In February of this year, the FDA cleared two wristworn activity trackers from British company Camntech: non-smartphone-connected, but highly accurate devices intended for use in clinical trials. In July, Australian company dorsaVi followed suit, obtaining clearance for its ViMove sensor system for detailed activity tracking. Meanwhile, Orthocare Innovations, a company that has long held FDA clearance for its StepWatch device, created a spin-off company called modus health to market their device, hitherto used mainly for research purposes, to clinicians. Even MC10’s recent partnership with biopharma company UCB held up movement tracking in patients with neurological disorders as a possible focus of the collaboration.
For specialists whose practice revolves around patients’ mobility, such as physical therapists, equipping patients with an activity monitor gives them a view into patients’ daily lives they’ve never had access to before. But consumer trackers don’t always cut it in these situations, either because they lack regulatory clearance, or because they’re not sensitive enough for a particular use case. This has left a vacuum that companies like modus and dorsaVi are rushing to fill.
Although their technology has existed, and even been in use, for years, the makers of clinical-grade activity monitors are suddenly stepping up their game, and as a result more and more physical therapists and neurological disorder specialists are beginning to use the technology in their clinics. This trend seems to have two major, converging drivers: a need for more quantitative data in an age of new payment models, and a trickle-down effect of the near ubiquity of direct-to-consumer activity trackers.
Why physical therapists like activity tracking
Dr. John Halamka, the CIO and a practicing emergency department physician at Beth Israel Deaconess Medical Center, told MobiHealthNews in a recent interview that his father’s death helped him realize the value of continuously-gathered, patient-generated data.
“He had multiple sclerosis for 23 years,” Halamka said of his father. “And it turned out — I didn’t know this — but he was using steroids on the day before I would come visit him, to mask his symptoms so we would have a more meaningful time when I visited. If he’d been using a Jawbone, Fitbit, or some other device, I would have seen that he walked 50 steps a day on average, every single day, except the days I visited, when he walked 500. … That’s an example of where getting telemetry from the home would be extraordinarily important, not just for doctors, but for other carers or caregivers, family members. It was very hard to get an objective sense of his activity level just by talking to him or asking him how he feels.”
That’s exactly what most physical therapists do now: to assess a patient’s mobility, they rely on self-reported data from patients or parents, combined with in-clinic assessments, such as video taping the patient walking for six minutes on a treadmill. Self-reported data is subject to both intentional and unintentional bias: patients who feel guilty about not moving enough might inflate their results artificially, or might just not have a good idea of how much they moved.
As for in-office clinical tests, that information is still valuable, and it’s not likely to go away any time soon. At the same time, it doesn’t always give the complete picture, according to Dr. George Fulk, a physical therapist, researcher, and professor at Clarkson University in Potsdam, New York.
Correction: A previous version of this article misstated Dr. Fulk’s university affiliation.
“One of the nice aspects of having this information from activity trackers is you can really see how active they are outside of the clinic, and sometimes it’s a mismatch both ways,” Fulk told MobiHealthNews. “People might perform really well on the tests you do in the clinic, and then you see their activity tracking data and they’re not really walking much at all, relatively speaking, compared to what you might have thought based on the clinical results. And then other times it’s the other way around, where you have a patient that you might think based on their clinical result didn’t perform that well, but they’re more active than you would have thought [when you look] at what they’re really doing.”
Another physical therapist, Dr. Kristie Bjornson, compared take-home activity monitors to Holter monitors, which drastically changed how cardiologists assessed their patients a long time ago (and which are gradually being replaced by mobile health devices themselves). Bjornson is a pediatric physical therapist and an associate professor of pediatrics at the University of Washington.
“If you take a look at cardiac rehab, they’re getting more and more sophisticated and using that as the information to monitor their patients,” Bjornson said. “So I’m expecting in 10 years or so we will do that as well. … I, as a physical therapist, I would love to know how the kid’s doing walking at 9 in the morning, versus 5 in the afternoon, or Monday versus Friday after a full week of school. Is he functioning the same, is he more fatigued, and that’s the sort of thing an activity tracker can tell me. It’ll be very similar to how cardiologists use Holter monitors on their kids. “
For physical therapists whose specialty isn’t walking, activity tracking might actually be even more valuable, because it allows researchers to draw a link between day to day movement and other physical ailment complaints, like lower back pain. That’s the specialty of Rob Laird, who works at a clinic called SuperSpine in Australia.
“Up until recently there was little progress in the ability to accurately work out any reliable relationship of movement to lower back conditions,” Laird told MobiHealthNews in an email. “But with the advent of increasingly smaller, wearable sensor technology such as the ViMove device from dorsaVi, clinicians have a much better ability to look at how real life movement may impact on musculoskeletal conditions. … Lower back pain in particular is an enormous economic burden for society, and is such a common problem. If movement is related to lower back conditions, then smarter and more accurate ways of measuring movement is very important.”