Getting dressed, brushing teeth, opening a jar to make a meal: many Canadians can take performing these tasks for granted. But for those living with osteoarthritis in their hands, the gripping and twisting motions of daily life are a regular source of pain and frustration.
“It can affect everything. Living with pain certainly has an impact, but it extends to all dimensions of life,” said Joy MacDermid, professor of physical therapy and co-director of the clinical research lab at the Roth | McFarlane Hand and Upper Limb Centre.
There are also economic implications if work is affected, as well as increased risk for isolation and depression. “We often hear from people who’ve had to give up things they value, like participating in sports, or doing crafts they used to enjoy,” said MacDermid. “Those activities are related to their social life and often done with friends.”
She and her colleagues are working on improving the quality of life for those living with hand osteoarthritis by studying the force used in daily tasks to develop new joint protection programs. Her research, done with the assistance of Pavlos Bobos, PhD’20, and in collaboration with engineering professors Louis Ferreira and Emily Lalone through Western’s Bone and Joint Institute, has received recognition from the Arthritis Society as one of its Top 10 Research Advances of 2020.
Joint protection programs — a group of strategies to decrease strain on the joints — have included training patients to do tasks differently, to use assistive devices or to pace high-force activities like carrying a heavy laundry basket throughout the day.
Until now, these programs have been based on theory alone, MacDermid said. “We’ve always thought if you put your joint in a neutral position, it makes sense biomechanically that it would lessen force through the joints, but we didn’t have measurements demonstrating that joint protection worked. We needed devices to do that.”
That’s where Ferreira’s and Lalone’s expertise in mechanical and material engineering, and specifically wearable technology, comes in. Ferreira designed a sensor allowing Lalone and her graduate students to measure, in real time, the forces in fingertips when performing functional tasks. Tiny strain gauges attached to the nailbed pick up a recording when the finger is depressed.
The first design saw the sensor embedded in fake fingernails, then evolved through the team’s investigations to be worn in small finger sleeves by test subjects in MacDermid’s lab.
“We had a kitchen area set up and a series of standardized tasks that patients would go through, such as pouring a tea kettle or lifting a cup,” she said. Patients were tested, first doing tasks their own way, then repeating them using joint protection strategies. The subjects were videotaped, and data on the amount of movement and force used for each task was analyzed.
Early results showed some strategies are very effective in reducing the amount of force going through the joint, but there were also unexpected observations. “There seems to be some tasks that people naturally gravitate toward doing correctly,” MacDermid said. For example, patients knew inherently how to lift a kettle in the best way to avoid strain. But with other tasks they had no idea when they were doing it incorrectly.
Biofeedback, in the form of an audio or visual cue while doing a task, could help patients avoid joint strain in the future, the study found.
This is part of MacDermid’s long-term vision, made possible through the transdisciplinary effort fostered through the Bone and Joint Institute.
“We first want to create an intervention where people would wear the sensors in the clinic and get feedback,” she said. “But in the long-term, as sensor technology develops and becomes more stable, we’re hoping we can give people a kit that gives them feedback when they practise the tasks in their own home for two or three weeks.”
She’s hoping her work will also influence updates to patient training materials, noting some still suggest using a pencil rather than a finger to dial a rotary phone. “The tasks people do today and the types of assistive devices we have to help people now are so different.”