KneeKG assessment systems in Halifax, Dartmouth, Cape Breton and the Annapolis Valley will help identify which knee osteoarthritis patients to refer to surgery and who to refer to physiotherapy. The system will also indicate which exercises are optimal for stabilizing joint function— to delay or avoid the need for surgery and/or improve surgery’s results.
Putting proven tools in place to manage joint problems, cut surgery waitlists
Nova Scotians with severe hip and knee pain will receive more timely care, customized to their needs, with the rollout of a suite of new technologies across the province this year.
“This is the culmination of five years of clinical studies to validate the effectiveness of these tools,” said Dr. Michael Dunbar, orthopedic surgeon and leader of the Atlantic Canada Opportunities Agency-funded project first announced in 2014 as Mobility@CapitalHealth.
New ACOA funding of $2 million announced in 2019 is supporting NSHA to determine exactly what needs to be done to integrate the now-proven tools into patient care province-wide.
The project is a partnership between NSHA, ACOA and three private firms: Emovi, makers of KneeKG, a knee-assessment system that analyzes the 3-D structure and function of the knee in motion; OrthoMX, a local company that developed InStride, a smartphone app that tracks and analyzes walking patterns (gait); and another Halifax firm, Kinduct Technologies, whose Kinduct Clinic web portal grants patients access to their own orthopedics records, gait analysis and KneeKG reports, customized exercise plans and instructions.
“These tools work together to give patients the opportunity to play a more active role in their own care, relieve the burden of unnecessary travel, and provide faster access to the most appropriate interventions,” noted Dr. Dunbar. “KneeKG, for example, allows us to evaluate if a person with osteoarthritis of the knee needs to see a surgeon urgently or if targeted physiotherapy exercises will improve joint function, relieve pain and reduce the urgency of the need to see a surgeon. This alone will take enormous pressure off wait times for surgery consults and joint replacement surgeries.”
“These tools work together to give patients the opportunity to play a more active role in their care, relieve the burden of unnecessary travel.”
After surgery, patients will use InStride to capture information about their walking patterns on their phones and send it directly to their surgery team.
“Their gait patterns can tell us if something is not going as expected after surgery,” noted Dr. Dunbar. “If it’s a risk, they will need to come in for an appointment. If not, they may be able to avoid an unnecessary trip to Halifax.”
Nova Scotia is the first province in Canada to test, and adopt, such an integrated set of tools for assessing and monitoring patients from a distance.
New remote technologies protect patients' hearts
By Melanie Jollymore
NSHA researchers are leading the way to keeping patients with cardiac arrhythmias safe. Many of these patients receive implantable defibrillators that monitor their heart rhythm patterns and correct any irregularities by setting a steady pace or sending a shock to the heart. But, as cardiologist Dr. Ratika Parkash explains, as many as 18 per cent of Nova Scotians with ventricular tachycardia (the most life-threatening arrhythmia) refuse the device because they would need to travel a long distance to Halifax for regular device check-ups that ensure their safety.
“The trip to Halifax to have the defibrillator checked is too costly and time-consuming for some patients…they opt out even though it puts them at higher risk of dying,” said Dr. Parkash. “That’s why we are developing and testing methods of monitoring the function of the devices from a distance.”
The problem is not confined to Nova Scotia alone. In fact, Dr. Parkash is heading an 18-centre, Canada-wide study to test a remote technology that allows patients to plug their defibrillator into a wall outlet, through which it transmits information about its own function to their device clinics (if there are any problems, the patient must bring in the device for servicing). The researchers are also testing a web-based app called VIRTUES (Virtual Integrated Reliable Transformative User-driven E-health System) in partnership with the Cardiac Arrhythmia Network (CANet) that allows clinic staff to send personalized information directly to patients about their devices and how they’re helping them. A $25,000 grant from the NSHA Research Fund has allowed Dr. Parkash to team up with Kinduct, a Halifax-based health technology firm. Together they’re developing and testing Kinduct AF and Kardiomobile, a platform for monitoring and educating people with atrial fibrillation, an arrhythmia of the heart’s upper chambers.
“When they have symptoms, patients put their finger on a wireless pad that is essentially a single-lead ECG,” Dr. Parkash explains. “This interacts with an app that gathers the heart rhythm data, puts it into a PDF and sends it to the patient’s phone along with personalized advice through the Kinduct AF platform about what to do. Patients can also use the app to message their health care providers.”
The new technologies are already making an impact, even in the testing stage.
“We’re getting very positive feedback from patients,” Dr. Parkash says. “We’re doing a massive overhaul of the follow-up system, putting more power and information in patients’ and providers’ hands and connecting them for easier, more effective information exchange.”