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Staartjes VE, Klukowska AM, Stumpo V, Vandertop WP, Schröder ML. Identifying clusters of objective functional impairment in patients with degenerative lumbar spinal disease using unsupervised learning. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:1320-1331. [PMID: 38127138 DOI: 10.1007/s00586-023-08070-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 10/22/2023] [Accepted: 11/27/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVES The five-repetition sit-to-stand (5R-STS) test was designed to capture objective functional impairment (OFI), and thus provides an adjunctive dimension in patient assessment. It is conceivable that there are different subsets of patients with OFI and degenerative lumbar disease. We aim to identify clusters of objectively functionally impaired individuals based on 5R-STS and unsupervised machine learning (ML). METHODS Data from two prospective cohort studies on patients with surgery for degenerative lumbar disease and 5R-STS times of ≥ 10.5 s-indicating presence of OFI. K-means clustering-an unsupervised ML algorithm-was applied to identify clusters of OFI. Cluster hallmarks were then identified using descriptive and inferential statistical analyses. RESULTS We included 173 patients (mean age [standard deviation]: 46.7 [12.7] years, 45% male) and identified three types of OFI. OFI Type 1 (57 pts., 32.9%), Type 2 (81 pts., 46.8%), and Type 3 (35 pts., 20.2%) exhibited mean 5R-STS test times of 14.0 (3.2), 14.5 (3.3), and 27.1 (4.4) seconds, respectively. The grades of OFI according to the validated baseline severity stratification of the 5R-STS increased significantly with each OFI type, as did extreme anxiety and depression symptoms, issues with mobility and daily activities. Types 1 and 2 are characterized by mild to moderate OFI-with female gender, lower body mass index, and less smokers as Type I hallmarks. CONCLUSIONS Unsupervised learning techniques identified three distinct clusters of patients with OFI that may represent a more holistic clinical classification of patients with OFI than test-time stratifications alone, by accounting for individual patient characteristics.
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Affiliation(s)
- Victor E Staartjes
- Machine Intelligence in Clinical Neuroscience (MICN) Laboratory, Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland.
- Amsterdam UMC, Vrije Universiteit Amsterdam, Neurosurgery, Amsterdam Movement Sciences, Amsterdam, The Netherlands.
- Department of Neurosurgery, Bergman Clinics, Amsterdam, The Netherlands.
| | - Anita M Klukowska
- Amsterdam UMC, Vrije Universiteit Amsterdam, Neurosurgery, Amsterdam Movement Sciences, Amsterdam, The Netherlands
- Department of Neurosurgery, Bergman Clinics, Amsterdam, The Netherlands
- Department of Surgery, Royal Derby Hospital, Derby, UK
| | - Vittorio Stumpo
- Machine Intelligence in Clinical Neuroscience (MICN) Laboratory, Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
| | - W Peter Vandertop
- Amsterdam UMC, Vrije Universiteit Amsterdam, Neurosurgery, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Marc L Schröder
- Department of Neurosurgery, Bergman Clinics, Amsterdam, The Netherlands
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Cramer H. Ask the Expert: A Recap on Patient-Reported Outcomes. JOURNAL OF INTEGRATIVE AND COMPLEMENTARY MEDICINE 2024; 30:207-208. [PMID: 38484316 DOI: 10.1089/jicm.2024.29129.editorial] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Affiliation(s)
- Holger Cramer
- Institute of General Practice and Interprofessional Care, University Hospital Tübingen, Tübingen, Germany
- Robert Bosch Center for Integrative Medicine and Health, Bosch Health Campus, Stuttgart, Germany
- Editor-in-Chief
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Hayat J, Ramadhan M, Gonnah AR, Alfadhli A, Al-Naseem AO. The Role of Mobile Health Technology in Perioperative Spinal Care: A Systematic Scoping Review and Narrative Synthesis. Cureus 2024; 16:e54254. [PMID: 38496189 PMCID: PMC10944329 DOI: 10.7759/cureus.54254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2024] [Indexed: 03/19/2024] Open
Abstract
Smartphone applications play a crucial role in contemporary healthcare by aiming to enhance patient care through technology. Mobile health (mHealth) applications have proven to have transformative potential in enhancing patients' outcomes in candidates undergoing orthopedic and spinal surgery. In the context of the pervasive use of smartphones and the exponential growth of mHealth apps, totaling over 99,000 in 2021, the applications had a significant impact on lifestyle management, supporting initiatives like smoking cessation with motivational reminders and progress tracking. Patient compliance is significantly enhanced, reducing surgery cancellations and improving outcomes through effective adherence to pre-operative treatments and instructions. Physiotherapy receives a substantial boost as mHealth facilitates video-guided exercises, potentially improving compliance and treatment outcomes. Data collection takes on innovative dimensions, with mHealth apps capturing post-operative metrics like physical activity, offering valuable insights into patient recovery trends. Remote care is streamlined through features like photo uploads and direct messaging, proving especially beneficial in times of crises such as the COVID-19 pandemic. Despite these merits, challenges emerge, including issues related to technological literacy, potential discrimination due to paywalls, and concerns about patient data confidentiality. Overcoming these challenges requires standardized approaches, legislative measures, and ongoing research to refine and optimize mHealth applications for diverse healthcare settings.
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Affiliation(s)
- Jafar Hayat
- General Surgery, Sheikh Jaber Al-Ahmad Al-Sabah Hospital, Kuwait City, KWT
| | - Mohammed Ramadhan
- General Surgery, Sheikh Jaber Al-Ahmad Al-Sabah Hospital, Kuwait City, KWT
- Medicine, Ministry of Health, Kuwait, Hawally, KWT
- School of Medical Sciences, The University of Manchester, Manchester, GBR
| | - Ahmed R Gonnah
- Medicine, Imperial College Healthcare NHS Trust, London, GBR
| | - Alwaleed Alfadhli
- Faculty of Medicine, Royal College of Surgeons in Ireland, Dublin, IRL
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Bi CL, Kurland DB, Ber R, Kondziolka D, Lau D, Pacione D, Frempong-Boadu A, Laufer I, Oermann EK. Digital Biomarkers and the Evolution of Spine Care Outcomes Measures: Smartphones and Wearables. Neurosurgery 2023; 93:745-754. [PMID: 37246874 DOI: 10.1227/neu.0000000000002519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 03/19/2023] [Indexed: 05/30/2023] Open
Abstract
Over the past generation, outcome measures in spine care have evolved from a reliance on clinician-reported assessment toward recognizing the importance of the patient's perspective and the wide incorporation of patient-reported outcomes (PROs). While patient-reported outcomes are now considered an integral component of outcomes assessments, they cannot wholly capture the state of a patient's functionality. There is a clear need for quantitative and objective patient-centered outcome measures. The pervasiveness of smartphones and wearable devices in modern society, which passively collect data related to health, has ushered in a new era of spine care outcome measurement. The patterns emerging from these data, so-called "digital biomarkers," can accurately describe characteristics of a patient's health, disease, or recovery state. Broadly, the spine care community has thus far concentrated on digital biomarkers related to mobility, although the researcher's toolkit is anticipated to expand in concert with advancements in technology. In this review of the nascent literature, we describe the evolution of spine care outcome measurements, outline how digital biomarkers can supplement current clinician-driven and patient-driven measures, appraise the present and future of the field in the modern era, as well as discuss present limitations and areas for further study, with a focus on smartphones (see Supplemental Digital Content , http://links.lww.com/NEU/D809 , for a similar appraisal of wearable devices).
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Affiliation(s)
- Christina L Bi
- Department of Neurological Surgery, New York University, New York , New York , USA
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Shen J, Nemani VM, Leveque JC, Sethi R. Personalized Medicine in Orthopaedic Surgery: The Case of Spine Surgery. J Am Acad Orthop Surg 2023; 31:901-907. [PMID: 37040614 DOI: 10.5435/jaaos-d-22-00789] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 03/01/2023] [Indexed: 04/13/2023] Open
Abstract
Personalized medicine has made a tremendous impact on patient care. Although initially, it revolutionized pharmaceutical development and targeted therapies in oncology, it has also made an important impact in orthopaedic surgery. The field of spine surgery highlights the effect of personalized medicine because the improved understanding of spinal pathologies and technological innovations has made personalized medicine a key component of patient care. There is evidence for several of these advancements to support their usage in improving patient care. Proper understanding of normative spinal alignment and surgical planning software has enabled surgeons to predict postoperative alignment accurately. Furthermore, 3D printing technologies have demonstrated the ability to improve pedicle screw placement accuracy compared with free-hand techniques. Patient-specific, precontoured rods have shown improved biomechanical properties, which reduces the risk of postoperative rod fractures. Moreover, approaches such as multidisciplinary evaluations tailored to specific patient needs have demonstrated the ability to decrease complications. Personalized medicine has shown the ability to improve care in all phases of surgical management, and several of these approaches are now readily available to orthopaedic surgeons.
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Affiliation(s)
- Jesse Shen
- From the Department of Orthopedic Surgery, Université de Montréal (Shen), the Virginia Mason Medical Center (Nemani, Leveque, and Sethi), University of Washington (Sethi)
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Haddas R, Lawlor M, Moghadam E, Fields A, Wood A. Spine patient care with wearable medical technology: state-of-the-art, opportunities, and challenges: a systematic review. Spine J 2023; 23:929-944. [PMID: 36893918 DOI: 10.1016/j.spinee.2023.02.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 02/27/2023] [Accepted: 02/27/2023] [Indexed: 03/11/2023]
Abstract
BACKGROUND CONTEXT Healthcare reforms that demand quantitative outcomes and technical innovations have emphasized the use of Disability and Functional Outcome Measurements (DFOMs) to spinal conditions and interventions. Virtual healthcare has become increasingly important following the COVID-19 pandemic and wearable medical devices have proven to be a useful adjunct. Thus, given the advancement of wearable technology, broad adoption of commercial devices (ie, smartwatches, phone applications, and wearable monitors) by the general public, and the growing demand from consumers to take control of their health, the medical industry is now primed to formally incorporate evidence-based wearable device-mediated telehealth into standards of care. PURPOSE To (1) identify all wearable devices in the peer-reviewed literature that were used to assess DFOMs in Spine, (2) analyze clinical studies implementing such devices in spine care, and (3) provide clinical commentary on how such devices might be integrated into standards of care. STUDY DESIGN/SETTING A systematic review. METHODS A comprehensive systematic review was conducted in adherence to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Guidelines (PRISMA) across the following databases: PubMed; MEDLINE; EMBASE (Elsevier); and Scopus. Articles related to wearables systems in spine healthcare were selected. Extracted data was collected as per a predetermined checklist including wearable device type, study design, and clinical indices studied. RESULTS Of the 2,646 publications that were initially screened, 55 were extensively analyzed and selected for retrieval. Ultimately 39 publications were identified as being suitable for inclusion based on the relevance of their content to the core objectives of this systematic review. The most relevant studies were included, with a focus on wearables technologies that can be used in patients' home environments. CONCLUSIONS Wearable technologies mentioned in this paper have the potential to revolutionize spine healthcare through their ability to collect data continuously and in any environment. In this paper, the vast majority of wearable spine devices rely exclusively on accelerometers. Thus, these metrics provide information about general health rather than specific impairments caused by spinal conditions. As wearable technology becomes more prevalent in orthopedics, healthcare costs may be reduced and patient outcomes will improve. A combination of DFOMs gathered using a wearable device in conjunction with patient-reported outcomes and radiographic measurements will provide a comprehensive evaluation of a spine patient's health and assist the physician with patient-specific treatment decision-making. Establishing these ubiquitous diagnostic capabilities will allow improvement in patient monitoring and help us learn about postoperative recovery and the impact of our interventions.
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Affiliation(s)
- Ram Haddas
- University of Rochester Medical Center, Rochester, NY 14642, USA.
| | - Mark Lawlor
- University of Rochester Medical Center, Rochester, NY 14642, USA
| | - Ehsan Moghadam
- University of Rochester Medical Center, Rochester, NY 14642, USA
| | - Andrew Fields
- Medtronic Spine & Biologics, University of Rochester Medical Center, Rochester, NY 14642, USA
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Gibbs D, Toop N, Grossbach AJ, Keister A, Mallory N, Hatef B, Weinberg J, Viljoen S, Xu D. Electronic versus paper patient-reported outcome measure compliance rates: A retrospective analysis. Clin Neurol Neurosurg 2023; 226:107618. [PMID: 36773533 DOI: 10.1016/j.clineuro.2023.107618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 01/31/2023] [Accepted: 02/04/2023] [Indexed: 02/11/2023]
Abstract
OBJECTIVE Patient-reported outcome measures (PROMs) are key tools used to inform clinical research and patient-centered care. Application of data collected from PROMs, however, may be limited by incomplete responses, and little is known regarding the efficacy of varied PROM delivery methods. The objective of this study was to compare PROMs compliance when delivered via paper and electronic formats. METHODS Elective adult spinal deformity patients were screened for inclusion. Data collected included demographics, type of surgery, PROMs compliance, and discharge care. Descriptive statistics and multivariate analysis (MVA) were performed to compare pre- and postoperative compliance rates. RESULTS Of the 474 included patients, 177 were administered paper PROMs, while 297 were electronic. Preoperatively, 101 patients (57.1%) had any portion of their paper PROMs available; 179 (60.3%) had any of their electronic PROMs available (p = 0.492). Among all patients, 76 (42.9%) and 170 (57.2%) had all of their completed preop PROMs available (p = 0.003). Among patients with any of their preop PROMs completed, 75.2% with paper and 95.0% with electronic were completed in their entirety (p < 0.001). Similar trends were observed among postoperative PROMs. MVA demonstrated electronic delivery as the only significant correlate with pre- and post-operative PROMs compliance (p < 0.001 and p = 0.003, respectively). CONCLUSIONS No differences were observed across modalities when considering any available PROMs, yet electronic PROM delivery was associated with higher completion of PROMs. In order to improve the quality of patient-reported data, electronic delivery with alternative methods of quality improvement may be considered to increase PROMs retention rates.
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Affiliation(s)
- David Gibbs
- The Ohio State University College of Medicine, Columbus, OH, USA.
| | - Nathaniel Toop
- The Ohio State University Wexner Medical Center, Department of Neurological Surgery, Columbus, OH, USA
| | - Andrew J Grossbach
- The Ohio State University Wexner Medical Center, Department of Neurological Surgery, Columbus, OH, USA
| | | | - Noah Mallory
- The Ohio State University College of Medicine, Columbus, OH, USA
| | - Benjamin Hatef
- The Ohio State University College of Medicine, Columbus, OH, USA
| | - Joshua Weinberg
- The Ohio State University Wexner Medical Center, Department of Neurological Surgery, Columbus, OH, USA
| | - Stephanus Viljoen
- The Ohio State University Wexner Medical Center, Department of Neurological Surgery, Columbus, OH, USA
| | - David Xu
- The Ohio State University Wexner Medical Center, Department of Neurological Surgery, Columbus, OH, USA
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Utilizing Data from Wearable Technologies in the Era of Telemedicine to Assess Patient Function and Outcomes in Neurosurgery: Systematic Review and Time-Trend Analysis of the Literature. World Neurosurg 2022; 166:90-119. [PMID: 35843580 DOI: 10.1016/j.wneu.2022.07.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 07/07/2022] [Accepted: 07/08/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND The COVID-19 pandemic has driven the increased use of telemedicine and the adoption of wearable technology in neurosurgery. We reviewed studies exploring the use of wearables on neurosurgical patients and analyzed wearables' scientific production trends. METHODS The review encompassed PubMed, EMBASE, Web of Science, and Cochrane Library. Bibliometric analysis was performed using citation data of the included studies through Elsevier's Scopus database. Linear regression was utilized to understand scientific production trends. All analyses were performed on R 4.1.2. RESULTS We identified 979 studies. After screening, 49 studies were included. Most studies evaluated wearable technology use for patients with spinal pathology (n = 31). The studies were published over a 24-year period (1998-2021). Forty-seven studies involved wearable device use relevant to telemedicine. Bibliometric analysis revealed a compounded annual growth rate of 7.3%, adjusted for inflation, in annual scientific production from 1998 to 2021 (coefficient=1.3; 95% Confidence Interval = [0.7, 1.9], P < 0.01). Scientific production steadily increased in 2014 (n = 1) and peaked from 2019 (n = 8) to 2021 (n = 13) in correlation with the COVID-19 pandemic. Publications spanned 34 journals, averaged 24.4 citations per article, 3.0 citations per year per article, and 8.3 authors per article. CONCLUSION Wearables can provide clinicians with objective measurements to determine patient function and quality of life. The rise in articles related to wearables in neurosurgery demonstrates the increased adoption of wearable devices during the COVID-19 pandemic. Wearable devices appear to be a key component in this era of telemedicine and their positive utility and practicality are increasingly being realized in neurosurgery.
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van Hout L, Bökkerink WJV, Vriens PWHE. Clinical feasibility of the Q1.6 Inguinal Hernia application: a prospective cohort study. Hernia 2022; 27:449-458. [PMID: 35840840 DOI: 10.1007/s10029-022-02646-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 06/04/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE Patient-reported outcomes (PROs) are essential to evaluate inguinal hernia surgery. There is a need for digital and disease-specific PRO measurement. Current measuring instruments (PROMs) have several disadvantages, for example, fixed measuring moments with a chance of recall bias. The Q1.6 Inguinal Hernia application has been developed to overcome these challenges. This pilot study reports the first clinical feasibility results. METHODS All surgically treated inguinal hernia patients were eligible for inclusion. The application uses "twitch crowdsourcing"; after unlocking a smartphone or tablet, a single short question is asked. This can easily be repeated multiple times a day/week/month. Questions from validated questionnaires were implemented. The adaptive question engine generates an individualised set of questions. Alerts are generated when a complication is suspected. RESULTS A total of 229 patients were given over 50.000 questions of which 92% were answered. Pre- and postoperative patient characteristics and their reported clinical outcomes confirmed a standard inguinal hernia population. Compliance with the application was 91.7% after 14 days, 69.0% after 3 months and 28.8% after one year. After months 3, 6 and 11, respectively, 3.0%, 4.4% and 4.5% of patients reported inguinal pain or discomfort (NRS ≥ 4). Patients were highly satisfied (92.8% preferred the app over standard care). CONCLUSIONS This smartphone application shows promising results for clinical practice. It might allow for continuous digital patient-reported outcome measurement using non-intrusive, concise questions. Remote monitoring may become standard postoperative care after (inguinal hernia) surgery. The current application will be further improved and evaluated for cost-effectiveness, safety and validity.
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Affiliation(s)
- L van Hout
- Department of Surgery, Hernia Center Brabant, Elisabeth-TweeSteden Hospital (ETZ), Tilburg, The Netherlands.
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - W J V Bökkerink
- Department of Surgery, Hernia Center Brabant, Elisabeth-TweeSteden Hospital (ETZ), Tilburg, The Netherlands
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - P W H E Vriens
- Department of Surgery, Hernia Center Brabant, Elisabeth-TweeSteden Hospital (ETZ), Tilburg, The Netherlands
- Department of Medical and Clinical Psychology, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
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Zeitlberger AM, Sosnova M, Ziga M, Gautschi OP, Regli L, Bozinov O, Weyerbrock A, Stienen MN, Maldaner N. Distance to first symptoms measured by the 6-min walking test differentiates between treatment success and failure in patients with degenerative lumbar disorders. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2022; 31:596-603. [PMID: 35015137 DOI: 10.1007/s00586-021-07103-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 12/12/2021] [Accepted: 12/21/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE The smartphone-based 6-min walking test (6WT) is an established digital outcome measure in patients undergoing surgery for degenerative lumbar disorders (DLD). In addition to the 6WTs primary outcome measure, the 6-min walking distance (6WD), the patient's distance to first symptoms (DTFS) and time to first symptoms (TTFS) can be recorded. This is the first study to analyse the psychometric properties of the DTFS and TTFS. METHODS Forty-nine consecutive patients (55 ± 15.8 years) completed the 6WT pre- and 6 weeks (W6) postoperative. DTFS and TTFS were assessed for reliability and content validity using disease-specific patient-reported outcome measures. The Zurich Claudication Questionnaire patient satisfaction subscale was used as external criterion for treatment success. Internal and external responsiveness for both measures at W6 was evaluated. RESULTS There was a significant improvement in DTFS and TTFS from baseline to W6 (p < 0.001). Both measures demonstrated a good test-retest reliability (β = 0.86, 95% CI 0.81-0.90 and β = 0.83, 95% CI 0.76-0.87, both p < 0.001). The DTFS exceeded the 6WD capability to differentiate between satisfied (82%) and unsatisfied patients (18%) with an AUC of 0.75 (95% CI 0.53-0.98) vs. 0.70 (95% CI 0.52-0.90). The TTFS did not demonstrate meaningful discriminative abilities. CONCLUSION Change in DTFS can differentiate between satisfied and unsatisfied patients after spine surgery. Digital outcome measures on the 6WT metric provide spine surgeons and researchers with a mean to assess their patient's functional disability and response to surgical treatment in DLD.
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Affiliation(s)
- Anna M Zeitlberger
- Department of Neurosurgery, Clinical Neuroscience Center, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Marketa Sosnova
- Department of Neurosurgery, Clinical Neuroscience Center, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Michal Ziga
- Department of Neurosurgery, Clinical Neuroscience Center, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Oliver P Gautschi
- Neuro- and Spine Center, Hirslanden Clinic St. Anna, Lucerne, Switzerland
| | - Luca Regli
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Oliver Bozinov
- Department of Neurosurgery, Clinical Neuroscience Center, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Astrid Weyerbrock
- Department of Neurosurgery, Clinical Neuroscience Center, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Martin N Stienen
- Department of Neurosurgery, Clinical Neuroscience Center, Kantonsspital St. Gallen, St. Gallen, Switzerland.,Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Nicolai Maldaner
- Department of Neurosurgery, Clinical Neuroscience Center, Kantonsspital St. Gallen, St. Gallen, Switzerland. .,University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland. .,Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
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Determining the impact of postoperative complications in neurosurgery based on simulated longitudinal smartphone app-based assessment. Acta Neurochir (Wien) 2022; 164:207-217. [PMID: 34420108 PMCID: PMC8761146 DOI: 10.1007/s00701-021-04967-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 08/07/2021] [Indexed: 11/25/2022]
Abstract
Background Complications after neurosurgical operations can have severe impact on patient well-being, which is poorly reflected by current grading systems. The objective of this work was to develop and conduct a feasibility study of a new smartphone application that allows for the longitudinal assessment of postoperative well-being and complications. Methods We developed a smartphone application “Post OP Tracker” according to requirements from clinical experience and tested it on simulated patients. Participants received regular notifications through the app, inquiring them about their well-being and complications that had to be answered according to their assigned scenarios. After a 12-week period, subjects answered a questionnaire about the app’s functionality, user-friendliness, and acceptability. Results A total of 13 participants (mean age 34.8, range 24–68 years, 4 (30.8%) female) volunteered in this feasibility study. Most of them had a professional background in either health care or software development. All participants downloaded, installed, and applied the app for an average of 12.9 weeks. On a scale of 1 (worst) to 4 (best), the app was rated on average 3.6 in overall satisfaction and 3.8 in acceptance. The design achieved a somewhat favorable score of 3.1. One participant (7.7%) reported major technical issues. The gathered patient data can be used to graphically display the simulated outcome and assess the impact of postoperative complications. Conclusions This study suggests the feasibility to longitudinally gather postoperative data on subjective well-being through a smartphone application. Among potential patients, our application indicated to be functional, user-friendly, and well accepted. Using this app-based approach, further studies will enable us to classify postoperative complications according to their impact on the patient’s well-being. Supplementary Information The online version contains supplementary material available at 10.1007/s00701-021-04967-0.
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Voglis S, Ziga M, Zeitlberger AM, Sosnova M, Bozinov O, Regli L, Bellut D, Weyerbrock A, Stienen MN, Maldaner N. Smartphone-based real-life activity data for physical performance outcome in comparison to conventional subjective and objective outcome measures after degenerative lumbar spine surgery. BRAIN AND SPINE 2022; 2:100881. [PMID: 36248147 PMCID: PMC9560683 DOI: 10.1016/j.bas.2022.100881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 02/22/2022] [Accepted: 03/15/2022] [Indexed: 12/02/2022]
Abstract
Introduction Outcome assessments after surgery for degenerative lumbar disorders (DLDs) rely on subjective patient-reported outcomes (PROMs). New objective functional capacity tests, like the smartphone-based 6-min walking test (6WT), have been introduced but presumably also do not reflect the patient's real-life functional performance. Research question Pilot study to analyze changes in smartphone-based real-life activity data for physical performance outcome in patients undergoing surgery for DLD. Material and methods Prospective observational study of DLD patients. Objective functional capacity and subjective outcomes were measured using 6WT and PROMs. Real-life physical performance data were acquired retrospectively using Apple iPhone Health data and compared against objective capacity and subjective outcomes. Results Eight patients (mean 46 years, 62% male) provided 286.858 smartphone mile counts. PROMs and physical capacity (6WT) significantly improved postoperatively. 6WT results increased from 352m pre-to 555/567m at 6/12 weeks postoperatively (p = 0.03). For physical performance a linear mixed effect models showed an increase in daily distance in the first 4 months after surgery (slope +0.178; p < 0.001). However, those increases reversed from 4 until 12 months postoperatively (negative slope estimate of −0.076; p < 0.001). Smartphone-derived physical performance measures showed a positive correlation with corresponding physical capacity in the 6WT (R = 0.57,p = 0.004) and negative correlations with PROMs (COMI: R = −0.62p = 0.001; ZCQ-Physical-Function: R = −0.68,p < 0.001; ZCQ-Symptom-Severity: R = −0.52,p = 0.009). Discussion and conclusion Smartphone-based real-life activity data allows for longitudinal physical performance assessment. Physical performance correlated with physical capacity and patient's subjective perception of disability. However, physical performance may be more resistant to postoperative longtime change which should consult a more cautious use as objective outcome measure. Smartphone-based activity data allows for continuous longitudinal physical performance assessment after lumbar spine surgery. It captures both, a preoperative deterioration, and a postoperative improvement of patients' physical performance. Although smartphone-based performance correlated with physical capacity/PROMs, daily activity decreased again postoperatively This discrepancy indicates that smartphone-based performance may provide a more in-depth assessment of function over time.
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Affiliation(s)
- Stefanos Voglis
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, Zurich, Switzerland
| | - Michal Ziga
- Department of Neurosurgery, Canton Hospital St. Gallen, University of St. Gallen Medical School, St. Gallen, Switzerland
| | - Anna M. Zeitlberger
- Department of Neurosurgery, Canton Hospital St. Gallen, University of St. Gallen Medical School, St. Gallen, Switzerland
| | - Marketa Sosnova
- Department of Neurosurgery, Canton Hospital St. Gallen, University of St. Gallen Medical School, St. Gallen, Switzerland
| | - Oliver Bozinov
- Department of Neurosurgery, Canton Hospital St. Gallen, University of St. Gallen Medical School, St. Gallen, Switzerland
| | - Luca Regli
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, Zurich, Switzerland
| | - David Bellut
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, Zurich, Switzerland
| | - Astrid Weyerbrock
- Department of Neurosurgery, Canton Hospital St. Gallen, University of St. Gallen Medical School, St. Gallen, Switzerland
| | - Martin N. Stienen
- Department of Neurosurgery, Canton Hospital St. Gallen, University of St. Gallen Medical School, St. Gallen, Switzerland
| | - Nicolai Maldaner
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, Zurich, Switzerland
- Department of Neurosurgery, Canton Hospital St. Gallen, University of St. Gallen Medical School, St. Gallen, Switzerland
- Corresponding author. Department of Neurosurgery University Hospital Zurich, Clinical Neuroscience Center University of Zurich, Zurich, Switzerland.
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