Rheumatology & Neurology

Using digital health to monitor podiatric pain progression

940 Words
8 min. reading time

Dr Andrea Coda is a senior podiatry lecturer who is passionate about paediatric and digital health. He is the clinical course coordinator and former program convenor (Research Honors, Central Coast Campus) at the College of Health, Medicine and Wellbeing (University of Newcastle, Australia). Andrea is also a senior member of the Priority Research Centre for Health Behaviour at the Hunter Medical Research Institute. In 2018, he was appointed conjoint senior lecturer from the University of Manresa-Barcelona (Spain).

Dr Andrea Coda discusses the intersection between digital health and pain management.

Pain is a complex and multifactorial phenomenon that can negatively impact a patient’s health-related quality of life.

What do we know already?

When it comes to the complex topic of pain, as podiatrists we understand the following:

Pain is a complex and multifactorial phenomenon that can negatively impact a patient’s health-related quality of life.
Pain outcome measures are commonly used to assess the severity of symptoms in children, adolescents, and adults.
Traditionally, symptom progression has been recorded using the visual analog scale (VAS), Wong Baker scale, numeric rating scale, verbal rating scale, and faces pain scale-revised.
These tools have been extensively validated as appropriate measures for assessing pain and are commonly used daily by podiatrists and other allied health professionals (AHPs).

Yet there are accompanying challenges

Evidence suggests there are limitations associated with the more traditional paper pain outcome measures that are still commonly used in various clinical settings.

Drawn face scales may result in incorrect recordings if a child experiences difficulty in distinguishing between the feeling of pain and the emotional state. Smiling faces can also result in overestimation of pain intensity.

These limitations are mostly based on paper pain scales being cumbersome, occasionally complex to use, and at risk of possible practitioner error.

Mobile health enters the picture

The continuous growth of mobile health (mHealth) offers unparalleled opportunities for podiatrists to address issues related to health systems and accessing accurate, reliable, and frequent health data. For example:

The introduction of smart technology in paediatric and adult pain evaluation may offer opportunities to implement tailored pain assessments within different podiatric clinical settings.
Recently, novel technologies have emerged that utilise smart devices to improve the existing traditional pain outcome measures. Yet few of these novel technologies have been examined for reliability and validity among children, adolescents, and adults, with most employing small sample sizes.

There is growing evidence to suggest that electronic pain outcome measures are interchangeable with existing traditional pain outcome measures, but more mHealth and eHealth research is needed to test the validity and reliability of the electronic VAS (eVAS) among children and adolescents.

By evaluating the validity of mHealth and eHealth interventions available to patients and clinicians, we can equip AHPs with a more effective tool to measure symptom progression.

Novel mHealth tools, such as the eVAS app, may make the work of podiatrists even more efficient and increase reliability during their clinical assessments.

Clinical implications: in summary

The growing use of digital health has the potential to improve pain management.
eHealth and mHealth may have the ability to improve adherence to pain reporting, allow real-time data capture, and improve communication between podiatrists and patients.

What we need to remember

Space matters: For podiatrists and researchers (especially those involved in the community) the time, cost, and space savings of data storage using the eVAS may be considerable. This is when compared with the traditional pVAS (where manual transcription into clinical notes is required).

The eVAS app allows for automatic calculation of the VAS score, preventing possible human errors while using a ruler.

Variables exist: Patients may also draw multiple lines on the pVAS or use inappropriate pens or thick highlighters. This can become confusing for podiatrists to thoroughly interpret and record the intended results.

Tools help: A recent scoping review of systematic reviews highlighted that mHealth and hand-held electronic devices allow for accurate and complete medical documentation. This provides instant access to reliable health data that may support clinical decision making. Novel mHealth tools, such as the eVAS app, may make the work of podiatrist even more efficient and increase reliability during their clinical assessments.

eVAS can minimise error: For podiatrists and researchers, especially those involved in the community, the time, cost, and space savings of data storage using the eVAS may be considerable when compared with the traditional pVAS, where manual transcription into clinical notes is required. eVAS app allows for automatic calculation of the VAS score, preventing possible human errors while using a ruler.

It is important that modern digital health technologies adhere to the standards of digital health interventions set by the World Health Organization (WHO) in 2016, and the Australian Government Health Authorities’ guidelines with regard to how to validate new digital mHealth systems for the benefit of patients, clinicians, and the community. These include:

monitoring and evaluating linear stages of development from prototype through to pilot studies showing efficacy
demonstration of effectiveness
scaling up, and integration into the clinical environment.

If promptly introduced within different paediatric and adult pain clinic services, the eVAS may support early pain detection, preventing incidences of unnecessary prolonged pain, with a consequent improvement in the patient’s quality of life.

More on the eVAS app

It can benefit patients in remote areas or who are immobile: The eVAS app allows for the objective monitoring and recording of patients’ pain levels. This mHealth tool might become advantageous for those patients living in geographically remote areas, where limited access to specialists is apparent. Patients and parents/caregivers may not always be required to visit the hospital, consequently saving the time and money required to travel long distances from rural areas. If promptly introduced within different paediatric and adult pain clinic services, the eVAS may support early pain detection, preventing incidences of unnecessary prolonged pain, with a consequent improvement in the patient’s quality of life. This improved podiatric management of pain may also lead to a reduction in absence from school or work.

It can collect useful patient data: The eVAS app may also be capable of recording the time and day when the measures are taken. This important feature could be integrated within clinical settings and automatically reported within patient clinical records to highlight any diurnal variation in pain perception. Notably, this functionality may provide greater understanding for podiatrists of the complex nature of pain in response to environmental conditions or treatment plans.