treat back problems brought on by dysfunction in the spine after finishing a series of experiments testing accurate, objective measurements they have mastered in the lab.
In a new study that was published in Clinical Biomechanics, researchers evaluated lower-back function in individuals who had undergone lumbar fusion surgery by combining self-reported pain and disability assessments with information from a wearable motion-sensing system.
The objective measurements did not find any real functional improvement in the spine until at least six months following surgery, even though postoperative pain alleviation and lower impairment were self-reported within six weeks.
The researchers concluded that these precise motion-based measurements, along with their inclusion in a developing national database of patient spine-function scores and other medical data, could serve as the foundation for more objective clinical decision-making for surgical patients.
You simply can’t only ask people how they feel about their back.
William Marras, Study Senior Author and Executive Director, Spine Research Institute, Ohio State University
“For back pain, people are asked to rate how they feel on a scale of 1 to 10. However, since you do not have pain receptors in the disc, what does that mean? Our technology tries to bring objective metrics to the problem and look at not only how people feel about their back pain, but also quantitatively measure how their motions are different and what that means in terms of biomechanics,” said Marras.
Marras was also a Professor in Integrated Systems Engineering at the College of Medicine, Ohio State University.
To measure how motions impact the back while carrying out a variety of tasks in a variety of environments, Marras’ lab created the first wearable back sensor 30 years ago. The lab has been studying the effects of daily living on the spine for decades. More lately, his team has modified similar gadgets with commercially accessible chips that can pinpoint our location in space. These chips are normally found in cell phones.
The “Conity” device uses a clinical lumbar motion monitor with chip sensors set on the upper back and waist belts to record an individual’s three-dimensional “motion signature” while they complete a sequence of predetermined actions.
The combined technologies produce quantitative data on movement velocity, acceleration, and range of motion, all of which, according to Marras’ research, are more useful indicators of how the spine functions.
The 121 lumbar fusion surgery participants in the research had their forward and backward bending, side-to-side bending, and spine rotation measured once before and five times after the procedure.
Their data was compared to a composite measure created using information gathered from healthy controls to obtain their functional performance score. At the baseline and post-operative visits, participants also filled out questionnaires measuring their pain, handicap, fear-avoidance behaviors, and quality of life.
The patients’ motion-sensing data-based functional performance improvements did not appear until six months after surgery, and functions continued to improve over the next 18 months. However, as early as six weeks following surgery, patients were reporting meaningful improvements in pain, ability, and fear avoidance.
Even though pain relief is crucial, the researchers pointed out those objective functional tests may provide a more accurate indication of when it is safe to resume daily activities following spinal fusion surgery.
Our technology can look at, 1, whether or not you have a back impairment, and 2, what is its status? Is it getting better, is it getting worse, is it progressing, or is it off the scales? When you are doing damage to the back, and particularly the discs, you do not know when the damage occurs because we have very few nerve receptors in the disc. You could be doing damage and people would never know.
William Marras, Study Senior Author and Executive Director, Spine Research Institute, Ohio State University
Because of Marras’ use of motion monitors in an earlier study, the military became interested in the technology and provided funding to the Department of Defense so it could be used to evaluate spine function in aircrews, a class of service members known to suffer from low-back discomfort.
“In the world of low-back disorders, it’s all about not letting it go on for months or years until it gets really bad because then it’s really hard to address. Military leaders, we talked to think this could get aircrews to the right solution and prevent problems down the line,” Marras said.
“That allowed us to beef up our databases, develop the technology a lot more and turn this into a digital health system platform that could help a lot of people across the military solve their problems. And that’s been a launching pad that opened up opportunities with the National Institutes of Health to do the same thing.”
To provide highly individualized assessments and increase the analytical capability of the platform, the scientists are also incorporating diagnostic imaging results and electronic medical record documentary evidence into the dataset, in addition to information from patient survey questions and motion-sensing data.
Marras is continuing to gather motion-sensor data on persons with and without back pain independently of that trial while also serving as co-principal investigator for Ohio State’s participation in a future federally sponsored clinical trial to assess spine treatments.
Additionally, his team has created clinical software to increase the availability of motion-sensor testing throughout the nation.
We are building up a systematic computer platform that we could distribute anywhere around the country. We hope that by collaborating with different universities, we’ll be able to build up a database large enough that we could use artificial intelligence and machine learning to cut through and figure out what is most important. We think we know, but a sophisticated analysis of tons and tons of data could help us find anything we might be missing
William Marras, Study Senior Author and Executive Director, Spine Research Institute, Ohio State University
Journal Reference:
Khan, S., et al. (2022) Quantitative dynamic wearable motion-based metric compared to patient-reported outcomes as indicators of functional recovery after lumbar fusion surgery. Clinical Biomechanics. doi.org/10.1016/j.clinbiomech.2022.105706.