Donald M. Petersen Jr., BS, HCD(hc), FICC(h), Publisher
About a year ago, I had an interesting conversation with a DC who made house calls. When I asked why, she was quick to explain she learns much more about her patients when she sees them at home than she could ever observe in the office. She believes her ability to understand her patients in their normal environment makes her a better doctor.
On a related note, a new pilot study of low-back pain patients conducted in Australia examined the ability of a new device to monitor patients' movement outside the office. Researchers used a monitor with "wearable wireless motion-sensors that can quantify and analyse kinematic musculoskeletal function. This technology can assist in the evaluation of lumbopelvic movement patterns and postures, both in the clinic and in the patient's daily functional activity (dorsaVi Ltd, Melbourne, Australia).
"These devices can also be easily programmed to provide individualised biofeedback to people with back pain to reinforce clinician-determined rehabilitation strategies in their everyday vocational, social and recreational activities, where changes to habituated movement behaviours most need to be reinforced."1
The pilot study included a small group of patients (58) with either subacute (3-12 weeks) or chronic (>12 weeks) low back pain. Both groups received usual medical / physiotherapy care and all patients wore the motion-sensor system (which was rendered inoperable in the control group) every day for 4-10 hours over the 10-week treatment period.
The motion-sensor system consisted of: "(i) two wireless motion-sensors that measure three-dimensional movement, movement velocity and acceleration, and orientation to gravity, (ii) two wireless surface electromyography (EMG) sensors that measure paraspinal muscle activation, (iii) a wireless recording device (approximately the size of a cigarette packet) that captures the sensor data, has a button that patients can push when an event occurs (such as an onset or increase in pain), an audio and vibration function that can be programmed to provide patient-specific biofeedback alerts, and (iv) a charging dock for these wireless devices. The system also has a comprehensive computer software application that clinicians use to observe movement characteristics in real-time, to download movement data from the recording device captured during activities of daily living, to analyse these data with the use of graphics-rich reports, and to compare an individual's movement pattern with their previous assessments or with reference values. Using gyroscopes built into the two motion-sensors, the system also records whether the patient is sitting, standing, walking or lying down, at every time point during measurement."
Members of the intervention (the "biofeedback" group) were assessed to determine if their pain was related to movement or posture. If it were, the clinician identified the patient's dysfunctional movement patters and programmed the motion sensors to detect the following:
- Excessive end-range postural positions or repeated end-range movements
- Reduced muscle activation
- Excessive muscle activation
The sensors would beep or vibrate to notify the patient of dysfunctional movement. Patients were trained in the doctor's office on how to change their posture or movement based on the biofeedback signals generated by the sensors.
Patients in the biofeedback group showed significant improvement in their pain-related activity limitations over the course of the study – and not just during the treatment phase. In fact, patients continued improving beyond the 10-week treatment period for the full 52 weeks of study.
While this is still only a pilot investigation it's worth taking a few moments to read it. (See reference #1 below and link to the study in the online version of this article.) It is yet another example of how technology is shaping your future as a doctor of chiropractic. Apple, dorsaVi (the company that makes this particular motion-sensor system – ViMove) and others are willing to invest considerable amounts of money to develop systems that will let you monitor your patients as they live their lives, assisting your efforts to help them get – and stay – healthier.2-3
Your willingness to embrace these new technologies will begin to take chiropractic beyond your clinic, extending your care into your patients' daily lives. In essence, through technology, your patients will be able to enjoy the benefits of chiropractic care (your care) every day.
References
- Kent P, Laird R, Haines T. The effect of changing movement and posture using motion-sensor biofeedback, versus guidelines-based care, on the clinical outcomes of people with sub-acute or chronic low back pain – a multicentre, cluster-randomised, placebo-controlled, pilot trial. BMC Musculoskeletal Disorders, 2015;16:131.
- Petersen Jr. D. "Apple Takes a Bite Out of Research." Dynamic Chiropractic, May 1, 2015.
- ViMove - produced by dorsaVi.
Read more findings on my blog: http://blog.toyourhealth.com/wrblog/. You can also visit me on Facebook.
