Most of us know what it’s like to suffer from some sort of back pain. But because it’s so common yet caused by many different factors—and also subjective to the patient—it’s hard for clinicians to know exactly how to treat it.
Engineering and medical researchers from Ohio State University want to make that easier with a digital health system approach aimed at improving decision-making for how to treat back pain, they said. The solution includes motion-sensing technology that can help evaluate low-back function to assess the next steps for treatment, they said.
Researchers from the lab of William Marras, executive director of the Spine Research Institute at Ohio State, combined patients’ own self-reporting on pain and disability levels with data from a wearable motion-sensing system to evaluate low-back function. Their study focused specifically on lumbar-fusion surgery patients, but can be applied to other pain sufferers as well. The team found that there was a discrepancy between how people said they felt about their pain and movement and the actual functional improvement, or lack thereof, that they made after their surgery, researchers said. For instance, while patients said that their pain had minimized after six weeks of surgery, the objective metrics didn’t detect actual functional improvement in the spine for at least six months after surgery, they said.
"You simply can’t only ask people how they feel about their back," Marras noted in an article for Ohio State News. "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?"
How the Wearable Technology Works
Marras’s lab has been studying daily living forces on the spine for decades and developed the first wearable back sensor 30 years ago to assess how movements people make while performing a range of tasks in a variety of settings affect the back. More recently, his team has retrofitted these devices with commercially available chips—typically found in mobile devices—that locate people in space.
The motion-sensing system the team developed is called “Conity,” and it features a clinical lumbar motion monitor outfitted with chip sensors mounted on upper back and waist harnesses. These sensors capture a person’s three-dimensional “motion signature” during performance of a series of standardized movements.
The combined technologies can provide quantitative data on not only range of motion, but also movement velocity and acceleration. Indeed, it is data regarding the latter movements that Marras’s research has found more informative to understand how the spine functions, he said.
Researchers said by including the data from their study and others that use the technology in a burgeoning national database of patient spine-function scores and other medical data, scientists around the world can have a tool for more-objective clinical decision-making for surgical patients, they said.
“We are building up a systematic computer platform that we could distribute anywhere around the country,” Marras said in the article. “Our hope is that by collaborating with different universities, we’ll be able to build up a database large enough that we could use artificial intelligence and machine learning to cut through and figure out what is most important.”
Studying Surgery Patients
One-hundred twenty-one lumbar fusion surgery patients participated in the study. They were assessed once before and five times after surgery on forward and backward bending, side-to-side bending and spine rotation.
To determine their functional performance score, researchers compared individual data to a composite measure based on data collected from healthy “control” patients. Participants also completed questionnaires to assess their pain, disability, fear-avoidance behaviors, and quality of life at baseline and post-operative visits. Researchers said.
Because of the discrepancy of when patients first reported pain relief and when the data actually showed spinal improvements, researchers surmised that objective functional assessments may be a better gauge of when it’s safe for spinal-fusion patients to return to normal activities after their surgery, Marras observed.
“Our technology is able to look at, one, whether or not you have a back impairment, and two, what is its status? Is it getting better, is it getting worse, is it progressing, or is it off the scales?” he said. “When you’re doing damage to the back, and particularly the discs, you don’t know when the damage occurs because we have very few nerve receptors in the disc. You could be doing damage and people would never know.”
Researchers published a paper on their report in the journal Clinical Biomechanics.
Aside from self-reporting by patients and the data derived from Conity, researchers are also incorporating medical-imaging results and electronic medical record documentation into the database to provide highly individualized assessments and provide broader analysis of patient scenarios, they said.
The team plans to continue to collect motion-sensor data on people with and without back pain independently of that trial to improve the technology as well as expand motion-sensor testing availability across the country through clinician software that researchers developed, they said.