Digital health systems can tell clinicians if someone’s risk of heart disease requires a cholesterol-lowering drug, or if someone with type 2 diabetes needs insulin injections.

However, for millions of people with back pain, care decisions rely heavily on subjective measures of patient discomfort, often leading to costly tests and treatments (back pain is linked to diabetes and heart disease). (It’s the third-highest medical expense in the United States, after disease.) It doesn’t necessarily provide a permanent solution.

Engineering and medical researchers at Ohio State University are developing a digital health system approach designed to enhance clinical decision-making in back pain. After completing a series of studies testing accurate and objective measurements completed in the lab, the team decided to apply data-driven practices to the assessment and repair of back problems caused by spinal dysfunction. I am aiming.

In a recent study published in clinical biomechanics, Researchers combined self-reported pain and disability measures with data from a wearable motion-sensing system to assess lumbar function in lumbar fusion patients. Although postoperative pain relief and reduced disability he self-reported within 6 weeks, objective measures detected no real functional improvement in the spine for at least 6 months after surgery.

These precise motion-based measurements, and their inclusion in a rapidly growing national database of patient spinal function scores and other medical data, are the basis for more objective clinical decision-making for surgical patients. The researchers concluded that they could form

“You can’t just ask people how they feel about their backs,” said senior author William Maras, executive director of the Ohio Spine Institute.

“For back pain, we are asked to rate how it feels on a scale of 1 to 10. But there are no pain receptors in the disc, so what does that mean? Our technology brings an objective metric to the question, looking not just at how people feel about back pain, but also how their movements differ and what that means from a biomechanical perspective. You can also quantitatively measure how well you do” and physiotherapy and rehabilitation.

For decades, Maras’ lab has studied the forces of everyday life on the spine, assessing how movement affects the back while performing different tasks in different settings. To do this, we developed the first wearable back sensor 30 years ago. These days, his team embeds off-the-shelf chips (usually found in mobile phones) into these devices to tell us where we are in space.

Called “Conity,” the system is clinical-grade with chip sensors attached to the upper back and waist harness to capture a person’s three-dimensional “motion signature” while performing a series of standardized movements. It features a lumbar motion monitor. Combined, these techniques provide quantitative data on locomotion speed and acceleration, as well as range of motion. The numbers found in Marras’ study are more informative in understanding spinal function.

The 121 lumbar fusion surgery patients who participated in this study were evaluated once before surgery and five times after surgery for forward flexion, back flexion, side-to-side flexion, and spinal rotation. Individual data were compared to composite measures based on data collected from healthy controls to determine functional performance scores. Participants also completed questionnaires assessing pain, disability, fear-avoidance behavior, and quality of life at baseline and at postoperative visits.

The first significant functional performance improvement based on motion-sensing data was not seen in these patients until 6 months after surgery, and function progressed steadily over the following 18 months. However, patients self-reported significant improvements in pain, ability, and fear avoidance as early as 6 weeks after surgery.

While pain relief is important, researchers say objective functional assessment may be a better indicator for determining when it’s safe to return to normal activity after spinal fusion surgery. says.

“Our technology can tell us: 1. Is there a back problem? 2. What is the condition? can be examined. Maras said. “If you’re damaging your back, especially your discs, you never know when the damage will happen because there are very few nerve receptors in your discs. You could be doing damage and people will never know. .”

Marras’ use of motion monitors in previous research has sparked military interest in the technology, resulting in funding for the technology from the Department of Defense. This technology can now be used to assess spinal function in crew members. pain.

“In the world of back pain, it’s all about not letting it go for months or years until it really gets worse, because it’s really hard to deal with.” He believed that he could lead the crew to the correct solution and prevent problems before they occur.

“This has allowed us to enhance our database, further develop our technology, and turn this into a digital health system platform that will help many people across the military solve their problems. The National Institutes of Health does the same.” will do.”

Researchers can incorporate information from patient questionnaires and motion-sensing data, as well as medical imaging results and electronic medical record documents into the database to provide highly individualized assessments and extend the analytical power of the platform. I’m here.

Marras is a co-principal investigator on the state of Ohio’s participation in a federally funded clinical trial to evaluate spinal treatments, and separately collected motion sensor data from people with and without low back pain. continue. His team also developed clinician software to expand the availability of motion sensor testing nationwide.

“We are building a systematic computer platform that can be distributed anywhere in the country,” he said. and be able to build a database big enough to understand what’s most important, as we all know, that advanced analysis of vast amounts of data You can find things you may have missed.”

Co-authors of the Lumbar Fusion study, all from Ohio, include Safdar Khan, Prasath Mageswaran, Guy Brock, Mariah Eisner, and Sue Ferguson. This work was supported in part by the National Center for Translational Science Advancement.


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