Over the past 10 years, wearable technology has filtered into the mainstream, with market-leading Fitbit counting over 23 million active users. Wearables are used for tracking general measures of health such as heart rate, physical activity and sleep. Neurosurgeon Ralph Mobbs (Sydney, Australia) believes that wearables could offer physicians and researchers invaluable insights into patient recovery.
How can wearables be used in spinal research?
Walking is a fundamental part of living, and its importance is not limited by age, race or medical status. A deterioration in how we walk is associated with poor health outcomes. Because walking distance and speed is quick and easy to monitor using wearable devices, they form a reliable, valid and sensitive measure of how healthy we are. The power of these devices in spine research is to monitor rate and quality of recovery after surgery, using objective, continuous and real-time data.
It is not just objective outcomes research that I am interested in, but every step of the way of how we treat our patients including the work-up, the recovery and the long-term maintenance of health, irrespective of the intervention. I envisage a day when smart wearables will pre-diagnose common health problems, assist the healthcare provider workout the best management plan, assist in the recovery after a procedure or intervention and, finally, detect problems before the patient or doctor realise there is a problem!
How did you become interested in the role of wearables in research?
I treated a patient in 2006 with spinal claudication who worked as a biomechanics lecturer. Our discussions on his problems with walking led us down the road of questioning how to objectively monitor walking and health outcomes. In 2011 the first commercially available accelerometer—the Fitbit Zip—was released in Australia, providing the opportunity to objectively monitor patient recovery with an easy to use and cost-effective device. Since then, however, this technology has improved a hundredfold. The nuance of detail we can now collect, analyse and use to monitor outcomes in real-time is incredibly powerful.
The last 10 years has not been easy though. I have approached multiple companies to assist in the development of wearables to monitor surgical outcomes, but until recently there has been minimal interest. It is all changing very rapidly now, as everyone is finally realising the power of these devices.
What research have you performed so far, and what have you learned?
After some simple case-based studies of attaching activity monitors to patients to assess compliance and proof of concept, we undertook the first prospective study, using the original Fitbit, to compare standardised outcome measures (ODI, SF12, VAS) to objective measurements such as daily steps taken. We hope this landmark study will set the foundation for a move from subjective data outcomes reporting to objective data collection and analysis.
Based on our study, published in the Global Spine Journal, we established that real-time objective data collection in the post-operative period has the capacity to provide similar outcomes analysis to traditional forms-based outcome scores.
Currently, we are pairing with a USA-based outcomes assessment company, Vision Tree (VTOC), to link objective and subjective outcome measures for patient assessment following orthopaedic- and cancer-based interventions. Their robust cloud-based platform of outcomes recording will be a solid link between validated subjective outcomes assessment, and what we are offering with wearables research.
How could physicians use this kind of data in clinical practice?
Physicians can start by requesting that patients wear these devices after surgery to monitor and motivate them during the recovery process. It is simple and easy to administer. From my experience, patients do enjoy keeping an eye on their progress using the online and phone-based tools that come standard with these devices.
Do you anticipate regulatory hurdles to the adoption of this technology in a clinical setting?
The wearable devices themselves have been validated to report a high degree of accuracy in terms of steps taken, walking distance, velocity and heart rate; and the list goes on. I do not envisage regulatory issues with using these devices to record and assess outcomes, although this is a focus of our ongoing research. The issue will be patient compliance with wearing the devices in the first place—we can address this by using devices that the patient already is comfortable with, such as a watch or bracelet.
What are your hopes and predictions for wearable technology in spine over the next five years?
There will always be a place for subjective outcomes assessment, however my hopes are that the future of outcome measurement becomes universal throughout the healthcare sector, with a transition from subjective to a combination of subjective and objective measurement tools.
I predict that this kind of technology will be used across healthcare to track all kinds of data from diagnosis to postoperative recovery. Insurers will demand firm evidence that a particular intervention works, and this technology could one day provide hard data to support payment for all kinds of treatment.
Ralph Mobbs is a neurosurgeon at Prince of Wales Hospital, Sydney, Australia, editor-in-chief of the Journal of Spine Surgery, and chair of the NeuroSpine Surgery Research Group (NSURG).