Smartphone-based real-life activity data for physical performance outcome in comparison to conventional subjective and objective outcome measures after degenerative lumbar spine surgery

Voglis, Stefanos; Ziga, Michal; Zeitlberger, Anna Maria; Sosnova, Marketa; Bozinov, Oliver; Regli, Luca; Bellut, David; Weyerbrock, Astrid; Stienen, Martin N.; Maldaner, Nicolai

doi:10.1016/j.bas.2022.100881

Cited by 13 publications

(13 citation statements)

References 17 publications

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“…Studies to date have focused on prolonged perioperative activity monitoring as a way of objectively measuring surgical outcomes. 11,12,14,15 These efforts have typically used activity data from smartphones or, rarely, participants' own wearable trackers. 13 Although such efforts have clear value, the prognostic importance of isolated preoperative activity measures and their use in guiding perioperative interventions remain unknown.…”

Section: Discussionmentioning

confidence: 99%

“…3,[21][22][23] In recent years, several groups have used accelerometer data to measure patient activity as a tool for quantifying objective changes after surgery. 11,12,14,15 By comparison, we have focused on investigating a rigorous, multimodal, multidimensional preoperative protocol that may predict surgical outcome and guide perioperative treatments, such as psychosocial interventions and targeted prehabilitation. 24 This study reports the feasibility and acceptability of this novel assessment.…”

Section: Discussionmentioning

confidence: 99%

“…This study also has limitations. First, although our sample size was larger than most previous mHealth studies in spine surgery patients, 11,12,14 we only enrolled patients from a single center, and these participants were primarily White and non-Hispanic. Likewise, we only enrolled 23% of participants meeting inclusion criteria, which may suggest challenges with broader clinical…”

Section: Limitationsmentioning

confidence: 99%

“…To date, most mHealth studies in spine surgery patients have focused on using activity to objectively measure surgical outcome. [11][12][13][14][15] Nonetheless, growing evidence suggests that the relationship between activity and pain is variable across patients, 16 and it is unknown whether preoperative activity levels alone significantly predict surgical outcome. Consequently, a more personalized approach that integrates physiological, functional, and patientreported data may more effectively predict surgical outcome and guide perioperative management.…”

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confidence: 99%

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Feasibility and Acceptability of a Preoperative Multimodal Mobile Health Assessment in Spine Surgery Candidates

et al. 2022

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BACKGROUND: Rapid growth in smartphone use has expanded opportunities to use mobile health (mHealth) technology to collect real-time patient-reported and objective biometric data. These data may have important implication for personalized treatments of degenerative spine disease. However, no large-scale study has examined the feasibility and acceptability of these methods in spine surgery patients. OBJECTIVE: To evaluate the feasibility and acceptability of a multimodal preoperative mHealth assessment in patients with degenerative spine disease. METHODS: Adults undergoing elective spine surgery were provided with Fitbit trackers and sent preoperative ecological momentary assessments (EMAs) assessing pain, disability, mood, and catastrophizing 5 times daily for 3 weeks. Objective adherence rates and a subjective acceptability survey were used to evaluate feasibility of these methods. RESULTS: The 77 included participants completed an average of 82 EMAs each, with an average completion rate of 86%. Younger age and chronic pulmonary disease were significantly associated with lower EMA adherence. Seventy-two (93%) participants completed Fitbit monitoring and wore the Fitbits for an average of 247 hours each. On average, participants wore the Fitbits for at least 12 hours per day for 15 days. Only worse mood scores were independently associated with lower Fitbit adherence. Most participants endorsed positive experiences with the study protocol, including 91% who said they would be willing to complete EMAs to improve their preoperative surgical guidance. CONCLUSION: Spine fusion candidates successfully completed a preoperative multimodal mHealth assessment with high acceptability. The intensive longitudinal data collected may provide new insights that improve patient selection and treatment guidance.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Limitationsmentioning

confidence: 99%

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confidence: 99%

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Feasibility and Acceptability of a Preoperative Multimodal Mobile Health Assessment in Spine Surgery Candidates

et al. 2022

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“…18 This great leap in data granularity can be used to establish digital activity biomarkers that may lead the way for more precise diagnostics, as well as targeted interventions, in the future. 19,20 Early experience with accelerometers has indicated that reported pain and functional impairment of patients with DTD may, in fact, result in decreased objective physical activity as demonstrated by recovery/improvement after spine intervention. 6,7,20 However, while an increase in step counts of patients with DTD after treatment suggests a baseline deterioration in physical activity, this has not been reported to date.…”

Section: Understanding the Impact Of Dtd On Baseline Physical Activitymentioning

confidence: 99%

Standardizing Physical Activity Monitoring in Patients With Degenerative Lumbar Disorders

Maldaner,

Tang,

Fatemi

et al. 2023

Neurosurgery

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BACKGROUND AND OBJECTIVES: Degenerative thoracolumbar disorders (DTDs) typically cause pain and functional impairment. However, little is known regarding the DTD impact on patient's real-life physical activity. The objective of this study is to validate a wearable measure of physical activity monitoring in patients with DTD and to create gender- and sex-specific performance thresholds that are standardized to the mean of a control population. METHODS: A commercially available smartwatch (Apple Watch) was used to monitor preoperative physical activity in patients undergoing surgery for DTD. Mean preoperative physical activity 2 weeks before the scheduled surgery was expressed as raw step count. Standardized z-scores were referenced to age- and sex-specific values of a control population from a large public database. Step counts were assessed for convergent validity with established patient-reported outcome measures, and impairment in activity was stratified into performance groups based on z-score cutoff values. RESULTS: Sixty-five patients (62% female) with a mean (±SD) age of 63.8 (±12.8) years had a mean preoperative daily step count of 5556 (±3978). Physical activity showed significant correlation with patient-reported outcome measures, including Oswestry disability index (r = −0.26, 95% CI: −0.47-0.01), 36-Item Short Form Survey Physical Component Summary score (r = 0.30, 95% CI: 0.06-0.51), and Patient-Reported Outcomes Measurement Information System Physical Function (r = 0.49, 95% CI: 0.27-0.65). “No,” “Mild,” “moderate,” and “severe impairment” in activity performance were defined as corresponding z-scores of >0, 0 to −0.99, −1 to −1.99, and ≤−2, accounting for 22%, 34%, 40%, and 5% of the study population. Each one-step category increase in activity impairment resulted in increased subjective disability as measured by the Oswestry Disability Index, 36-Item Short Form Survey Physical Component Summary, and Patient-Reported Outcomes Measurement Information System Physical Function (all P-values <.05). CONCLUSION: We establish the first wearable objective measure of real-life physical activity for patients with DTD, with the first age- and sex-adjusted standard scores to enable clinicians and researchers to set treatment goals and directly compare activity levels between individual patients with DTD and normal controls.

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Spine patient care with wearable medical technology: state-of-the-art, opportunities, and challenges: a systematic review

et al. 2023

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Smartphone-based real-life activity data for physical performance outcome in comparison to conventional subjective and objective outcome measures after degenerative lumbar spine surgery

Cited by 13 publications

References 17 publications

Feasibility and Acceptability of a Preoperative Multimodal Mobile Health Assessment in Spine Surgery Candidates

Feasibility and Acceptability of a Preoperative Multimodal Mobile Health Assessment in Spine Surgery Candidates

Standardizing Physical Activity Monitoring in Patients With Degenerative Lumbar Disorders

Spine patient care with wearable medical technology: state-of-the-art, opportunities, and challenges: a systematic review

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