Objective evaluation of postoperative changes in real-life activity levels in the postoperative course of lumbar spinal surgery using wearable trackers

Abstract

Background: Lumbar spinal disease causes disabilities in performing daily activities. Operative treatments are aimed at pain relief and rapid return to routine activity. Patient-based outcome measures are used to evaluate pathologies and therapeutic effects associated with lumbar spinal disease. Nevertheless, it remains unknown as to how much such treatment improves activity levels. The purpose of the current study was to measure changes in activity levels before and after lumbar spinal surgery using a wearable activity tracker and to analyze the differences between results and patient-based outcomes. Methods: Sixty patients who underwent lumbar surgery were studied. The physical activity of participants was objectively evaluated using a wearable Micro-Motion logger system (Actigraph). We measured the amount of activity before and at 1, 3, 6, and 12 months after the surgery to evaluate postoperative changes. The Japanese Orthopaedic Association Back Pain Evaluation Questionnaire, Oswestry Disability Index, Roland-Morris Disability Questionnaire and visual analog scale were used to assess patient-based outcomes of pain and activities of daily living-related scores; we analyzed the relationships between scores and actual activity levels. Results: The amount of actual activity decreased significantly 1 month after the surgery compared to that during the preoperative period, which then improved after 3 months postoperatively (p < 0.01). Furthermore, there was a significant improvement 6 months after the surgery compared to that during the preoperative period (p < 0.05). The changes in activity for each period were strongly correlated, regardless of the period. In contrast, a significant improvement was observed at 1 month after the surgery in almost all items of the patient-based questionnaires (p < 0.05). Conclusions: The objective activity tracker demonstrated that lumbar surgery results in the amount of activity decreasing 1 month just after surgery followed by gradual postoperative recovery within 3 months. By contrast, patient-based outcomes showed improvement in 1 month that was significantly different from the change in actual activity, indicating a gap between patient-oriented clinical scores and their actual activities.

Early postoperative physical activity and function: a descriptive case series study of 53 patients after lumbar spine surgery

“…One potential explanation for differences in objectively-measured physical activity levels may relate to the geographic region (i.e., culture) and sample characteristics. The patients in the current study were younger and had a slightly higher and more variable BMI than the sample by Schulte et al [22], and had higher BMI than the sample by Inoue et al [60]. The variability in BMI could be an influential factor in why we observed low values of physical activity.…”

“…There are a few studies describing physical activity after lumbar spine surgery [ 21 – 23 , 60 , 61 ]. Rolving et al [ 61 ] examined patient-reported physical activity using the Physical Activity Scale in patients 1 year after lumbar spine surgery and found patients reported a moderate level of physical activity based on self-report of activity time.…”

“…At the 3-month time point, Schulte et al [ 22 ] reported patients achieved an average of 4145 gait cycles per day, which is approximately a two-fold higher physical activity level compared to the current study (i.e., 1 gait cycle = 2 steps). A study conducted in Japan by Inoue et al [ 60 ] found that the activity counts increased at 3-, 6- and 12-months following spine surgery compared to the preoperative time point. One potential explanation for differences in objectively-measured physical activity levels may relate to the geographic region (i.e., culture) and sample characteristics.…”

“…Another reason for physical activity differences across studies could be due to the monitoring devices and location of placement. Schulte et al [ 22 ] used a StepWatch monitor worn on the ankle, Inoue et al [ 60 ] used an Actigraph monitor worn on the wrist, and the current study used an Actigraph monitor worn around the hip. Previous studies in older adults have shown that wrist [ 63 ] and ankle [ 64 ] worn monitors may count more steps compared to hip worn monitors.…”

Functional recovery after discharge in enhanced recovery video‐assisted thoracoscopic lobectomy: a pilot prospective cohort study

“…However, at present, the majority of these outcomes are assessed by self-reporting scales, which may be subject to patient bias [4,7]. Recently, assessment using wearable monitors has been demonstrated to improve the accuracy of patient reporting [8][9][10][11][12][13][14][15]. To the best of our knowledge, no procedure-specific evidence exists on post-discharge functional recovery after VATS lobectomy within an effective ERAS protocol using objective monitoring combined with patient-reported outcomes.…”