How new motion-sensing technology can help normalize back pain care

Digital health systems can tell clinicians when a person’s heart disease risk requires medication to lower cholesterol or whether insulin injections are warranted for someone with type 2 diabetes.

But for millions of people with low back pain, care decisions rely heavily on subjective measures of patient discomfort, often resulting in costly testing and treatment (back pain is the third largest care expense highest health status in the United States, after diabetes and heart disease). t necessarily offer a permanent solution.

Engineering and medical researchers at Ohio State University are developing a digital health system approach designed to improve clinical decision making in back pain. After completing a series of studies testing precise, objective measurements that they have perfected in the lab, the team aims to apply data-driven practices to the assessment and repair of back problems caused by dysfunction. of the spine.

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 patients who underwent lumbar fusion surgery. While postoperative pain relief and reduction in disability were self-reported within six weeks, objective measures did not detect real functional improvement in the spine for at least six months after surgery.

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

“You just can’t ask people what they think of their backs,” said lead author William Marras, executive director of Ohio State’s Spine Research Institute.

“For back pain, people are asked to rate how they feel on a scale of 1 to 10. But since you don’t have pain receptors in the disc, what does that mean? Our technology is trying to bring objective measurements to the problem and examine not only how people feel about their back pain, but also quantitatively measure how their movements are different and what that means in terms of biomechanics.” , said Marras, professor of integrated systems. engineering with academic appointments in the College of Medicine in Orthopedics, Neurosurgery, and Physical Medicine and Rehabilitation.

The Marras lab has been studying everyday life forces on the spine for decades and developed the first wearable back sensor 30 years ago to assess how movements while performing a range of tasks in various settings affect the back. More recently, his team has retrofitted these devices with commercially available chips – typically found in cellphones – that tell us where we are in space.

The system, called “Conity”, includes a clinical lumbar motion monitor equipped with smart sensors mounted on the upper back and the waist harnesses to capture a person’s three-dimensional “motion signature” while performing a a series of standardized movements. The combined technologies provide quantitative data not only on range of motion, but also on speed and acceleration of motion – the numbers that Marras’ research found are more informative for understanding spine function.

The 121 patients who underwent lumbar fusion surgery in the study were assessed once before and five times after surgery on forward and backward flexion, lateral flexion and rotation of the spine. To determine their functional performance score, their individual data was compared to a composite measure based on data collected from healthy controls. Participants also completed questionnaires assessing their pain, disability, fear-avoidance behaviors, and quality of life at initial and postoperative visits.

The first significant improvements in functional performance based on motion sensing data were not observed in these patients until six months after surgery, with function progressing steadily over the following 18 months. But the patients themselves reported significant improvements in pain, ability and fear avoidance as early as six weeks after surgery.

Although pain relief is important, the researchers noted that objective functional assessments may be a better indicator of when it is safe to return to normal activities after spinal fusion surgery.

“Our technology is able to look at, 1, whether or not you have a back disability, and 2, what is its status? Is it getting better, is it getting worse, is it is progressing, or is it going beyond the scales?” says Marras. “When you do damage to the back, and especially to the discs, you don’t know when the damage is happening because we have very few nerve receptors in the back. disk. You could do damage and people would never know.

Marras’ use of motion monitors in an earlier study sparked military interest and generated Department of Defense funding for this technology so it could be used to assess spinal function in aircrews. – a group of servicemen known to suffer from low back pain.

“In the world of lower back issues, it’s about not letting it go on for months or years until it gets really bad, because then it’s really hard to fix,” said Marras. “Military leaders we’ve spoken to believe this could lead aircrews to find the right solution and prevent problems down the line.

“It allowed us to strengthen our databases, develop the technology a lot more and turn it into a digital health system platform that could help many people in the military with their problems. And that was a launchpad that opened up opportunities with the National Institutes of Health to do the same thing.

Beyond information from patient questionnaires and motion detection data, researchers are also integrating medical imaging results and electronic medical record documentation into the database to provide highly individualized assessments and expand the power platform analytics.

Marras is co-principal investigator on Ohio State’s participation in an upcoming federally funded clinical trial to evaluate spine treatments, and continues to collect motion sensor data on sufferers. or not back pain regardless of this trial. His team has also developed clinician software to expand the availability of motion detection testing across the country.

“We are building a systematic computing platform that we could distribute all over the country,” he said. “Our hope is that by collaborating with different universities, we will be able to build a database large enough that we can use artificial intelligence and machine learning to cut and figure out what is most important. We think we know, but sophisticated analysis of tons and tons of data could help us find everything we’re missing.

Co-authors of the lumbar fusion surgery study, all from Ohio State, included Safdar Khan, Prasath Mageswaran, Guy Brock, Mariah Eisner and Sue Ferguson. The work was supported in part by the National Center for Advancing Translational Sciences.

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