Jim Newman explores how technology is helping knee surgeons understand the one great mystery of patient recovery.
There’s a problem with the traditional surgeon, physio, patient relationship. As my colleague Dave Duffy pointed out in his recent post, physio is an essential element of the recovery equation. Ahead of treatment (in so-called prehab) it prepares your body for the rigours of the procedure. After an operation it ensures your muscles get the workout they need to ensure that, once your activity levels increase, your knee is up to the challenge.
The problem is that it’s impossible for surgeons or physiotherapists to know for sure whether a patient continues with their exercises once they get home.
In the dark
After your knee replacement, for example, we might refer you to a physio who will prepare a weekly or monthly report on your range of motion. The physio may report that the knee is stiff, which could tell us that there’s an underlying problem with the knee that wasn’t previously identified. Rarely, it may tell us there’s an issue with the implant. It could indicate that, whilst you’ve been regularly performing your physio exercises, you’ve not been doing them precisely as shown and that their effect has therefore been limited. It could tell us that you’ve not been doing the exercises at all.
The fact is, without further investigation, it’s very difficult to tell.
That’s one of the lesser discussed benefits of the latest generation of ‘patient journey’ technology, designed to monitor, amongst other things, patient movement and activity. Typically wearable and app based (a little bit like a Fitbit or similar) these devices collect data so that, if there’s an issue that needs addressing, we know where to look.
The tech can analyse movement patterns, so if you’re doing your exercises but need a little help in doing them correctly, it can flag up the issue, ensuring you get greater benefit for your effort.
If you’re doing the exercises like a professional and there’s still a problem, the data can help us understand where the real problem lies.
And if the issue is that you simply aren’t doing the exercises (or doing enough of them) it will tell us that too.
PROMS without the probing?
There are other benefits too. When a patient undergoes surgery, they complete a pre- and post-op questionnaire about their health and quality of life known as PROMS (patient reported outcome measures).
But PROMS are a bit of a faff for patients. The data is, by its nature, subjective and as one 2015 study found: “The majority of PROMs analysed are written at a level that is incomprehensible to the average UK adult.”
Wearable patient journey tech could give us lots of PROMS-type information without (or with a much reduced) need for effort on the part of the patient.
There are issues. Is an app that checks you’re doing your exercises a step too far? An invasive ‘spy’ who tells tales when you decide you’d rather give the exercises a miss for a day? As with all technology, there are ethical issues about data collection, use and storage – and cost will inevitably be a major factor.
But if we can resolve these issues, we’ll be in a much better place to understand patient recovery, and we’ll be better able to help patients manage that recovery.
To explore options for treating your knee pain, please talk to us.
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Consultant Knee Surgeon at the Yorkshire Knee Clinic
“I’m walking normally now - no sticks or anything. I’d like to thank Mr Newman for what he’s done for me. It’s been life changing.”
Paul Morgan, YKC patient