Machine learning–augmented objective functional testing in the degenerative spine: quantifying impairment using patient-specific five-repetition sit-to-stand assessment

Abstract

OBJECTIVE What is considered “abnormal” in clinical testing is typically defined by simple thresholds derived from normative data. For instance, when testing using the five-repetition sit-to-stand (5R-STS) test, the upper limit of normal (ULN) from a population of spine-healthy volunteers (10.5 seconds) is used to identify objective functional impairment (OFI), but this fails to consider different properties of individuals (e.g., taller and shorter, older and younger). Therefore, the authors developed a personalized testing strategy to quantify patient-specific OFI using machine learning. METHODS Patients with disc herniation, spinal stenosis, spondylolisthesis, or discogenic chronic low-back pain and a population of spine-healthy volunteers, from two prospective studies, were included. A machine learning model was trained on normative data to predict personalized “expected” test times and their confidence intervals and ULNs (99th percentiles) based on simple demographics. OFI was defined as a test time greater than the personalized ULN. OFI was categorized into types 1 to 3 based on a clustering algorithm. A web app was developed to deploy the model clinically. RESULTS Overall, 288 patients and 129 spine-healthy individuals were included. The model predicted “expected” test times with a mean absolute error of 1.18 (95% CI 1.13–1.21) seconds and R2 of 0.37 (95% CI 0.34–0.41). Based on the implemented personalized testing strategy, 191 patients (66.3%) exhibited OFI. Type 1, 2, and 3 impairments were seen in 64 (33.5%), 91 (47.6%), and 36 (18.8%) patients, respectively. Increasing detected levels of OFI were associated with statistically significant increases in subjective functional impairment, extreme anxiety and depression symptoms, being bedridden, extreme pain or discomfort, inability to carry out activities of daily living, and a limited ability to work. CONCLUSIONS In the era of “precision medicine,” simple population-based thresholds may eventually not be adequate to monitor quality and safety in neurosurgery. Individualized assessment integrating machine learning techniques provides more detailed and objective clinical assessment. The personalized testing strategy demonstrated concurrent validity with quality-of-life measures, and the freely accessible web app (https://neurosurgery.shinyapps.io/5RSTS/) enabled clinical application.

An update on animal models of intervertebral disc degeneration and low back pain: Exploring the potential of artificial intelligence to improve research analysis and development of prospective therapeutics

“…MRIs in this dataset can be automatically measured and manually checked with Image J 264–266 . Integrating machine learning techniques have been developed to provide detailed and objective clinical assessments of IVDD effects on patient mobility 267 . The five‐repetition sit‐to‐stand (5R‐STS) test is an objective tool for the testing of everyday flexibility and muscular co‐ordination in spinal movements and has found application in the evaluation of the validity and reliability of the 5R‐STS test in patients with degenerative pathologies of the lumbar spine and functional impairment induced by IVDD 268 …”

“…[264][265][266] Integrating machine learning techniques have been developed to provide detailed and objective clinical assessments of IVDD effects on patient mobility. 267 The fiverepetition sit-to-stand (5R-STS) test is an objective tool for the testing of everyday flexibility and muscular co-ordination in spinal movements and has found application in the evaluation of the validity and reliability of the 5R-STS test in patients with degenerative pathologies of the lumbar spine and functional impairment induced by IVDD. 268 Modic changes (MCs) are used to describe MRI signal intensity changes in vertebrae and correlated with disease pathology in degenerative spinal disorders.…”