Post-acute rehabilitation is a critical part of helping patients get back to as normal of a life as possible after an acute illness. Often that means extended stays at inpatient facilities and trips to outpatient clinics a few times per week. And even when discharged from those settings, their recovery is often incomplete – they just no longer qualify for professional support.
Emerging mobile technology could be poised to change how we deliver this care. A recent abstract presented at the recent American College of Cardiology conference suggesting significant benefits in the use of a smartphone app on outcomes in cardiac rehabilitation recently brought this potential into focus.
Going beyond apps and even traditional health devices like blood pressure cuffs, advances in wearable sensors that monitor gait, position, and activity hint at a future where formal rehabilitation programs can be delivered remotely long after patients leave the confines of the rehabilitation facility.
In a recent study out of the Mayo Clinic, patients undergoing cardiac rehabilitation post-MI were offered the opportunity to use an app that provides the ability to track their progress and delivers daily supportive messaging as well as education material. In addition to greater improvements in body weight, blood pressure, and quality of life when compared to a non-user population, they also found a significant reduction in rehospitalization.
Granted, there are many confounders in this study and a randomized trial (which is supposedly in the works) will give us far more insight into the incremental gains here. The data also has yet to be formally published.
That being said, it intuitively should make sense how an app could be useful here. Patients are often given plans for exercises and other activities outside their scheduled sessions and to continue after they are discharged from therapy. Apps offer a lot of potential uses here including:
- Just-in-time support to encourage execution of personalized plans
- Improved tracking to enable more effective follow up
- Potential mechanism for remote monitoring and support
- Integration with social media to help engage friends and family
- More robust options for delivering ongoing education
Furthermore, the embedded functionality of mobile devices offers interesting opportunities for more sophisticated rehabilitation programs. The data captured by the iPhone’s M7 coprocessor and other devices with similar functionality gives a great deal of insight into the activity level of an individual – distance travelled, speed, and more. Apps using the smartphone camera can capture everything from heart rate, respiratory rate, and even oxygen saturation.
For patients undergoing pulmonary or cardiac rehabilitation, such physiologic data may have a great deal of utility in crafting really effective remote programs. Some researchers are also exploring use of the camera in assessing joint range of motion, which may have applications in the rehabilitation of patients after a variety of orthopedic surgeries.
In addition, the explosion in wearable sensors and the low-power connectivity options now available may offer yet more options for capturing useful data that can be rolled into remote, individualized, and patient-driven rehabilitation programs. For example, consider a patient with a stroke causing significant left upper extremity weakness. It’s well recognized that early rehabilitation can improve the degree of functional recovery – perhaps with a smart watch on the left arm, one could design an effective app that helps patients push their rehabilitation efforts just a little harder.
As with much of mobile health, there is a great deal of potential here – the actual combinations of physiologic data captured by smartphones or wearables and app features that will lead to measurable benefits remains to be seen.