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Longitudinal smartphone-based self-assessment of objective functional impairment in patients undergoing surgery for lumbar degenerative disc disease: initial experience

  • Technical Note - Spine degenerative
  • Published:
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Abstract

Background

The worldwide spread of smartphone usage enables new possibilities for longitudinal monitoring of objective functional impairment (OFI) in patients undergoing surgery for lumbar degenerative disc disease (DDD).

Methods

Three patients, undergoing elective surgery for lumbar DDD, self-assessed OFI using a recently validated 6-min walking test (6WT) smartphone application. Results are presented as raw 6-min walking distance (6WD) as well as in reference to age- and sex-specific healthy population reference values using standardized z-scores (number of standard deviations). In parallel, patient-reported outcome measures (PROMs), including numeric rating scale (NRS) leg-pain and Core Outcome Measures Index (COMI) were obtained before (pre) and 6 weeks (6 W) as well as 3 months (3 M) after surgery. Descriptive analyses were used to compare PROMs with repeated 6WT measurements over time. The feasibility and benefits of the longitudinal OFI measurements using the 6WT app are discussed.

Results

One patient presented a favorable outcome, reflected by a clinically meaningful improvement in PROMs. Correspondingly, the 6WT distance gradually improved above the normal population values ((pre 399 m (z-score − 1.96) vs. 6 W 494 m (− 0.85) vs. 3 M 557 m (− 0.1)). One patient experienced initial improvement at 6 W, followed by a decline in 6WD at 3 M which promoted further interventions with subsequent recovery ((358 m (z-score − 3.29) vs 440 m (− 2.2) vs 431 m (− 2.32) vs 471 m (− 1.78)). The last patient showed a lack of improvement in PROMs as well as in OFI (360 m (z-score 0.0) vs 401 m (0.30) vs 345 m (− 0.11)) resulting in secondary surgery.

Conclusion

The longitudinal assessment of OFI using the 6WT app was feasible and provided the physician with a detailed history of patients’ postoperative walking capacity complementing commonly used PROMs.

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Abbreviations

6WT:

Six-minute walking test

6WD:

Six-minute waking distance

App:

Application

CI:

Confidence interval

BMRC:

British Medical Research Council

COMI:

Core Outcome Measure Index

DDD:

Degenerative disc disease

GPS:

Global positioning system

LSS:

Lumbar spinal stenosis

LDH:

Lumbar disc herniation

MCID:

Minimal clinically important difference

m:

Meters

NRS:

Numerical rating scale

OFI:

Objective functional impairment

PROMs:

Patient reported outcome measures

References

  1. Copay AG, Glassman SD, Subach BR, Berven S, Schuler TC, Carreon LY Minimum clinically important difference in lumbar spine surgery patients: a choice of methods using the Oswestry Disability Index, Medical Outcomes Study questionnaire Short Form 36, and pain scales. Spine J 8(6):968–974. https://doi.org/10.1016/j.spinee.2007.11.006

  2. Gautschi OP, Joswig H, Corniola MV, Smoll NR, Schaller K, Hildebrandt G, Stienen MN (2016) Pre- and postoperative correlation of patient-reported outcome measures with standardized timed up and go (TUG) test results in lumbar degenerative disc disease. Acta Neurochir. https://doi.org/10.1007/s00701-016-2899-9

  3. Joswig H, Stienen MN, Smoll NR, Corniola MV, Chau I, Schaller K, Hildebrandt G, Gautschi OP (2017) Patients’ preference of the timed up and go test or patient-reported outcome measures before and after surgery for lumbar degenerative disk disease. World Neurosurg. https://doi.org/10.1016/j.wneu.2016.11.039

  4. Loske S, Nüesch C, Byrnes KS, Fiebig O, Schären S, Mündermann A, Netzer C (2018) Decompression surgery improves gait quality in patients with symptomatic lumbar spinal stenosis. Spine J. https://doi.org/10.1016/j.spinee.2018.04.016

  5. Maldaner N, Desai A, Gautschi OP, Regli L, Ratliff JK, Park J, Stienen MN (2019) Improving the patient-physician relationship in the digital era-transformation from subjective questionnaires into objective real-time and patient-specific data reporting tools. Neurospine. https://doi.org/10.14245/ns.1938400.200

  6. Mannion AF, Balagué F, Pellisé F, Cedraschi C (2007) Pain measurement in patients with low back pain. Nat Clin Pract Rheumatol 3(11):610–618

    Article  Google Scholar 

  7. Mannion AF, Elfering A, Staerkle R, Junge A, Grob D, Semmer NK, Jacobshagen N, Dvorak J, Boos N (2005) Outcome assessment in low back pain: how low can you go? Eur Spine J. https://doi.org/10.1007/s00586-005-0911-9

  8. Mannion AF, Porchet F, Kleinstück FS, Lattig F, Jeszenszky D, Bartanusz V, Dvorak J, Grob D (2009) The quality of spine surgery from the patient’s perspective: part 2. Minimal clinically important difference for improvement and deterioration as measured with the Core Outcome Measures Index. Eur Spine J 18(Suppl 3):374–379

    Article  Google Scholar 

  9. Parai C, Hägg O, Lind B, Brisby H (2018) The value of patient global assessment in lumbar spine surgery: an evaluation based on more than 90,000 patients. Eur Spine J. https://doi.org/10.1007/s00586-017-5331-0

  10. Staartjes VE, Beusekamp F, Schröder ML (2019) Can objective functional impairment in lumbar degenerative disease be reliably assessed at home using the five-repetition sit-to-stand test? A prospective study. Eur Spine J. https://doi.org/10.1007/s00586-019-05897-3

  11. Staartjes VE, Schröder ML (2018) The five-repetition sit-to-stand test: evaluation of a simple and objective tool for the assessment of degenerative pathologies of the lumbar spine. J Neurosurg Spine. https://doi.org/10.3171/2018.2.SPINE171416

  12. Stienen MN, Gautschi OP, Staartjes VE et al (2019) Reliability of the 6-minute walking test smartphone application. J Neurosurg Spine. https://doi.org/10.3171/2019.6.spine19559

  13. Stienen MN, Ho AL, Staartjes VE et al (2019) Objective measures of functional impairment for degenerative diseases of the lumbar spine: a systematic review of the literature. Spine J. https://doi.org/10.1016/j.spinee.2019.02.014

  14. Stienen MN, Smoll NR, Joswig H, Corniola MV, Schaller K, Hildebrandt G, Gautschi OP (2017) Validation of the baseline severity stratification of objective functional impairment in lumbar degenerative disc disease. J Neurosurg Spine 26(5):598–604

    Article  Google Scholar 

  15. Stienen MN, Smoll NR, Joswig H, Snagowski J, Corniola MV, Schaller K, Hildebrandt G, Gautschi OP (2017) Influence of the mental health status on a new measure of objective functional impairment in lumbar degenerative disc disease. Spine J. https://doi.org/10.1016/j.spinee.2016.12.004

  16. Stucki G, Daltroy L, Liang MH, Lipson SJ, Fossel AH, Katz JN (1996) Measurement properties of a self-administered outcome measure in lumbar spinal stenosis. Spine (Phila Pa 1976). https://doi.org/10.1097/00007632-199604010-00004

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Authors and Affiliations

  1. Department of Neurosurgery, Kantonsspital St. Gallen, Rorschacher Strasse 95, 9001, St. Gallen, Switzerland

    Marketa Sosnova, Anna Maria Zeitlberger, Michal Ziga, Astrid Weyerbrock & Nicolai Maldaner

  2. Neuro and Spine Center, Hirslanden Clinic St. Anna, Lucerne, Switzerland

    Oliver P. Gautschi

  3. Department of Neurosurgery, University Hospital Zurich & Clinical Neuroscience Center, University of Zurich, Zurich, Switzerland

    Martin N. Stienen & Nicolai Maldaner

Authors
  1. Marketa Sosnova
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  2. Anna Maria Zeitlberger
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  3. Michal Ziga
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  4. Oliver P. Gautschi
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  5. Astrid Weyerbrock
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  6. Martin N. Stienen
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  7. Nicolai Maldaner
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Correspondence to Marketa Sosnova.

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All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria, educational grants, participation in speakers’ bureaus, membership, employment, consultancies, stock ownership or other equity interest, and expert testimony or patent-licensing arrangements) or non-financial interest (such as personal or professional relationships, affiliations, knowledge, or beliefs) in the subject matter or materials discussed in this manuscript.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

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Appendix

Appendix

Link to 6WT smartphone app:

  1. 1.

    Android Google Play Store: https://play.google.com/store/apps/details?id=ch.webgearing.walkingapp&hl=de

  2. 2.

    Apple App Store: https://apps.apple.com/de/app/6wt-app/id1454002232

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Sosnova, M., Zeitlberger, A.M., Ziga, M. et al. Longitudinal smartphone-based self-assessment of objective functional impairment in patients undergoing surgery for lumbar degenerative disc disease: initial experience. Acta Neurochir 162, 2061–2068 (2020). https://doi.org/10.1007/s00701-020-04377-8

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