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

Abstract

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). 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 6weeks (6W) as well as 3months (3M) 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. 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 399m (z-score - 1.96) vs. 6W 494m (- 0.85) vs. 3M 557m (- 0.1)). One patient experienced initial improvement at 6W, followed by a decline in 6WD at 3M which promoted further interventions with subsequent recovery ((358m (z-score - 3.29) vs 440m (- 2.2) vs 431m (- 2.32) vs 471m (- 1.78)). The last patient showed a lack of improvement in PROMs as well as in OFI (360m (z-score 0.0) vs 401m (0.30) vs 345m (- 0.11)) resulting in secondary surgery. 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.