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Tell us more about yourself and the author team
My name is Alexandra (Alex) DeJong Lempke, and I am currently a clinical assistant professor at the University of Michigan. I completed my PhD in Kinesiology – Sports Medicine at the University of Virginia in 2021 under the advisement of Dr. Jay Hertel, studying running-related injuries using wearable technology. I was so fortunate to work with an outstanding team of undergraduate research assistants, doctoral students, Physical Medicine & Rehabilitation physicians, statisticians, and other faculty in Kinesiology (reflected in my author team) to complete my dissertation projects and other studies throughout my four years.
What is the story behind your study?
I based this study on the first paper that emanated from my dissertation work. My first study assessed runners with exercise-related lower leg pain (ERLLP, or in lay terms, “shin splints”) compared to uninjured runners during typical bouts of outdoor running using lightweight wearable technology capable of measuring running biomechanics. I worked with doctoral students and faculty in data science to use machine learning to identify apparent differences in running biomechanics between runners with ERLLP and uninjured runners. We found that runners with ERLLP had increased and more variable ground contact time measures compared to healthy runners. Given this finding, I knew that I wanted to expand upon this work and develop an outdoor gait-training program for runners with ERLLP to see if we could improve their injury outcomes. My hope was that by meeting patients in their natural training environments and intervening in their biomechanical movement patterns, we would be able to reduce the injury burden and lead to long-term recovery. I continued to work with the data science team to develop a program linking the wearable technology to a wristwatch to provide runners with feedback when they exceeded a contact time threshold. We set the threshold to be specific to each runner by aiming to decrease their contact time by 5% over the course of the study based on our initial research. Using this vibration feedback, runners would be able to adjust their biomechanics while running outdoors and advance gait-training interventions for injured runners. The ultimate study design was a randomised controlled trial in which runners with ERLLP were randomly allocated into a 4-week feedback group with home exercises or home exercises alone to determine the effects of outdoor gait training to adjust contact time beyond the standard of care.
In your own words, what did you find?
We found that the outdoor wearable sensor gait-training approach successfully reduced runners’ contact time compared to baseline and the home exercise group. More importantly, we identified that this intervention led to more favourable patient-reported outcome measures for these injured runners. By adjusting their running biomechanics in natural settings, runners were able to reduce their pain and increase their perceived function to the point where they would no longer be classified as having ERLLP. This was a very rewarding finding, demonstrating the promise of this objective outdoor gait-training approach to advance the clinical care of injured runners.
What was the main challenge you faced in your study?
Given that this study launched in February 2020, the largest challenge that we faced during data collection was the COVID-19 pandemic. Unfortunately, this limited our data collection window and the number of participants that we were reasonably able to include in our study. However, our outdoor gait training and home exercise approach ended up being an extremely favourable means to deliver rehabilitation, given that this limited the amount of indoor, in-person contact with participants throughout the study.
If there is one take-home message from your study, what would that be?
This study highlights the importance of generating intervention programs directly geared towards patient needs and sports environments. While there are inherent challenges to moving outside of the laboratory to conduct assessments and interventions, this approach allows researchers to determine a greater depth and breadth of patient information to improve clinical approaches to care. Our findings support this notion, as we identified and were able to intervene in movement patterns that have not previously been identified in laboratory spaces. Overall, I think the advent and advancements in wearable technology will continue to change the approach to patient management and care, and clinicians and researchers should capitalize on these opportunities to meet patients on their “home turf.”