Wearable technologies promise to redefine assessment of health behaviors, yet their clinical implementation remains a challenge. To address this gap, two of the NIH’s Big Data to Knowledge Centers of Excellence organized a workshop on potential clinical applications of wearables. A workgroup comprised of 14 stakeholders from diverse backgrounds (hospital administration, clinical medicine, academia, insurance, and the commercial device industry) discussed two successful digital health interventions that involve wearables to identify common features responsible for their success. Seven features were identified including: a clearly defined problem, integration into a system of healthcare delivery, technology support, personalized experience, focus on end-user experience, alignment with reimbursement models, and inclusion of clinician champions. Health providers and systems keen to establish new models of care inclusive of wearables may consider these features during program design. A better understanding of these features is necessary to guide future clinical applications of wearable technology.

Habitual gait speed (HGS) and the figure-of-8 walking test (F8WT) are measures of walking ability that have been associated with mobility outcomes and disability among older adults. Our objective was to contrast the physiologic, health, and behavioral attributes underlying performance of these two walking tests among older adults with mobility limitations. HGS and F8WT were the primary outcomes. HGS was measured as time needed to walk a 4-m straight course at usual pace from standstill position. F8WT was measured as time to walk in a figure-of-8 pattern at self-selected usual pace from standstill position. Separate multivariable linear regression models were constructed that predicted walking performance. Independent variables included physiologic, cognitive–behavioral health attributes, and demographic information. Of 430 participants, 414 completed both walking tests. Participants were 67.7% female, had a mean age of 76.5±7.0 years and a mean of 4.1±2.0 chronic conditions. Mean HGS was 0.94±0.23 m/s and mean F8WT was 8.80±2.90 seconds. Within separate multivariable linear regression models (HGS: R² = .46, p_model < .001; F8WT: R² = .47, p_model < .001), attributes statistically significant within both models included: trunk extension endurance, ankle range of motion, leg press velocity at peak power, executive function, and sensory loss. Cognitive and physiologic attributes uniquely associated with F8WT were cognitive processing speed and self-efficacy, and reaction time and heel-to-floor time. Pain and peak leg press strength were associated with only HGS. Both HGS and F8WT are useful tests of walking performance. Factors uniquely associated with F8WT suggest that it may be well suited for use among older adult patients with balance problems or at risk for falls.

Context: Carpal tunnel syndrome (CTS) is the most frequent peripheral compression-induced neuropathy observed in patients worldwide. Surgery is necessary when conservative treatments fail and severe symptoms persist. Traditional Open carpal tunnel release (OCTR) with visualization of carpal tunnel is considered the gold standard for decompression. However, Endoscopic carpal tunnel release (ECTR), a less invasive technique than OCTR is emerging as a standard of care in recent years. Evidence Acquisition: Criteria for this systematic review were derived from Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Two review authors searched PubMed, MEDLINE, and the Cochrane Database in May 2018 using the following MeSH terms from 1993-2016: ‘carpal tunnel syndrome,’ ‘median nerve neuropathy,’ ‘endoscopic carpal tunnel release,’ ‘endoscopic surgery,’ ‘open carpal tunnel release,’ ‘open surgery,’ and ‘carpal tunnel surgery.’ Additional sources, including Google Scholar, were added. Also, based on bibliographies and consultation with experts, appropriate publications were identified. The primary outcome measure was pain relief. Results: For this analysis, 27 studies met inclusion criteria. Results indicate that ECTR produced superior post-operative pain outcomes during short-term follow-up. Of the studies meeting inclusion criteria for this analysis, 17 studies evaluated pain as a primary or secondary outcome, and 15 studies evaluated pain, pillar tenderness, or incision tenderness at short-term follow-up. Most studies employed a VAS for assessment, and the majority reported superior short-term pain outcomes following ECTR at intervals ranging from one hour up to 12 weeks. Several additional studies reported equivalent pain outcomes at short-term follow-up as early as one week. No study reported inferior short-term pain outcomes following ECTR. Conclusions: ECTR and OCTR produce satisfactory results in pain relief, symptom resolution, patient satisfaction, time to return to work, and adverse events. There is a growing body of evidence favoring the endoscopic technique for pain relief, functional outcomes, and satisfaction, at least in the early post-operative period, even if this difference disappears over time. Several studies have demonstrated a quicker return to work and activities of daily living with the endoscopic technique.

Objective: The purpose of this review is to critically appraise the literature for evidence supporting the health care resource utilization and cost-effectiveness of spinal cord stimulation (SCS) compared with conventional therapies (CTs) for chronic low back and leg pain. Methods: The PubMed, MEDLINE, Embase, CINAHL, and Rehabilitation & Sports Medicine databases were searched for studies published from January 2008 through October 2018, using the following MeSH terms: “spinal cord stimulation,” “chronic pain,” “back pain,” “patient readmission,” “economics,” and “costs and cost analysis.” Additional sources were added based on bibliographies and consultation with experts. The following data were extracted and analyzed: demographic information, study design, objectives, sample sizes, outcome measures, SCS indications, complications, costs, readmissions, and resource utilization data. Results: Of 204 studies screened, 11 studies met inclusion criteria, representing 31,439 SCS patients and 299,182 CT patients. The mean age was 53.5 years for SCS and 55.6 years for CT. In eight of 11 studies, SCS was associated with favorable outcomes and found to be more cost-effective than CT for chronic low back pain. Compared with CT, SCS resulted in shorter hospital stays and lower complication rates and health care costs at 90 days. SCS was associated with significant improvement in health-related quality of life, health status, and quality-adjusted life-years. Conclusions: For the treatment of chronic low back and leg pain, the majority of studies are of fair quality, with level 3 or 4 evidence in support of SCS as potentially more cost-effective than CT, with less resource expenditure but higher complication rates. SCS therapy may yet play a role in mitigating the financial burden associated with chronic low back and leg pain.