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Wearables from Lab to Bedside: The Stanford Wearable Health Lab Storywww.iotevents.ca - info@iotevents.ca#IoTHealthcareW

Matthew Smuck, MD

Chief, Physical Medicine & RehabilitationAssociate Professor, OrthopaedicsDirector, Wearable Health LabStanford University

IoT, Big Data Healthcare SummitFeb 1, 2017

Thanks to!Wearable Health Lab

Faculty and StaffMatthew Smuck, MD (Director)Christy Tomkins-Lane, PhDAgnes Martinez-IthMing-Chi Kao, MD, PhD

Students & Post-DocsJustin NordenAman SinhaVibhu AgarwalAmir Muaremi, PhDPatricia Zheng, MD

Collaborations with:Scott Delp, PhD (Stanford Mobilize Center)William Haskell, PhD (Stanford Prevention Center)Nigam Shah, PhD (Stanford Bioinformatics)

Supported by: NIH U54EB020405 Stanford Mobilize Center

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Precision Medicine

http://med.stanford.edu/precisionhealth.html

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Precision Medicine

Definition:

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Precision Medicine

Definition: The right treatment.

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Precision Medicine

Definition: The right treatment.For the right person.

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Precision Medicine

Definition: The right treatment.For the right person.At the right time.

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Wearables & Precision Medicine

Zio-Patch

http://www.irhythmtech.com/patients/how-it-works

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My motivation

the BIGGEST problem in orthopedics research

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My motivation

the BIGGEST problem in orthopedics research

Imprecise & Subjective Outcomes

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ProblemImprecise & Subjective Outcomes

As a result, we lack a common language to discuss with patients the context and consequences of treatment choices

I was frustrated by sentiments such as these. Lets presume this woman had a large disc herniation, motor deficit and failed aggressive conservative care. You know and I know that surgery is an excellent option for her. Yet, after recommending and discussing it with her she remains reluctant. Why?

90% chance of success (what does success mean, full relief, normal life, no future spine problems). Inquisitive patients ask what do you mean by success?90% chance of a 2-point reduction in pain score80% chance of a 15-point improvement in ODI

That is the problem that made start looking for a technologic solution. 11

The exception that proves the rule.

Reliance on Subjective Outcomes

90% chance of success (what does success mean, full relief, normal life, no future spine problems). Inquisitive patients ask what do you mean by success?90% chance of a 2-point reduction in pain score80% chance of a 15-point improvement in ODI

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What we communicate to patients is defined by what we measure

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What we communicate to patients is defined by what we measureTHE SOLUTION STARTS WITH

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Outcomes Measurement

PainHuman Function

There is a strong rational for this approach15

motivation

http://www.everymac.com/systems/apple/iphone/iphone-faq/differences-between-the-original-iphone-and-iphone-3g.html

There is a strong rational for this approach16

Solutions from Mobile Wearable Technology

Physical Activity Monitoring

Problem Solved ??A ubiquitous, objective FUNCTIONAL outcomes measure

Will increase continue to increase for several yearsImpacting our understanding of spine disease, precision of disease monitoring and outcomes, and the way treat patientsThe power of this device to change spine care stems from two features. 1. Simple, passive, and reliable functional outcome 2. Ability to provide new insights

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Surprising Fact

Current activity monitors are useless in my clinic

If you come to my clinic with this information, I dont find it particularly useful

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PHYSICAL ACTIVITY MONITORING IN MSK RESEARCHResults are counterintuitive WHY?

Earliest studies showed minor or now change in Physical Activity What about PERFORMANCE??19

Physical Performance Analysis: A new approach to assessing free-living physical activity in musculoskeletal pain and mobility limited populations Kao MCJ, Jarosz R, Tomkins-Lane C, Smuck M. Publication Pending.

Existing Intervals (VO2 based)

Standard measurement of physical activity

StepsEnergy expenditure

Finally - An objective functional outcomes tool Recently applied to spine research. What have we learned?20

Physical Performance Analysis: A new approach to assessing free-living physical activity in musculoskeletal pain and mobility limited populations Kao MCJ, Jarosz R, Tomkins-Lane C, Smuck M. Publication Pending.

ResultsEmpirically derived novel intervals for analysis of physical performance

Physical Performance IntervalsExisting Intervals (VO2 based)

Finally - An objective functional outcomes tool Recently applied to spine research. What have we learned?21

- First applications of this novel tool - Measure differences between spinal stenosis subjects & controls - Evaluate post-op changes in PHYSICAL PERFORMANCE

Activity Monitoring with Accelerometry Outperforms Self-Reported and Laboratory Assessments of Function in Patients with Lumbar Spinal Stenosis Smuck M, Buman M, Ith MA, Haskell WL, Kao MCJ. PM&R. 2013 Sept:5(9):S292.

Lumbar Spinal Stenosis Decompression Normalizes Free-Living Physical Activity ImpairmentSmuck M, Buman M, Ith MA, Haskell WL, Kao MCJ. Spine J. 2013 Sept;13(9S):S41-S42.

Finally - An objective functional outcomes tool Recently applied to spine research. What have we learned?22

Phenotypes of Physical Performance for Knee Osteoarthritis and Lumbar Spinal StenosisNorden J, Singah A, Ith MA, Tomkins-Lane C, Smuck M.

LSS vs. NHANESOAI vs. NHANESLSS vs. OAI# of Features in Sparse Set4910Classification Accuracy*0.800.830.72

Leveraging 3 existing datasets

Knee OA (OAI)Lumbar Spinal Stenosis (LSS) Population control (NHANES)Results

Finally - An objective functional outcomes tool Recently applied to spine research. What have we learned?23

BENEFICIAL SIDE EFFECTS

- New insights into disease mechanism

Finally - An objective functional outcomes tool Recently applied to spine research. What have we learned?24

What have we learned from this ?

Biosensor data analysis has to match the clinical conditionWhat have we learned from this ?

Biosensor data analysis has to match the clinical conditionWhat have we learned from this ?Solution to Problem Access to an objective and quantitative functional outcomes measure (physical performance) using accelerometry

Biosensor data analysis has to match the clinical conditionWhat have we learned from this ?Solution to Problem Access to an objective and quantitative functional outcomes measure (physical performance) using accelerometrySolution to Problem Opportunity for meaningful context in the clinical conversation

What have we learned from this ?Solution to Problem Opportunity for meaningful context in the clinical conversationPerformance Phenotypes are digital biomarkers that can be used to develop predictive models for Precision Health Biosensor data analysis has to match the clinical conditionSolution to Problem Access to an objective and quantitative functional outcomes measure (physical performance) using accelerometry

Thank You!

Matthew Smuck, MD

Chief, Physical Medicine & RehabilitationAssociate Professor, OrthopaedicsDirector, Wearable Health Lab

msmuck@stanford.edu