Objective activity tracking in spine surgery: a prospective feasibility study with a low-cost consumer grade wearable accelerometer

Abstract

patient-reported outcome measures (pRoMs) are commonly used to estimate disability of patients with spinal degenerative disease. emerging technological advances present an opportunity to provide objective measurements of activity. In a prospective, observational study we utilized a lowcost consumer grade wearable accelerometer (LCA) to determine patient activity (steps per day) preoperatively (baseline) and up to one year (Y1) after cervical and lumbar spine surgery. We studied 30 patients (46.7% male; mean age 57 years; 70% Caucasian) with a baseline activity level of 5624 steps per day. The activity level decreased by 71% in the 1 st postoperative week (p < 0.001) and remained 37% lower in the 2 nd (p < 0.001) and 23% lower in the 4 th week (p = 0.015). At no time point until Y1 did patients increase their activity level, compared to baseline. Activity was greater in patients with cervical, as compared to patients with lumbar spine disease. Age, sex, ethnic group, anesthesia risk score and fusion were variables associated with activity. there was no correlation between activity and PROMs, but a strong correlation with depression. Determining activity using LCAs provides real-time and longitudinal information about patient mobility and return of function. Recovery took place over the first eight postoperative weeks, with subtle improvement afterwards.

Subjective and Objective Measures of Symptoms, Function, and Outcome in Patients With Degenerative Spine Disease

“…In addition, generic outcome measures (that are not disease‐specific instruments for spinal pathologies), such as the Patient‐Reported Outcome Measurement Information System measures, or HRQOL measures, such as the SF‐12/SF‐36 or the EQ‐5D, have been extensively reviewed in the literature elsewhere . Other objective measures of function that exceed the scope of this paper but are systematically reviewed elsewhere include the SPWT, the 6‐minute walking test (6WT), the five‐repetition sit‐to‐stand test, the shuttle walking test, and the Short Physical Performance Battery besides step counters .…”

“…Regarding the evaluation of pain/disability over time, a baseline assessment, followed by 3‐month and 12‐month follow‐up assessments after the initiation of treatment appears reasonable. Recent research indicates that most functional recovery after surgery can be expected within 8 to 12 weeks .…”

“…The broader availability of modern technologies such as smartphones or wearable devices with global positioning systems (GPS), combined with patient demand for a more personalized and transparent care, drive the trend to construct detailed, accurate, and intelligible medical profiles based on objective activity data . Tests such as the TUG test, the MTT, or the SPWT are already established and validated objective outcome measures used in spine care and research and can complement PROMs and add a further dimension to an in‐depth patient evaluation.…”

“…Apart from subjective PROMs, objective measures of function are gaining increasing attention in spine research and have found their way into clinical practice . Measurements like the Timed Up‐and‐Go (TUG) test and the motorized treadmill test (MTT) assess a patient's objective functional impairment (OFI) and add a new dimension to the comprehensive patient evaluation .…”

Non-Surgical Interventions for Lumbar Spinal Stenosis Leading To Neurogenic Claudication: A Clinical Practice Guideline

“…84 Sedentary and nutrition lifestyle modification for patients with limited walking ability and overweight or obese individuals with related comorbidities may include low-cost wearable accelerometer or pedometer-based physical activity promotion, nutrition education by a dietitian, and advice from an exercise physiologist over a 12-week intervention. 77,131,136 In a pilot trial, participants logged on to the e-health Web site to access personal step goals, nutrition education videos, and a discussion board. 136 Despite the benefits of physical activity for reducing the risk of chronic health conditions, only 32% of clinicians advise older adult patients to begin or continue to do exercise or physical activity during office visits.…”