New technology and the future of detecting health and disease
In the United States we have one of the highest health care expenditures globally, without the concomitant results in health status to show for it.
The U.S. consumes around $350 billion per year with direct health care costs and associated loss of productivity. From 1996-2016, the U.S. went from $1.4 trillion to $3.1 trillion in health care associated costs — that’s 17.9% of the GDP (Dieleman, et al., 2020). The many factors of this issue are beyond our scope here, but there are some things we, in conservative care, can do to help the situation.
Comorbidities and chief complaints
First off, some of the costliest conditions fall under our scope of practice and are conditions we manage in our practices daily.
Low-back and neck pain was number one in health care costs with $134.5 billion per year; number two was other musculoskeletal conditions and pain at $129.8 billion; and number three was diabetes at $111.2 billion. A significant percentage of these costs are due to chronic issues derived from acute problems that were left unresolved.
Second is that there is a high rate of comorbidities with many patients who enter our clinics. The percentage of adults in English-speaking areas is >1 comorbidity for 67-72% of females and 59-64% of males, respectively (NowaKowska, et al., 2019). Often, they may not be a diagnosed problem that is being managed. These comorbidities may have an impact on success in treating the actual chief complaint or become a major problem on their own in the future.
With the high rate of existing comorbidities, mental health issues continue to rise, in addition to the associated cost and negative influences. In the United States, sedentarism is close to 60%, obesity is 42% and prediabetes is over 50%, with diagnosed diabetes as high as 30% in some demographics.
Dysfunctional movement at the source
What is the ultimate goal in conservative physical medicine and rehabilitation? The quick reflex response is, “to get people out of pain.” However, that’s not the actual answer.
Patients enter our clinics often with a chief complaint of pain; however, on further analysis it’s due to dysfunctional movement or limitation. People often remain in pain for months or even years prior to seeking assistance from a health care professional. And we could be at fault for using that as a main criterion for resolution and subsequent discharge from care.
Pain has evolved into a prognostic indicator when it’s really one of several symptoms of a problem. Therefore, the mere absence of pain is not consistent with performance-based or functional resolution. For example, waiting for pain to be the indicator of dysfunction in the cardiovascular system and subsequent management to only reduce pain as a considered successful treatment could be fatal.
Early evaluation and intervention
Early evaluation is not a new concept in health and medicine and includes such basics as measuring vital signs (measures of essential bodily functions) to determine disruption of homeostasis, indicative of a disorder if not disease.
There are other tests proven to be efficacious for this very reason, to include colon, prostate, breast, etc.; however, we lack musculoskeletal screening beyond adolescent scoliosis. Most musculoskeletal conditions may not be fatal but do impact quality of life, and lack of appropriate function can cause a reduction in other disease-fighting interventions.
For example, not being able to meet minimum mobility standards, let alone exercise, results in earlier death and reduces disease-fighting opportunity, respectively. In addition, as previously mentioned, these musculoskeletal conditions are also major consumptions of health care dollars.
For example, in low-back pain there have been several papers on “naturally occurring” degenerative spinal presentations associated with age, most recently Paranteau, et al. (2021). Consistently, the term “asymptomatic” is used as a criterion to match various markers such as age, weight, etc., to degeneration and most often determine it (spinal degeneration) increases with age. Again, because we are using “asymptomatic” as a criterion for not being pathological is referring to the absence of pain, we are missing certain prediction opportunities. Ironically, people can even experience pain without correlation to their degree of spinal degeneration, including number of segments involved.
Further considering comorbidities
Although most patients enter our system due to the perception of pain, we must further consider the impact of comorbidities.
For example, having diabetes mellitus is strongly associated with neurovascular and neurodegenerative disease (Pugazhenthi, 2017). Both result in dysfunctional movement, although likely not the standard limitation of movement that most consider the result of pain. However, these movement dysfunctions can improve our overall evaluation of the patient as a whole, something many of us attempt to provide to patients.
Movement disturbances may in fact provide earlier evidence of cognitive decline even before typical cognitive tests (Morris, 2017). Even if we are not able to slow the progression of certain diseases, we may decrease risk associated with other comorbidities, or at-risk events such as falls in the elderly.
Reducing health care costs
Conservative early intervention is not only associated with costing less in health care dollars (this includes out-of-pocket expenses as well) but can have long-term, multi-system impact. Early intervention has shown not only improved results with fewer and later visits, but overall lowered heath care costs (Rogerson, 2010).
However, early intervention is the key to minimizing a condition from becoming a chronic issue that is not only more challenging to manage but also costs considerably more than its acute counterparts; for example, acute versus chronic low-back pain. Early intervention can also result in fewer invasive procedures such as joint replacements, a considerable health care cost with a predicted exponential rise for the future (Chen, 2019).
It’s more than just early intervention, however. It must also include early prediction of a potential problem. Evidence-based practitioners struggle with this concept, and for good reason. Many of our associations/correlations have come from more linear analysis research, which also comes from linearity in how we collect information on variables.
For example: simply defining progression of a condition based on its difference from the normative value of whatever metric is being used, such as a pain scale in musculoskeletal or blood glucose levels in diabetes. Although important measures, on their own they are not completely predictive nor prognostic.
Early prediction and technology
With advances in technology, we have experienced a new era of assessment, bringing in artificial intelligence and machine learning algorithm development in creating more robust ways to collect and assess data.
For example, even how a person walks is a very nonlinear process with the interaction of the various body systems involved and how they function. We now know early prediction is not only possible, but that early prediction of conditions results in reducing progression of more serious pathologies (Wu, 2022). Global movement analysis for early detection of many conditions we manage can be the precursor to deciding on further investigation of negative outcomes.
With today’s technology, this ability is now accessible to us in the clinic and can be accomplished in just a few minutes. The best part is, this is our endgame: helping patients move better and treating the whole person to reduce risk of disease. They may initially come to the clinic for a chronic condition, but they stay because they feel healthier.
CHRISTOPHER M. PROULX, DC, PhD(abd), CSCS, is director of education at DIGITSOLE. Learn more at digitsole.com.