The digital health system can alert the doctor if a patient’s heart risk requires a medication to lower cholesterol levels or if insulin shots are appropriate for someone suffering from the type II diabetes.
However, for millions of lower-back patients, treatment decisions depend heavily on subjective assessments of discomfort for patients which can lead to costly treatments and tests (back discomfort is among the third most expensive U.S. health care expenditure in the United States, following heart disease and diabetes) but they don’t always offer the long-term solution.
Ohio State University engineering and medical researchers are working on an approach to digital health developed to improve back pain decision-making. After completing a number of tests that test exact, objective measures they’ve developed in their lab, the group is aiming to apply their data-driven techniques for the evaluation and treatment of back issues caused by problems in the spine.
In a study that was recently released in Clinical Biomechanics , researchers used self-reported disability and pain measurements along with information from a wearable motion-sensing system to assess low-back function in patients who undergo lumbar fusion surgery. Although after surgery pain relief and lower disability were reported by patients within 6 weeks of surgery, objective measures did not reveal any real improvement on spinal spine up to six months following surgery.
These precise motion-based scores and their inclusion into an ever-growing national database of spine function scores, as well as other medical information could provide the foundation of more objective clinical decision-making in surgical patients, according to the study’s findings.
“You aren’t able to inquire about how people feel concerning your back,” said senior author William Marras, executive director of the Spine Research Institute at Ohio State.
“For back pain, people are asked to rate their experience on a scale from 1 to 10. If you don’t have pain receptors in your disc, what exactly does that mean? Our technology attempts to provide an objective perspective to the issue and examine not just the way people feel about their back discomfort as well as quantitatively assessing the way their movements differ and what this means in terms of biomechanics.” said Marras who is a professor in integrated system engineering and College of Medicine academic appointments in neurosurgery, orthopaedics, and physical rehabilitation and medicine.
Marras The lab of Marras has been researching daily life-forces on the spine for a long time, and invented his original wearable back sensor over 30 years ago to determine the effects of movements when performing various tasks in a variety situations impact the back. Recently, his team has retrofitted the devices with the chips that are commercially available which are usually found in mobile phonesthat can provide us with information about which space we’re in.
The system, which is dubbed “Conity,” features a medical lumbar motion sensor that’s equipped with chip sensors that are placed on the upper back as well as waist belts that detect a person’s 3D “motion signature” as they perform various standard motions. The system’s combined technology provides quantifiable data about not just movement range but also the speed of movement and speed — numbers that Marras study has revealed are more useful in understanding spine function.
The 121 lumbar-fusion surgery participants in the study were surveyed one time prior to and five times following surgery on back and forward bends, side-toside bending and spine rotation. To measure their functional performance the individual data of each patient was compared with an aggregate measure that was that was derived from data taken from healthy subjects. Participants were also asked to complete questionnaires that assessed their disability, pain as well as fear-avoidance behavior and their overall quality of life during the beginning and at post-operative appointments.
The first noticeable functional improvements that were based on motion-sensing information weren’t evident in the patients for 6 months following surgery, and performance steadily improving for the next 18 months. Patients reported substantial improvements in pain, performance and fear-avoiding behavior from as early as six weeks after surgery.
Even though pain relief is important, researchers found that objective functional assessments could provide a better indicator of the time when you can resume normal activities following spinal surgical fusion.
“Our technology can analyze, 1. whether or not you’re suffering from an back limitation, as well as, 2 what’s the state of your back? Does it improve or more severe, or is it advancing or are you out of the range?” Marras said. “When you’re causing damage to the back and especially discs, you won’t be aware of the time the damage takes place due to the fact that there are very small nerve receptors within the disc. There’s a chance that you’re doing damage , and nobody would be aware of it.”
Marras’s use of motion monitors in a previous study has sparked interest from the military in the technology, and led to Department of Defense funding for the technology in order that it could be utilized to determine spine functioning in Aircrewswhich is a subset of military members who suffer from low-back pain.
“In the realm of low-back problems, it’s all about preventing it from going for a long time or until it gets to the point of becoming really serious which is when it’s difficult to deal with,” Marras said. “Military officials we spoke to believe this will help aircrews get to the right answer and help prevent issues later on.
“That has allowed us to build our databases, build the technology more and transform it into an online health system that can help a lot of people in the military deal with their problems. This has been a launch pad for opportunities for other organizations like the National Institutes of Health to accomplish the same thing.”
In addition to the information from questionnaires for patients and motion-sensing-related data, researchers are also integrating results from medical imaging and electronic medical records into the database to give high-quality, individualized assessments as well as increase the analytical capabilities on the database.
Marras is an investigator co-principal on Ohio State’s participation in a forthcoming federally funded clinical trial that will test spine treatments. He continues to collect motion sensor data from people suffering from and with no back pain outside of that trial. His team has also created clinical software that will expand testing of motion sensors across the nation.
“We are building an organized computer platform that we can distribute in the United States,” he said. “Our goal is to working with universities across the country in the future, we’ll be able create a database big enough to allow us to make use of machine learning and artificial intelligence to cut through the clutter and figure out what’s the most crucial. We believe we know the answer that, but a thorough analysis of massive amounts of data might help us identify anything we’re missing.”
Co-authors on the lumbar-lumbar Fusion Surgery study who all came are from Ohio State, included Safdar Khan, Prasath Mageswaran, Guy Brock, Mariah Eisner and Sue Ferguson. The research was funded partly by the National Center for Advancing Translational Sciences.
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