Designing a Sustainable in-Clinic Protocol to Expand Postural Stability Data Collection

Purpose: Assessing postural stability may help to predict fall risk and aid in understanding underlying mechanisms of injuries due to falls. Several studies have compared postural stability in different populations of patients; however, the age, gender, race, health conditions, and the number of participants were limited. To answer clinical questions on the relationship between postural stability and fall risk, it is necessary to expand the dataset by including minority and vulnerable populations. The objective of this study is to design a sustainable clinic research data collection protocol to better understand fall risk in the diverse minority populations surrounding the HSC community and provide clinicians with sway information on their patients. Methods: Sustainable data collection protocol: Third-year medical students rotating in OMM clinic collected sway data for one half day during their month-long rotation. Data collectors were presented a video demo of the protocol and a didactic video on balance and falls before collecting data. Medical assistants in the clinic brought patients to students before the appointment time or when the patient's physician was seeing another patient, to avoid delays in clinic schedule. The total time for data collection is approximately two minutes. Postural sway data: Postural sway was evaluated in patients seen in the Osteopathic Manipulated Medicine (OMM) clinic at the University of North Texas Health Science Center between 6/7/2021 and 12/21/2021. Patients who were cane or wheelchair-dependent and children less than 65 lbs. were excluded. Patients took off their shoes and put on shoe covers. Patients then stood on footprints attached to the Bertec Force Plate (Bertec Columbus, Ohio). Patients were asked to stand straight, hands by their sides, body facing toward and looking at a target in front of them for 10 seconds with their eyes open. The same procedure was repeated with their eyes closed. Three trials of each condition were performed. A rest period of three seconds took place between each trial. Measurements of Mean Center of Gravity Sway Velocity were collected. Postural sway data was retrospectively analyzed from the clinic data collection (UNTHSC IRB# 2013-102). Results: 701 postural sway measurements were collected on a total of 511 patients between 06/07/2021 and 12/21/2021. Conclusion: As a result of creating a sustainable data collecting model by incorporating third-year medical students in their rotations as data collectors, 701 postural sway measurements were obtained in approximately seven months. This achievement was possible due to the continuous improvement of the protocol with the collaboration of clinic staff and physicians to ensure data collection incorporates smoothly into the natural flow of the clinic. Future steps: One next step is to allow treatment providers secure access to their patient's data so they can discuss changes in sway during clinic visits. Another is to partner with artificial intelligence experts to form algorithms to analyze the data on diverse patient populations to assist clinicians in clinical assessments/treatments and possibly provide fall prediction alerts.