Introducing wearables in orthopedics – Hospital for Special Surgery's Dr. Stephen Lyman explains how

Spinal Tech

As technology and devices evolve, physicians continue to look for inventive ways to continuously receive feedback on a patient's recovery.

Stephen Lyman, PhD, an associate scientist at New York City-based Hospital for Special Surgery explains how combining wearables and telehealth in orthopedics can benefit physicians and patients.


Question: What steps are device manufacturers and physicians taking to introduce wearables to orthopedics?


Dr. Stephen Lyman: We are only now beginning to understand how to use the information gained from wearables as a clinical tool. There is a lot of research and validation work that needs to be done before we can introduce wearables into a clinical setting. For this reason, very few device manufacturers and

physicians have introduced wearables into orthopedics.


Q: Will the use of telehealth improve orthopedics and the developments of wearables?


SL: Success in orthopedics is rarely black and white. With orthopedic procedures, such as joint replacement surgery, we’re not treating diseases or completely resolving medical conditions. Rather, we're typically working to reduce pain and improve function. Success is making it easier for the patient to live their

everyday life.


Wearable technology and telehealth advancements can greatly improve orthopedic patient outcomes by allowing us to accurately measure outcomes following orthopedic procedures. Not only will clinicians be able to monitor the patient’s rehabilitation remotely, but this technology can also help physicians identify

potential problems as patients are recovering. Wearables could also encourage patients to follow rehabilitation protocols, simply because they’re aware their progress is being observed (a phenomenon known as the Hawthorne Effect).


There are substantial potential cost savings and efficiency gains as well. If physicians can monitor a patient’s recovery process remotely, they can reduce the number of physical therapy visits and postoperative clinic visits. If a patient is complying with their rehabilitation and isn’t experiencing pain, there’s no need for

the patient to come in for a follow-up appointment. This saves time for both the patient and healthcare providers and ultimately reduces costs to the patient and their insurer. On the other hand, if the patient is experiencing challenges in their recovery, clinicians can pinpoint these issues early on and be more proactive

in determining the appropriate course of treatment to get the patient back on track. This all ladders up to ensure quality outcomes for patients recovering from orthopedic procedures.


Q: What challenges do wearable devices used in orthopedics need to overcome in order to be fully integrated into daily use?


SL: Here are several challenges to fully integrate wearables into orthopedic care.


The first step is validating the information received from these devices to answer the question, “What matters?” Steps? Steps/Minute? Minutes active? We don’t know at this point, and we need to validate the data to find out.


Then, we need to get the information into a usable format that contextualizes the information for both the patient and the provider. At this point, most wearables have been designed for the fitness market with interfaces to match. However, this has been virtually no thought to having a clinical face to the information.

The existing information may not be relevant to patients or may actually encourage unsafe behavior. For example, many fitness devices recommend 10,000 steps per day, but this may actually be harmful to someone recovering from orthopedic surgery or perhaps a patient with a lower extremity stress fracture.


Finally, we need patients to be compliant with wearables and clinicians to integrate the information into their care pathway for successful implementation. For example, older adults may not be comfortable with this new technology, may not charge their device, etc. Likewise, the best diagnostic or prognostic test in the

world is not helpful if clinicians don’t look at the results. We need to work closely with clinicians to confirm the information is, in fact, valuable and useful. The ultimate wearable may end up being sensors embedded into orthopedic devices, which could potentially provide precise information about the patient’s mobility,

the implant’s condition, etc.


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