A simple technology may offer more specific rehabilitation plans, smoother recoveries and clearer expectations about the future for thousands of knee-replacement patients nationwide.
By combining wearable sensors with machine learning, Western Medical Biophysics and Surgery professor Matthew Teeter is helping patients with arthritis better understand their present conditions in order to have realistic expectations for life after surgery.
For his work, Teeter was recently honoured by the Arthritis Society of Canada as one of the Top 10 Research Advancements of 2019.
Part of current methods of evaluating surgery success – where a questionnaire is given to patients afterward – are subjective and limited, said Teeter, adding studies show 20 per cent of patients are disappointed with their results. “A lot of that disappointment is unrealistic expectations.”
By introducing these sensors prior to an operation, Teeter believes patients and doctors will both benefit from being better informed of current health conditions, how they relate to a larger pool of similar patients, and then be able to shape recovery expectations, lessening the chance for patient dissatisfaction afterward.
Functionality tests are not new. Take the ‘up-and-go test,’ for example: Typically, a patients would be timed standing up, walking 10 feet, and then returning to a seated position. The faster they can do this, the more knee function they are viewed as having.
That might not be the clearest picture of a patient’s current condition, Teeter explained.
“Perhaps the patient could complete the task, but a stiff knee forced them to limp the whole time,” he said. “Then that’s not giving you a perfect measure of knee health.”
Teeter proposes using sensors to add information to the test and create a data pool of similar patients. That data collected before and after surgery will let doctors quantify how function changes for thousands patients. They can then use that data to predict if a particular patient will respond with improved function following surgery or simply maintain normal function.
“Part of that challenge is the surgeon doesn’t know if you are going to be a ‘responder’ or a ‘maintainer,” Teeter said. “It can be a good outcome for you if the function you have now stays the same and we got rid of the pain. But if you thought you were going to do much better, and you’re unhappy, you’re more likely to complain.”
Predicting how satisfied a patient will be based on their functional outcome helps to set targets for potential interventions to speed up recovery.
“While it will take time to heal, how you are doing two weeks after surgery is a strong predictor of how you are going to do at one year,” Teeter said. “So if you’re already showing some problems with your function that early maybe physicians should take a look and perhaps figure out another way to do rehab.”
Informing patients about what will happen after surgery – setting reasonable expectations and predicting probable functionality – creates a more personalized approach to the prognosis, he added.
Imaging tools would be perfect in these sorts of cases to determine functionality, but access and expense make them prohibitive. However, wearable sensors – which cost around a couple hundred dollars each – offer hope for information and affordability.
Teeter suggested sensors could become part of the entire surgical process – from pre-op to post-op, and perhaps even offering guidance on what surgical techniques to employ or implants to use.
“If a surgeon goes on their experience, they’re fantastic. But they can only do so much,” he said. “Imagine adding these personalized measurements.”
Teeter said being lauded by an organization such as the Arthritis Society of Canada is amazing.
“I want to have an impact on patients’ lives. So for a group like the Arthritis Society to say this is something, and can potentially have an impact, is great.”
The Arthritis Society of Canada also lauded Physiology and Pharmacology professor Frank Beier and Chemistry professor Elizabeth Gillies for their work tackling the debilitating effects of osteoarthritis.