At the North American Spine Society Annual Meeting, Matthew Smuck, MD, chief of physical medicine and rehabilitation at Stanford University, gave a presentation about how mobile technology is impacting spine surgery.
"Over the past 50 years, technological innovations have done wonders in improving the way we can look inside people in the forms of diagnostic imaging," said Dr. Smuck. "It's done wonderful things in improving the tools and instruments we use in the care of our patients, but when you think about it, it's done absolutely nothing to improve our interaction with patients and our ability to gather and capture information about patients and all of that is about to change. The reason that's changing is that there are new tools available to us and computer models and computer systems have finally reached the point where we can develop new models and ways of looking at things."
His presentation was titled "Mobile Tech: Impact on Clinical and Surgical Care." He talked about accelerometry and how it could impact surgical care.
There are two advantages of accelerometer he mentioned: to provide a simple and objective way to figure out what people are up to on a day-to-day basis and help surgeons answer patient questions they were unable to answer in the past. An accelerometer measures the volume, duration and intensity of activity. You can look at the data in several ways: patterns of activity, intensity of activity or identify activity at a more granular level.
"Even though this is new in the area of spine research, there are a couple of decades of research on activity monitors in one form or another," he says. "There are whole journals on this stuff in other areas of medicine. They are validated tools; they've just never been applied in the spine arena."
Physical activity is beneficial and reduces mortality. In the spine field, several studies have shown physical activity can help workers compensation patients return to work and normal activity more adequately. He went over several health benefits and physiological changes that derived from physical activity.
While activity has clear benefits for spine patients, one of the things that held up people who were using them for research was that the measures were designed for cardiologists. Researchers found that a better way to examine musculoskeletal diseases was it was within the lower range activities where these patients had the most disturbances.
"If you apply a different type of analysis, you can distinguish between different types of musculoskeletal problems," he said. Several papers have been developed as a result of the clinical research using accelerometers and they have had an impact on functional outcomes measures. "We're really on the verge of having a simple objective outcomes tool to apply to comparative effectiveness research in many other arenas."
He went on to mention that with EMR that has a self-portal and Blue Tooth, these activities can be monitored. The research-grade activity monitors currently used are very informative and other devices can give feedback, but there is a technology gap that needs to be solved before applying research grade accelerometers to the commercially available devices.
So, where are things going? Dr. Smuck outlined a few areas where he sees this type of technology helping in the future:
• Forming more precise diagnostics
• Monitoring disease and looking for changes in patients' activity that might indicate the need for a treatment
• Helping make treatment decisions
• Detecting potential post-surgical complications that should be treated before patients realize them
He also noted how accelerometers could provide data that will spark conversation between physicians and patients about their current situation and how different types of treatment could impact them.
"We currently lack the common language with our patients to discuss these things," he said. "We don't have the language to describe to them what to expect; but with monitoring and very specific objective outcomes that we can translate into very specific terms as to what happens in a person's daily life, now instead of having that awkward conversation, we can possibly say [to them] 'Look at this graph; you crossed the threshold where we know you could potentially have 90 percent success rate with surgery and 90 percent success means that within six weeks you're going to be right back here.'"
However, he noted that the objective information will not replace subjective information and what the patients want out of their care.
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