By Andrea Tiwari
Breakthroughs in health technologies are coming at us fast and furious. Innovative medicines show promise for many diseases, and cutting edge diagnostic tools and procedures are changing how we treat a range of conditions.
For guidance on how to prepare for health technologies that may disrupt the status quo, governments, health care organizations, clinicians, and patients turn to CADTH – an independent, not-for-profit agency that delivers unbiased evidence on drugs and medical devices.
So, according to CADTH, what innovations should we watch for in the year ahead?
Same-day total hip replacement
Total hip replacement is a common surgical procedure where the damaged hip joint is replaced with an artificial joint to help reduce pain and disability for people living with conditions like osteoarthritis. It’s major surgery and typically requires a hospital stay of several days, but could a new approach see patients come into the hospital for their operation and be discharged on the same day?
Successful outpatient total hip replacement requires a combination of factors. Patients must be carefully selected and have adequate home support in place. Pain management and anesthesia techniques are very important, including preventative pain relief and the minimal use of narcotics. And, minimally invasive surgical techniques are used to limit muscle damage and blood loss.
Studies on the procedure indicate that it’s safe and effective. The evidence also shows that the outpatient approach results in high levels of patient function and satisfaction, as well as decreased health care costs. However, we need more studies that include a broader range of patients (beyond younger, thinner, and healthier individuals). These types of studies are now underway, along with studies of outpatient knee replacement.
Across Canada, a few centres have performed the same-day procedure, including some in Quebec and Ontario. Given the growing demand for total hip replacement, the possibility of giving patients better outcomes, minimizing hospital stays, and reducing costs is appealing.
GPS locator devices for people with dementia
Many families of individuals living with dementia have experienced the frantic search for a loved one who has wandered away, knowing he or she can’t find their way home. But now, the GPS technology found in our cars and smartphone apps is being applied in new ways to help locate loved ones with dementia who wander, while also allowing them more independence.
GPS locator devices use a transmitter that sends a signal to a network of telecommunications satellites, which then relay the signal through mobile phone networks to a caregiver’s computer or mobile device, or to a call centre. A transmitter can be installed in items like wristbands, pendants, or even in shoes.
The Alberta Locator Device project is a recent Canadian study which concluded that locator devices should be a standard option for home care services and should be provided to people at an earlier stage of dementia so they can participate in deciding whether they wish to use the technology.
Because these assistive devices are a form of surveillance, their use raises important legal and ethical questions, but with more than half a million Canadians living with dementia and that number expected to more than double over the next 20 years, this technology may be an important tool to increase the independence of people with dementia and reduce the anxiety of caregivers.
Robotic exoskeletons for spinal cord injuries
Emerging technologies are one of the most powerful forces that can improve the lives of people living with a spinal cord injury. In particular, the development of robotic exoskeletons is giving some patients with paralysis the chance to stand, sit, walk, turn, and even take the stairs again.
Robotic exoskeletons are supportive, brace-like orthotics that are worn external to the body and support the legs and part of the upper body. Sensors detect shifts in weight and changes in the centre of gravity, and then generate pre-set movements in each leg that result in stepping.
Several studies on these powered exoskeletons have been published, assessing the training patients need to use the device, as well as an individual’s ability to perform skills such as starting and stopping movement, walking on uneven surfaces, and navigating things like electric doors and elevators.
Powered exoskeletons are expensive and they aren’t yet widely used, but some models can be found in centres across Canada, including facilities in Alberta, Nova Scotia, British Columbia, and Ontario. Before these devices gain widespread use, we need more evidence to help us understand where they fit in the rehabilitation continuum of care, how long the device can be worn comfortably, and which patients are most likely to benefit from the technology.
An implant to treat opioid addiction
Canada is now the world’s second largest per capita consumer of prescription opioids, and growing rates of addiction, overdoses, and deaths are just a few of the consequences stemming from our opioid crisis.
But an emerging technology in the form of an implant placed underneath the skin may offer a new treatment option for certain people coping with opioid addiction.
The Probuphine implant, the first of its kind, uses four rods placed underneath the skin on the upper-arm to deliver a constant, non-fluctuating dose of the drug buprenorphine, for up to six months at a time. The implant is inserted by a health care professional who has been specially trained to perform the procedure. It’s intended for patients who have achieved sustained and prolonged ‘clinical stability’ on low-to-moderate doses of the same medication, but taken in the form of a pill or a film that dissolves in the mouth.
The implant is not yet approved for sale in Canada, but when it arrives it will likely attract significant attention, given the collective efforts of governments and health care providers to increase patient access to safe and effective treatment options.
While the Probuphine implant may offer a novel opportunity to help patients who have hard time sticking with a daily medication, it’s not currently recommended for more than two 6-month treatment cycles and its use is limited to only those patients who are considered to be ‘clinically stable’ on other buprenorphine-containing drugs. And important questions still remain about the use of this drug in a wider population, its use beyond one year, and whether it’s cost-effective compared to other treatments that are currently available.
New devices to prevent positional obstructive sleep apnea
People living with obstructive sleep apnea (OSA) know that this chronic condition can wreak havoc on sleep, health, and overall quality of life.
OSA is a serious disorder that occurs when a person’s breathing stops and starts periodically while they sleep. The condition robs people of the restful sleep they need and can lead to serious complications such as fatigue, high blood pressure, diabetes, heart attacks, and strokes. For patients who stop breathing more often while on their backs, the disorder is known as positional OSA.
Positional therapy can sometimes help treat OSA by using simple things like a tennis ball or foam wedge to prevent a person from rolling onto their back while sleeping. But these solutions are uncomfortable, leading many patients to eventually abandon them. Recently, more advanced products have come to market, including devices that are worn on the back of the neck or across the chest. The devices use sensors to detect sleeping positions and they vibrate to discourage back-sleeping. They also come with computer software that analyzes the progress of the treatment.
The goal of all OSA treatments is to reduce the number of sleep interruptions (where breathing stops or is restricted) and alleviate other symptoms. The evidence for positional sleep devices suggests that they are effective at reducing the frequency of these interruptions, but it’s unclear whether they improve outcomes like daytime sleepiness.
CADTH Horizon Scanning
Every year health care organizations and governments are inundated with information about new health technologies touted as ‘game-changers’. How do they separate fact from fiction, so they can focus their scarce resources on proven innovations that will bring real benefits to patients?
That’s where CADTH comes in. Through a service called Horizon Scanning, CADTH works to identify technologies that could significantly impact Canadian health care. In particular, there is a focus on the emerging technologies that may prove to be safe and effective, deliver value for money, and align with the unmet needs of patients.
If you’d like to learn more about the technologies featured in this story, visit www.cadth.ca/horizonscanning. We offer detailed reports that assess and summarize information such as scientific evidence, regulatory status, potential costs, and implementation issues. And watch for new reports coming soon — topics include mobile stroke units and patient-controlled tissue expansion.
Andrea Tiwari is a communications officer at CADTH.