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The evolution of medical technologies

Medical technologies have evolved considerably over the last 100 years, with a significant increase over the last 30 years as computing power and data storage has increased, and manufacturing has evolved from macro to nano technology.

What this means to the medical profession is there is now an abundance of digital tech with built in intelligence.  And for the end user there are now many devices they can use to monitor a wide range of functions.

This is an excellent position to be in for both medical professionals and end users.  But of course, it does also bring confusion to both clinicians and end users.  With so many different systems available how does one choose which is best for your need?

I take two examples heart ECG monitoring and gait monitoring because everyone has heard of them and both have a wide spectrum of devices to choose from.

I found an excellent paper on ECG monitoring which reviews all the different types of systems, how they work and what they can be used for.  For those of you who are interested, here is the link

https://pmc.ncbi.nlm.nih.gov/articles/PMC7147367/

In summary, all the different systems are designed to address different needs.  The more complex are designed for diagnosis and prognosis, whereas the simpler devices are used to monitor, either once a condition is diagnosed, or to track performance.

The same is true for gait analysis, where technology advancements have resulted in a wide range of new technologies for clinical and home use.  However, you wouldn’t seriously expect to see a doctor and be diagnosed or assessed for osteoarthritis, joint mobility following hip or knee arthroplasty or ACL reconstruction using a smart watch on your wrist, a sensor around your waist or pressure pads in your feet.  You would expect an analysis of the joints.  But once you have your diagnosis and a treatment plan then the simpler systems may be perfect for monitoring progress and performance.

Where does GaitSmart fit in?

Helping patients get the right diagnosis

GaitSmart has been designed to monitor gait kinematics i.e how joints move when walking.  Our early research tool was used to establish how healthy people walk.  Without a healthy reference it is impossible to diagnosis any condition.  This, incidentally, is true for any measurement device, where the measurement range for healthy people should be clearly articulated.  The healthy reference for GaitSmart has enabled us to introduce a RAG grading scale and scoring system, very much like blood pressure does.

The next piece of work was to establish whether the gait kinematics of a person with a specific musculoskeletal (MSK) condition deviated significantly from the healthy cohort.  Our focus was on people suffering from hip and knee osteoarthritis (OA), hip and knee replacement patients and older people at risk of falls.  We did also look at ankle fracture, haemophiliacs and ACL reconstruction but with smaller cohorts.  In total we monitored over 700 healthy people between the ages of 18 and 97 and 1,000 patients.

Our published evidence clearly demonstrated that gait kinematics changed significantly for each of these conditions, when compared to the healthy reference.  This gave us the assurance that monitoring gait kinematics in a clinical setting could help millions of people to obtain the correct diagnosis and treatment plan.

How does GaitSmart compare to other gait monitoring tools?

With GaitSmart the gait kinematic data accurately quantifies how the joints are moving.  This is the same as an optical gait lab, which was the original technological approach for obtaining accurate gait kinematic data.

Foot pressure solutions include pressurised walkways or instrumented insoles.  Both of these approaches determine how the limb is loaded but contains no information of how the limb moves through the swing phase.

Single sensor systems mounted on the waist measure the upper body reaction to certain limb issues.  And sensors worn on the wrist, such as Smart watches will only detect asymmetry if the arm swing is affected.

How are personalised exercise plans delivered?

As with any condition, it is important to get the right diagnosis in order to provide an effective treatment plan.  Treatment for the majority of MSK conditions involves exercising the weakened areas, even following surgical intervention like joint replacement or ACL reconstruction.

Using the gait kinematic data from GaitSmart it is possible to determine which muscles are weaker than normal.   And by modelling the complete set of strength and balance exercises GaitSmart can provide a truly personalised exercise plan.

This additional functionality was introduced 3 years ago with incredible success.

Patients now receive their gait kinematic data, identifying issues and severity using the RAG system.  They also receive a personalised exercise plan so they can get better at home on their own.  The icing on the cake is that they can come back after 3-4 weeks for a follow up test.  They see the improvements for themselves, which motivates them to continue and get a new set of exercises to work on at home.

There are a number of other ways that exercise plans can be provided.  One is through a physiotherapist, which comes with a cost.  The second is to provide an exercise plan based on the patient’s perception of their symptoms, which may be highly inaccurate.

The evidence behind GaitSmart and NICE Guidance 

GaitSmart is a wearable technology making it considerably easier to collect data from large patient cohorts, particularly older people, compared to a gait lab.  This is particularly relevant for people suffering from MSK conditions, who are predominately over 50.

Identifying and treating people in primary, secondary and community care is key to the NHS and NICE Guidance clearly states the care pathway for each of these patient cohorts.

GaitSmart is particularly relevant to patients suffering from OA, patients receiving a joint replacement or older people at risk of falls.

Each of these care pathways state that gait should be assessed and a personalised exercise plan should be provided.  The NHS conventionally uses physiotherapists to undertake these tasks.  But, in 2024, GaitSmart received NICE Guidance for use with Falls Prevention.  This decision was made on the strength of our clinical and economic evidence.

GaitSmart is now used in primary, secondary and community care.  The focus is on improving people’s ability to walk, which has a corresponding benefit to their overall health and wellbeing and reduction in their falls risk.

The future

People are now much more aware of technologies that can help them and their families; this is driving the uptake of new medical technologies. This will include early diagnosis, monitoring and smart intervention.  These digital solutions can be offered effectively in the community or home to reduce the pressure on primary and secondary care, which is known to be already overstretched.