New motion capture screening technology could slow progression of arthritis

Most people don’t think about their thumbs very often. But for people living with advancing arthritis, the simplest thumb movements—from grasping a cup to sending a text message—can be painful and incredibly challenging.

That’s why Michigan State University researchers set out to see if they could use motion capture technology to screen for differences between healthy hand movements and those in patients with osteoarthritis, or OA. This method could potentially detect arthritis earlier, possibly delaying and preventing the loss of thumb function. In turn, that could save arthritis patients from surgery and even being forced into assisted living.

The team’s research is published in Clinical Biomechanics.

“Our work suggests that three-dimensional motion tasks may be able to identify OA-associated motion deficits earlier than the two-dimensional motion tasks typically used in a clinical setting,” said Amber Vocelle, co-author on the research and a DO/Ph.D. student in the College of Osteopathic Medicine. “By identifying the disease earlier, we can treat OA earlier in the disease process.”

According to Vocelle, therapists and clinicians traditionally use goniometers, simple two-dimensional measurement tools, along with basic movements to screen for reduced hand function due to OA. But the results can vary depending on who’s doing the measuring, making it hard to track reliably over time.

“There are pieces of information that aren’t being gathered right now that could be useful for early prediction of OA of the thumb, or setting up thresholds to define when people should consider doing therapy before they’re in severe pain,” said Tamara Reid Bush, an associate professor of mechanical engineering in the College of Engineering who also worked on the research.

In contrast, motion capture technology records precise, objective measurements in three dimensions.

Both Bush and Vocelle, along with Gail Shafer, an assistant professor in the College of Human Medicine, put markers on participants’ hands, which were then monitored by motion capture technology as they went through a series of three-dimensional thumb movements. Differences between healthy and OA-diagnosed patients were observed.

The thumb isn’t usually looked at in isolation with reference to OA, but this research may be changing that.

“Thumbs aren’t just important for people playing the piano or knitting for fun. Almost everything you do on a daily basis involves the thumb in some way, shape or form,” Bush added.

Forthcoming research from the trio will look at how a six-week thumb exercise protocol impacted the ability to generate forces with the thumb. The researchers observed an increase in thumb strength in just two weeks.

So where could this go next? One avenue would be to develop tools for conducting these three-dimensional measurements in-clinic without the need for laboratory-grade motion capture devices. That would give therapists the ability to not only evaluate more complex movement patterns for earlier diagnosis, but also measure the impact of treatment for better outcomes.

This type of collaboration between research specialties can be difficult to pull off, but Vocelle’s rotations as part of her DO/Ph.D. program presented a meaningful opportunity for integration. The three combined Vocelle’s clinical knowledge, Shafer’s rehabilitation expertise, and Bush’s deep understanding of biomechanics to offer a fresh perspective on a long-standing clinical problem.

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Emergency departments slow to adopt proven opioid use disorder therapy

A new study by Yale researchers looking at nearly 400 clinicians at four urban academic emergency departments found that, despite scientific evidence supporting the benefits of buprenorphine for opioid use disorder, just 21% of emergency department clinicians indicated readiness to offer it to patients in need.

The study, which appears in the May 11 issue of JAMA Network Open, involved emergency departments at Mt. Sinai Hospital in Manhattan, the Johns Hopkins Hospital in Baltimore, Harborview Medical Center in Seattle, and University of Cincinnati Medial Center.

The study is the first installment in Project ED Health, an implementation study funded by the National Institute on Drug Abuse Clinical Trials Network to support strategies for increasing buprenorphine prescriptions in emergency departments. Buprenorphine, a partial opioid agonist—a drug that activates opioid receptors in the brain to a lesser degree than oxycodone and morphine—is safe to administer, relieves withdrawal symptoms, and can prevent overdose, according to years of established medical research. An implementation study reveals barriers to adopting research findings.

Project ED Health is led by two Yale physician-researchers, Dr. Gail D’Onofrio, professor and chair of the department of emergency medicine and Dr. David Fiellin, professor of internal medicine and director of the Yale Program in Addiction Medicine.

“This study provides a baseline evaluation of what care emergency departments are providing to patients with opioid use disorder,” said lead author Dr. Kathryn Hawk, assistant professor in emergency medicine and attending physician in the Yale New Haven Hospital Emergency Department.

Despite barriers, clinicians are willing to give buprenorphine to patients in the emergency department, provided that they receive sufficient support and training, the study found.

“The willingness of emergency department providers to take on a new treatment is changing drastically,” said Hawk.

Researchers conducted the study between April 2018 and January 2019. A team of addiction medicine physicians met with providers at the hospitals, including doctors, advance practice providers (APPs), and emergency medicine residents. Providers participated in a web-based anonymous survey that collected data about their demographics, training, experiences with ED-initiated buprenorphine, and readiness to administer buprenorphine for opioid use disorder on a scale of one to 10. Providers then rated their work culture, clinical experience, and perceived patient needs. Later, the study team ran focus groups to better understand factors impacting buprenorphine prescribing in the ED.

The researchers found that barriers to providing buprenorphine included lack of formal training, limitations on time, limited knowledge of local treatment resources, absence of local protocols and referral networks, and perceptions that initiating buprenorphine therapy falls outside the scope and practice of emergency medicine.

One resident physician quoted in the study said: “Trying to suss out which of those patients might be appropriate for initiating some therapy and which aren’t is a skill that I don’t have. I don’t think that it’s a skill that we’re necessarily being trained for right now.”

There was also confusion about required waivers. Just 3% of providers interviewed had DATA 2000 (x-waiver) training for buprenorphine. Providers need the waiver, which requires eight hours of approved training for physicians and 24 hours for APPs, to write a prescription for buprenorphine to be filed at a pharmacy. Emergency providers can give buprenorphine in the ED without the special waiver, said Hawk, but added that they “needed clarification around what they can and can’t do.”

Historically, emergency departments have not been thought of as places where patients are treated for opioid use disorder, she said. Typically, those patients were referred to outpatient clinics for treatment.

“The opioid epidemic has really changed that,” Hawk said.

In 2015, Yale researchers published a landmark study in JAMA that found that patients admitted to emergency departments for opioid use disorder who were treated with buprenorphine along with medical management in primary care were twice as likely than patients not given buprenorphine to remain in addiction treatment one month later.

“The big message of that study was that initiating treatment in the ED setting was very effective,” said D’Onofrio, “but true adoption lagged. So now we’re trying to understand why that is, and how we can improve implementation of this best practice.”

This latest study found that in order to improve adoption of ED-initiated buprenorphine there needs to be more education and training, established protocols, and enhanced communication across different stakeholder groups.

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