It’s time to make an introduction between two groups of people who ought to get along very well. Physiotherapists, athletic trainers, occupational therapists- I’d like to formally introduce you to the Quantified Self movement, which could help solve of the hardest problems you collectively deal with. Quantified Self thinkers and entrepreneurs, I’d like you to meet your biggest challenge so far- how to transform the rehabilitation community for the better, and make a significant positive difference in patients’ lives.
The problem: rehab is hard.
People get injured every day. They hurt their backs, hurt their shoulders and hurt their knees. Thankfully, many of these injuries are minor setbacks that don’t require any major health care intervention. But a lot of them don’t get better, and without proper intervention a one-time injury can deteriorate into chronic disability. The role of the rehabilitation professional- whether a physiotherapist, occupational therapist, athletic trainer, or anyone else who works in the field- is to prevent this decline and restore the patient to healthy, normal functioning. Rehab isn’t the most glamorous part of health care, but it’s one of the most important.
Although patients’ injuries certainly count as physical problems (a strained back, a sprained ankle, a torn ligament), their rehabilitation and recovery is just as much a psychological challenge as it is a physical one. The way patients think and feel about their injury and pain is critical to how it affects them and how they approach recovery. Overcoming chronic pain, in particular, can depend as much or more on psychological and environmental circumstances than physical ones. Dr. Geoff Dover, a professor of rehabilitation science and athletic therapist at Concordia University (and collaborator with us on Backtrack) explains,
“Recent research suggests that pain related fear can impact rehabilitation of chronic pain. Catastrophizing and fear avoidance beliefs can predict how long someone will miss work or how long they will take to rehabilitate an injury.”
Catastrophizing and fear-avoidance beliefs are two of the most prominent and studied barriers to clinical rehabilitation. Both of them are psychological obstacles having to do with how the patient perceives their injury, their pain and their recovery- essentially independently of the injury itself. If patients perceive their injuries and pain as overwhelming, excessively severe or ‘permanently’ injured, it’s much more difficult for them to take an active role in their recovery- and are more likely to lapse into long-term disability. This can be immensely frustrating for the patient and for their health care team. The rehabilitation community urgently needs a new approach to this problem, and I’m optimistic that a solution might be right around the corner.
Quantified Self: a movement in search of problems to solve.
Over the last five years, there’s been an explosion of popular interest in a new idea with powerful implications: What if we measured everything about ourselves? This idea- now known as The Quantified Self– stems from the basic philosophy that if you want to improve something, first you need to be able to measure its performance. Real-world applications are not hard to find- Toyota’s famous Kaizen philosophy, training plans for athletes, and effective study guides for the SAT all readily demonstrate how important it is to take good measurements, and take them often. This approach has been zealously embraced by the growing wearable computing sector, and a surge of consumer activity-tracking and life-tracking devices has hit the market in the past few years. Amidst all of this excitement, though, it’s worth asking: what more should we be doing with Quantified Self? Where can it make a difference? Helping people stay fit is certainly an important pursuit, but there must be more we can do with this new technology and new approach.
Let’s go back to this TED talk from 2010, when Wired editor Gary Wolf talks about where he thinks the movement is going and what it is for:
“What is this for? What should it be for?”
Gary hits the nail on the head, distilling what QS has to offer down to this:
“If we want to act more effectively in the world, we have to get to know ourselves better.”
A simple extension of that thought: for the Quantified Self approach to be useful and continue to expand its footprint, we need to search for problems relating to problematic perceptions that can be addressed through continuous measurement and good data-keeping.
This is precisely what we need in the rehabilitation community. The classic psychological barriers to recovery- fear avoidance behaviour and catastrophizing- are fundamentally problems of perception. When a patient with back pain restricts their activity out of fear of re-injury, it is because they perceive their pain as an inevitable consequence of movement. When a patient with good odds of making a complete recovery becomes demoralized and gives up a return to full health, it is because do not perceive they have made any progress with their rehabilitation. These are problems that continuous measurement, good data, and meaningful feedback can solve. What the rehab community needs are tools to help patients take active roles in their own recovery by making it easier for them to break through false perceptions of their injuries, pain and recovery. That has Quantified Self written all over it. (It’s also what we’re trying to accomplish with Backtrack, to help patients recover from back pain more effectively- if you haven’t already guessed.)
The good news is that you can already find examples of these ideas being tested in the real world. Quite a few startups have sprung up over the last few years that hope to bring Quantified Self into the rehabilitation world. Jintronix, a Montreal-based startup, brings an inspiring story and a novel approach to motion recovery after stroke. Lumo Bodytech has introduced the LumoBack and LumoLift, two ingenious little devices to help people maintain better posture through data and feedback. We still don’t have anything that helps to track movement and pain during recovery, but Backtrack is working on it (and I’m sure we’re not the only ones). We’re starting to see Top 10 iPad apps for PTs lists, and although there haven’t been any great Quantified Self applications there quite yet, it’s only a matter of time.
Even more encouragingly, we can see signs that patients, physiotherapists and the rehabilitation community are primed for a Quantified Self revolution. Standards of care for other chronic conditions have been completely transformed in the past decade thanks to effective home tracking. In diabetes care, for instance, home glucose monitors have become an indispensable tool for home management, and the growing community of health care developers have written APIs and other add-on tools to track, display and use patient data even more effectively.
So now that you’re introduced, let’s start innovating. Let’s solve some big problems together.