How may the use of wearable technology affect the physician-patient relationship?
Click Here to Manage Email Alerts
Click here to read the Cover Story, "Wearables, smart implants show promise for clinical use."
Remote monitoring for objective measurements
Remote patient monitoring with wearables can be used to objectively measure aspects of a patient’s function over time. In orthopedics, this is often using technology that assesses aspects of gait and activity levels.
This is in contrast to patient-reported assessments, which are subjective measurements of a patient’s activity and function. While patient-reported outcomes are growing in use in orthopedics to assess a patient’s function, contemporary evidence suggests that patient-reported outcomes are also strongly influenced by psychosocial factors, such as depression and resilience. For example, two patients with the same objective function may have completely different assessments of disability when using a patient-reported outcome measure. Remote patient monitoring has the ability to bridge this gap between the patient perspective and objective assessments of physiology. Examples of remote patient monitoring use in orthopedic surgery are to track patient activity levels before and after surgery. Other approaches have been to use remote patient monitoring to support transitioning site of care for patients and to assess vital signs of a patient immediately after surgery when the patient is recovering at home. For example, Modum Health is using wearables and machine learning to assess patient risk that supports transitioning surgery from the hospital to ASCs and monitoring patients at home after surgery. I strongly believe that remote patient monitoring will become a standard for assessing a patient’s health and will be routinely incorporated into medical decision-making in orthopedic surgery.
Rob Kamal, MD, MBA, MS, is an associate professor in the department of orthopedic surgery at Stanford University in Redwood City, California.
Personalize medical advice with wearable technology
In the last few years, there has been a rapid growth in the development and utilization of wearable sensors in orthopedics. Wearable sensors are well suited for applications in orthopedic surgery, where the primary focus is on improving patient activity and mobility. Currently available wearable technologies enable surgeons to monitor patient activity through step counts and heart rate and to measure joint motion via accelerometer-based sensors or “smart braces” with built-in goniometers. Newer iterations of these devices continue to improve in accuracy, reliability, interoperability and form factor. Most are paired with patient engagement platforms that transform the raw data into meaningful insights that can be shared between patients and the orthopedic care team. While most of these devices are being used to enhance perioperative care and recovery, there is promise for these wearable sensors in nonsurgical management of musculoskeletal conditions, as well.
These technologies have the potential to improve patient care through improving patient engagement in postoperative recovery through immediate feedback and gamification of the recovery process, continuous monitoring of postoperative progress and early detection of complications. These are also powerful research tools given the ability of the technology to collect patient recovery metrics with minimal increased burden to the patient or research team. The physician-patient relationship will also be enhanced by these wearable sensors. Patients feel more connected and cared for with the continuous monitoring that these devices allow, and the surgeon will be able to provide patients with objective feedback on their recovery and offer personalized advice for improving their outcomes.
As the adoption and utilization of these technologies grows, research data will continue to guide use in cases where wearable sensors provide value both for patients and surgeons.
Charles M. Lawrie, MD, MSc, is an attending orthopedic surgeon in adult hip and knee reconstruction at Baptist Health Orthopedic Care and Baptist Health South Florida in Miami.
Possible improvement in outcomes
The use of wearable technology in orthopedic surgery and sports medicine has advanced immensely in recent years. This technology initially accepted by endurance athletes is now ubiquitous across the sports world. Wearable devices traditionally were used as pedometers and heart rate monitors, but now we have the ability to provide real-time physiologic, workload and movement data. This technology has been adopted by essentially every professional sports team, including sensors in the soccer balls for the World Cup in Qatar.
Wearable technology has found a home in sports medicine to monitor athlete workload in an attempt to prevent or predict the risk of injury. Personalized training programs are developed based on an athlete’s personal movement profile. Our research group has published on the use of accelerometer/gyrometer-equipped GPS devices in professional American football to predict the risk of soft tissue injury, such as hamstring strain, using the acute to chronic workload formula. Other research groups have published workload and injury data in soccer, Australian-rules football, rugby and collegiate football.
Due to increasing ease of use and cost efficiency, wearable technology is now employed in orthopedic rehabilitation for all specialties. DME companies have implanted sensors in braces to monitor range of motion and movement with easy-to-use dashboards accessed on personal electronic devices. Our research team is utilizing a wearable muscle oxygen sensor to assess quadriceps muscle recovery after ACL reconstruction to guide rehabilitation and safe return to play. Continued application of wearable technology to monitor the recovery of patients undergoing outpatient total joint arthroplasty, for example, is underway at several academic centers.
Future development of wearable technology will not only measure vital sign and movement data, but also provide the ability to assess physiologic markers of fatigue, such as lactate, nitric oxide and muscle oxygenation. The ease of both patients and physicians to use these data has significant potential in improving outcomes of essentially every orthopedic procedure as the move to outpatient surgery has continued in health care. The applications for wearable technology are endless and an exciting new frontier in orthopedic surgery.
- References:
- Li RT, et al. Sports Health. 2020;doi:10.1177/1941738119868477.
- Seshadri DR, et al. Front Sports Act Living. 2021;doi:10.3389/fspor.2020.630576.
- Seshadri DR, et al. NPJ Digit Med. 2019;doi:10.1038/s41746-019-0149-2.
- Seshadri DR, et al. NPJ Digit Med. 2019;doi:10.1038/s41746-019-0150-9.
James E. Voos, MD, is professor and chair in the department of orthopedic surgery at University Hospitals and the Jack and Mary Herrick Distinguished Chair in Orthopedics and Sports Medicine in Cleveland.
Collapse
Read more about
Click Here to Manage Email Alerts