Digital Rehabilitation

More than 100 million people in Europe suffer from chronic musculoskeletal disorders such as rheumatoid arthritis, chronic neck and lumbar pain. For many patients, however, standard rehabilitation protocols are costly and ineffective, and some rehabilitation programs are not followed consistently. Up to 80% of patients abandon treatment prematurely, increasing the likelihood of relapse.

Digital Rehabilitation and Chronic Lower Back Pain

Despite recent developments in the diagnosis and treatment of chronic musculoskeletal diseases, chronic low back pain, the burden of the disease for patients and the healthcare system still remains high. Chronic low back pain, for example, is not only the leading cause of years spent in disability globally, but has a one-month prevalence of around 30% of the global population. The vast majority of patients suffer from non-specific chronic low back pain rather than with an identifiable cause that is treatable with specific treatment.

Recently, treatment paradigms have shifted from a purely somatic disease concept of chronic low back pain towards a bio-psycho-social model, a more comprehensive approach that encompasses somatic aspects and psychological and environmental factors.

The current treatment of chronic low back pain in primary and secondary medicine is often limited to a mono-causal somatic approach. Multidisciplinary pain treatment, a combined program that includes educational, physical and psychological interventions, has been shown to be effective in the treatment of chronic low back pain with positive effects on pain level, function and other outcome parameters, including the quality of life. As such, multidisciplinary pain management is part of the recommendations for the treatment of chronic low back pain in several international guidelines.

Multidisciplinary programs are relatively expensive and limited to specialized centers, which limits their use. Only recently, digital and mobile health interventions have emerged as new treatment options for non-drug interventions of various pathological conditions. Guidelines for mHealth app development are under development and rapid progress requires constant adjustments in structure, composition and content. Especially in chronic conditions, which require adequate self-management strategies for optimal treatment outcomes, mobile or web-based solutions show great potential and sometimes even more desirable outcomes than current, often standard drug therapies.

Various solutions, both mHealth or web-based, have been designed for the self-management of chronic lower back pain; however, only a few of them have undergone prospective clinical trials. Recent reviews have identified relevant clinical studies presenting a wide variety of different approaches, many of them based on cognitive behavioral strategies. Due to the heterogeneity of the included interventions and the primary endpoints, authors have found the inconclusiveevidences. The clinical standard of chronic low back pain treatment considers physical activity and activation.

Recent evaluations of commercially available applications have revealed that the vast majority of applications available in the app stores are not based on scientific verification.

Recent rehabilitation guidelines

The most recent studies in the field of neuroscience lead to a progressive evolution of the rehabilitation proposal, taking into consideration the subject as a whole. This vision is well compatible with the virtual environments created for this new type of interactive game; in fact, during play activities, the required performances do not concern only a gesture, but an integrated function in a target context (the whole body is involved in achieving a goal).

This is well highlighted eg. from studies in which brain activity is monitored and recorded during the execution of a functional performance.

Rehabilitation has also developed new tools to act through, borrowing different technologies, from electro-medical equipment for physical therapies to assistive robots such as exoskeletons.

The use of virtual reality in rehabilitation treatment protocols is increasingly present with very positive studies and results, even in rehabilitation therapy in some types of neuromotor deficits.

More than anything else, tools for motion analysis have been developed. For the latter, the usedtechnologies are several and always constantly updated; from laboratories equipped with optoelectronic systems to posturometric platforms. One of these technologies, which in recent years is experiencing maximum development and diffusion: inertial sensors.

These sensors exploit the inertia of a mass contained within them to measure linear accelerations (accelerometers, with inertia to linear motion) or angular velocities (gyroscopes, with inertia to angular motion).

To provide useful data about the positions and angles of an object in space, accelerometers and gyroscopes work together in what is called the inertial platform, also integrated by a magnetometer, a sensor that provides more precise data regarding orientation in space. This type of sensor is widely used in the most varied fields, from navigation systems to motion capture, (in the world of cinema it is used, for example, for the creation of 3D animations).

Their use has also been extended to the biomedical field to carry out movement analysis, from widespread gait analysis to complex sport-specific movements. Since this instrumentation allows to collect an enormous amount of data and parameters on kinematics, which is useful in the study and analysis of different motor and neuromotor disorders, we wondered how it is possible to use this category of tools within a rehabilitation project relevance could have such application.