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Kowalski KL, Mistry J, Beilin A, Goodman M, Lukacs MJ, Rushton A. Physical functioning in the lumbar spinal surgery population: A systematic review and narrative synthesis of outcome measures and measurement properties of the physical measures. PLoS One 2024; 19:e0307004. [PMID: 39208263 PMCID: PMC11361614 DOI: 10.1371/journal.pone.0307004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 06/26/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND International agreement supports physical functioning as a key domain to measure interventions effectiveness for low back pain. Patient reported outcome measures (PROMs) are commonly used in the lumbar spinal surgery population but physical functioning is multidimensional and necessitates evaluation also with physical measures. OBJECTIVE 1) To identify outcome measures (PROMs and physical) used to evaluate physical functioning in the lumbar spinal surgery population. 2) To assess measurement properties and describe the feasibility and interpretability of physical measures of physical functioning in this population. STUDY DESIGN Two-staged systematic review and narrative synthesis. METHODS This systematic review was conducted according to a registered and published protocol. Two stages of searching were conducted in MEDLINE, EMBASE, Health & Psychosocial Instruments, CINAHL, Web of Science, PEDro and ProQuest Dissertations & Theses. Stage one included studies to identify physical functioning outcome measures (PROMs and physical) in the lumbar spinal surgery population. Stage two (inception to 10 July 2023) included studies assessing measurement properties of stage one physical measures. Two independent reviewers determined study eligibility, extracted data and assessed risk of bias (RoB) according to COSMIN guidelines. Measurement properties were rated according to COSMIN criteria. Level of evidence was determined using a modified GRADE approach. RESULTS Stage one included 1,101 reports using PROMs (n = 70 established in literature, n = 67 developed by study authors) and physical measures (n = 134). Stage two included 43 articles assessing measurement properties of 34 physical measures. Moderate-level evidence supported sufficient responsiveness of 1-minute stair climb and 50-foot walk tests, insufficient responsiveness of 5-minute walk and sufficient reliability of distance walked during the 6-minute walk. Very low/low-level evidence limits further understanding. CONCLUSIONS Many physical measures of physical functioning are used in lumbar spinal surgery populations. Few have investigations of measurement properties. Strongest evidence supports responsiveness of 1-minute stair climb and 50-foot walk tests and reliability of distance walked during the 6-minute walk. Further recommendations cannot be made because of very low/low-level evidence. Results highlight promise for a range of measures, but prospective, low RoB studies are required.
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Affiliation(s)
- Katie L. Kowalski
- School of Physical Therapy, Western University, London, Ontario, Canada
- Collaborative Specialization in Musculoskeletal Health Research, Bone and Joint Institute, Western University, London, Ontario, Canada
| | - Jai Mistry
- School of Physical Therapy, Western University, London, Ontario, Canada
- Physiotherapy, St George’s Hospital, London, United Kingdom
| | - Anthony Beilin
- School of Physical Therapy, Western University, London, Ontario, Canada
| | - Maren Goodman
- Western Libraries, Western University, London, Ontario, Canada
| | - Michael J. Lukacs
- School of Physical Therapy, Western University, London, Ontario, Canada
- Physiotherapy Department, London Health Sciences Centre, London, Ontario, Canada
| | - Alison Rushton
- School of Physical Therapy, Western University, London, Ontario, Canada
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Natarajan P, Fonseka RD, Maharaj MM, Koinis L, Mobbs RJ. Continuous data capture of gait and mobility metrics using wearable devices for postoperative monitoring in common elective orthopaedic procedures of the hip, knee, and spine: a scoping review. J Orthop Surg Res 2023; 18:812. [PMID: 37907943 PMCID: PMC10617143 DOI: 10.1186/s13018-023-04303-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 10/20/2023] [Indexed: 11/02/2023] Open
Abstract
BACKGROUND Surgical procedures involving the hip, knee, or spine represent a majority of orthopaedic procedures performed electively in the health care system. Postoperative care is a key aspect of surgery and mobilisation without injury is the primary objective. Recent advances in wearable technologies allow objective evaluation of walking metrics to inform and guide postoperative care following orthopaedic surgery. PURPOSE The aim of this scoping review is to explore current applications of wearable devices, objective data capture and gait analysis in monitoring postoperative recovery following commonly performed elective orthopaedic procedures of the hip, knee and spine. METHODS A search against pre-defined criteria was performed on the following scientific databases from date of inception to February 28th, 2021: Medline (via OvidSP), Embase (via OvidSP) and Cochrane Library (via CENTRAL). Data were collected according to a predetermined checklist including study participants, surgery, wearable device (model), sensor location, and monitoring parameters such as mobility metrics, monitoring timepoints and monitoring duration for each study included in our review. Quality was assessed independently using the Newcastle Ottawa Scale (NOS). CONCLUSIONS To our knowledge, this is the first review of wearable monitoring (of postoperative recovery) following hip, knee and spine surgery. Patients undergoing elective orthopaedic procedures may benefit from wearable monitoring of their walking health and mobility metrics.
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Affiliation(s)
- Pragadesh Natarajan
- Faculty of Medicine, University of New South Wales, Sydney, Australia
- NeuroSpine Surgery Research Group (NSURG), Sydney, Australia
- Wearables and Gait Analysis Research Group (WAGAR), Sydney, Australia
| | - R Dineth Fonseka
- Faculty of Medicine, University of New South Wales, Sydney, Australia
- NeuroSpine Surgery Research Group (NSURG), Sydney, Australia
- Wearables and Gait Analysis Research Group (WAGAR), Sydney, Australia
| | - Monish Movin Maharaj
- Faculty of Medicine, University of New South Wales, Sydney, Australia
- NeuroSpine Surgery Research Group (NSURG), Sydney, Australia
- Wearables and Gait Analysis Research Group (WAGAR), Sydney, Australia
- Department of Neurosurgery, Prince of Wales Hospital, Sydney, Australia
| | - Lianne Koinis
- Wearables and Gait Analysis Research Group (WAGAR), Sydney, Australia.
| | - Ralph Jasper Mobbs
- Faculty of Medicine, University of New South Wales, Sydney, Australia
- NeuroSpine Surgery Research Group (NSURG), Sydney, Australia
- Wearables and Gait Analysis Research Group (WAGAR), Sydney, Australia
- Department of Neurosurgery, Prince of Wales Hospital, Sydney, Australia
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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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Bonab MAR, Sener S, Colak TK, Amirrashedi M, Yeldan I, Konya D, Toktas ZO. Spatiotemporal Gait Parameters and Gait Asymmetry in Patients With Lumbar Disc Herniation, Treated With Microdiscectomy: A Prospective, Observational Study. Neurospine 2023; 20:947-958. [PMID: 37798989 PMCID: PMC10562239 DOI: 10.14245/ns.2346122.061] [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: 01/25/2023] [Revised: 06/11/2023] [Accepted: 06/23/2023] [Indexed: 10/07/2023] Open
Abstract
OBJECTIVE The aim of this study was to emphasize on the interaction of spatial and temporal gait parameters and analyse the gait asymmetry in the patients with lumbar disc herniation (LDH) before and after microdiscectomy. METHODS This was a prospective, observational study conducted on 59 cases of LDH planned for lumbar microdiscectomy, and healthy control group with 54 participants for analysis was performed prior to surgery and 15 days after surgery. The spatiotemporal gait parameters were measured using a "Win-Track" gait analysis platform system. All the participants walked barefoot for 10 times with their normal walking speed in the same day. The 3 flawless walking data were recorded and the arithmetic means were computed. The gait symmetry index was used to calculate the walking asymmetry. The pain intensity of the patients was recorded shortly before performing the analysis by a visual analogue scale. RESULTS In the postoperative assessment LDH patients had significantly shorter temporal parameters, longer spatial parameters, faster walking speed, and more cadence than the preoperative assessment (p < 0.05). There were improvements in the asymmetry values of the postoperative gait parameters compared to the preoperative values, but these differences were not significant (p > 0.05). In addition, there was a significant difference in all parameters in terms of gait asymmetry between the postoperative assessment and the healthy controls (p < 0.05). CONCLUSION These results can guide the patient-specific evaluating and implementation of gait rehabilitation programs, and design protocols before or after surgery in the LDH patients.
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Affiliation(s)
- Masoud Amir Rashedi Bonab
- Physiotherapy and Rehabilitation Department, Institute of Health Sciences, Marmara University, Istanbul, Turkey
| | - Suleyman Sener
- Department of Neurosurgery, GZA Sint-Augustinus, Wilrijk, Belgium
| | - Tugba Kuru Colak
- Physiotherapy and Rehabilitation Department, Faculty of Health Sciences, Marmara University, Istanbul, Turkey
| | - Mahsa Amirrashedi
- Department of Applied Mathematics and Computer Science, Technical University of Denmark, Kongens Lyngby, Denmark
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Amager and Hvidovre, Copenhagen, Denmark
| | - Ipek Yeldan
- Physiotherapy and Rehabilitation Department, Faculty of Health Sciences, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Deniz Konya
- Department of Neurosurgery, Faculty of Medicine, Bahçeşehir University, Istanbul, Turkey
| | - Zafer Orkun Toktas
- Department of Neurosurgery, Faculty of Medicine, Bahçeşehir University, Istanbul, Turkey
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McLean KA, Knight SR, Diehl TM, Varghese C, Ng N, Potter MA, Zafar SN, Bouamrane MM, Harrison EM. Readiness for implementation of novel digital health interventions for postoperative monitoring: a systematic review and clinical innovation network analysis. Lancet Digit Health 2023; 5:e295-e315. [PMID: 37100544 DOI: 10.1016/s2589-7500(23)00026-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 02/01/2023] [Accepted: 02/03/2023] [Indexed: 04/28/2023]
Abstract
An increasing number of digital health interventions (DHIs) for remote postoperative monitoring have been developed and evaluated. This systematic review identifies DHIs for postoperative monitoring and evaluates their readiness for implementation into routine health care. Studies were defined according to idea, development, exploration, assessment, and long-term follow-up (IDEAL) stages of innovation. A novel clinical innovation network analysis used coauthorship and citations to examine collaboration and progression within the field. 126 DHIs were identified, with 101 (80%) being early stage innovations (IDEAL stage 1 and 2a). None of the DHIs identified had large-scale routine implementation. There is little evidence of collaboration, and there are clear omissions in the evaluation of feasibility, accessibility, and the health-care impact. Use of DHIs for postoperative monitoring remains at an early stage of innovation, with promising but generally low-quality supporting evidence. Comprehensive evaluation within high-quality, large-scale trials and real-world data are required to definitively establish readiness for routine implementation.
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Affiliation(s)
- Kenneth A McLean
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Stephen R Knight
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Thomas M Diehl
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Chris Varghese
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Nathan Ng
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Mark A Potter
- Colorectal Unit, Western General Hospital, Edinburgh, UK
| | - Syed Nabeel Zafar
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Matt-Mouley Bouamrane
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Ewen M Harrison
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK.
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Maharaj M, Natarajan P, Fonseka RD, Khanna S, Choy WJ, Rooke K, Phan K, Mobbs RJ. The concept of recovery kinetics: an observational study of continuous post-operative monitoring in spine surgery. JOURNAL OF SPINE SURGERY (HONG KONG) 2022; 8:196-203. [PMID: 35875621 PMCID: PMC9263729 DOI: 10.21037/jss-22-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 04/06/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND The spine surgeon's understanding of an individual patient's burden of disease and functional disability in daily life is shaped by patient-reported outcome measures (PROMs). Although PROMs are useful in understanding the patient's perception of their disease, the use of PROMs constitutes a "snapshot" approach of single timepoint data capture, omitting day-to-day fluctuations in functional status. We introduce the concept of kinetics when considering continuous and objective postoperative patient monitoring with wearable sensors. METHODS A prospective single-centre series was performed using patients either undergoing lumbar decompression for lumbar spinal stenosis (LSS) (n=12), or posterior lumbar fusion for degenerative spondylolisthesis (n=12). The Oswestry Disability Index (PROM) was conducted preoperatively and 12-weeks postoperatively. During this timeframe, continuous measurements of step count and distance travelled were made using a wrist-based wearable accelerometer. RESULTS Over the 12-week study period, mean daily step count for all participants improved from 4,700 to 7,700 steps per day (P=0.013), following an initial dip in total steps taken. The mean daily distance travelled improved from 3,300 to 5,300 meters per day (P=0.003). Decompression group recovered at a faster rate than the fusion group. CONCLUSIONS Although overall improvement was similar between the decompression and fusion groups, the recovery kinetics varied. The recovery kinetics approach of continuous postoperative monitoring provides additional insight to postoperative patient progress.
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Affiliation(s)
- Monish Maharaj
- Faculty of Medicine, University of New South Wales, Sydney, Australia
- NeuroSpine Surgery Research Group (NSURG), Sydney, Australia
- Wearables and Gait Analysis Research Group (WAGAR), Sydney, Australia
- Department of Neurosurgery, Prince of Wales Hospital, Sydney, Australia
- NeuroSpine Clinic, Prince of Wales Private Hospital, Sydney, Australia
| | - Pragadesh Natarajan
- Faculty of Medicine, University of New South Wales, Sydney, Australia
- NeuroSpine Surgery Research Group (NSURG), Sydney, Australia
- Wearables and Gait Analysis Research Group (WAGAR), Sydney, Australia
| | - R. Dineth Fonseka
- Faculty of Medicine, University of New South Wales, Sydney, Australia
- NeuroSpine Surgery Research Group (NSURG), Sydney, Australia
- Wearables and Gait Analysis Research Group (WAGAR), Sydney, Australia
| | - Sukrit Khanna
- Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Wen Jie Choy
- Faculty of Medicine, University of New South Wales, Sydney, Australia
- NeuroSpine Surgery Research Group (NSURG), Sydney, Australia
- Wearables and Gait Analysis Research Group (WAGAR), Sydney, Australia
| | - Kaitlin Rooke
- NeuroSpine Clinic, Prince of Wales Private Hospital, Sydney, Australia
| | - Kevin Phan
- NeuroSpine Surgery Research Group (NSURG), Sydney, Australia
| | - Ralph Jasper Mobbs
- Faculty of Medicine, University of New South Wales, Sydney, Australia
- NeuroSpine Surgery Research Group (NSURG), Sydney, Australia
- Wearables and Gait Analysis Research Group (WAGAR), Sydney, Australia
- Department of Neurosurgery, Prince of Wales Hospital, Sydney, Australia
- NeuroSpine Clinic, Prince of Wales Private Hospital, Sydney, Australia
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Fonseka RD, Natarajan P, Maharaj MM, Mobbs RJ. Tracking the disease progression of lumbar spinal stenosis using objective gait metrics: a case report. JOURNAL OF SPINE SURGERY (HONG KONG) 2022; 8:163-169. [PMID: 35441109 PMCID: PMC8990394 DOI: 10.21037/jss-21-101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 01/19/2022] [Indexed: 06/14/2023]
Abstract
We present the case of an 85-year-old woman who presented to our clinic with neurogenic claudication due to lumbar spinal stenosis (LSS) over a period of two years. During this time a series of walking metrics were monitored including daily step count, walking speed, and step length. All metrics showed a deterioration over time and objectively document the disease progression of LSS (initial: walking speed =1.03 m/s, step length =0.49 m, and daily step count =3,136; final: walking speed =0.49 m/s, step length =0.37 m, and daily step count =334). At this time, the patient had also begun experiencing bilateral lower limb weakness and paraesthesia upon exertion, preventing her from mobilizing for more than a few meters at a time. After a shared decision-making process with the patient and her family, surgical management was recommended. The deterioration of the patient's walking metrics matched their increasing requirement for walking assistance, with no walking assistance being needed initially, compared to a four-wheel walker being required in the weeks prior to her surgery. Therefore, the extent of walking deterioration may be able to inform clinical decision-making regarding appropriate walking assistance. To our knowledge, this is the first report that objectively documents the deterioration of LSS using walking metrics for such a prolonged duration of time.
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Affiliation(s)
- R. Dineth Fonseka
- Faculty of Medicine, University of New South Wales, Sydney, Australia
- NeuroSpine Surgery Research Group (NSURG), Sydney, Australia
- Wearables and Gait Analysis Research Group (WAGAR), Sydney, Australia
| | - Pragadesh Natarajan
- Faculty of Medicine, University of New South Wales, Sydney, Australia
- NeuroSpine Surgery Research Group (NSURG), Sydney, Australia
- Wearables and Gait Analysis Research Group (WAGAR), Sydney, Australia
| | - Monish M. Maharaj
- Faculty of Medicine, University of New South Wales, Sydney, Australia
- NeuroSpine Surgery Research Group (NSURG), Sydney, Australia
- Wearables and Gait Analysis Research Group (WAGAR), Sydney, Australia
- Department of Neurosurgery, Prince of Wales Hospital, Sydney, Australia
| | - Ralph J. Mobbs
- Faculty of Medicine, University of New South Wales, Sydney, Australia
- NeuroSpine Surgery Research Group (NSURG), Sydney, Australia
- Wearables and Gait Analysis Research Group (WAGAR), Sydney, Australia
- Department of Neurosurgery, Prince of Wales Hospital, Sydney, Australia
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Fonseka RD, Natarajan P, Maharaj MM, Rooke K, Mobbs RJ. Two-year continuous data capture using a wearable sensor to remotely monitor the surgical spine patient: a case report. JOURNAL OF SPINE SURGERY (HONG KONG) 2022; 8:170-179. [PMID: 35441110 PMCID: PMC8990385 DOI: 10.21037/jss-21-89] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 11/24/2021] [Indexed: 06/14/2023]
Abstract
We report the case of a 46-year-old male with long-standing low back pain who presented with a deterioration of symptoms characterised by back and right leg pain corresponding to the L4 and L5 dermatomes. An MRI scan revealed severe central and lateral recess stenosis at L4/5 secondary to a large central disc protrusion. We remotely monitored activity and general health metrics over a time-period exceeding two years. This is the first study to monitor these metrics remotely and continuously in the surgical spine patient. Over this time, he received several interventions including a spinal cord stimulator implant, and an L4/5 microdiscectomy. We tracked his fluctuating health status using the Oura Ring [objectively measuring metrics including step count, sleep patterns, heart rate (HR), heart-rate variability (HRV), and respiratory rate (RR)] and with daily self-reported scores on the Visual Analogue Scale. The Oura Ring is a convenient and lightweight wearable device that is worn on any finger. Taken together, metrics provided a comprehensive picture of deterioration and recovery, paralleling key events in the patient's history. The use of wearable devices is feasible in enabling long-term remote continuous monitoring. This may assist surgeons and rehabilitation providers in identifying early deterioration and monitoring the post-intervention course of recovery.
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Affiliation(s)
- R Dineth Fonseka
- Faculty of Medicine, University of New South Wales, Sydney, Australia
- NeuroSpine Surgery Research Group (NSURG), Sydney, Australia
- Wearables and Gait Analysis Research Group (WAGAR), Sydney, Australia
| | - Pragadesh Natarajan
- Faculty of Medicine, University of New South Wales, Sydney, Australia
- NeuroSpine Surgery Research Group (NSURG), Sydney, Australia
- Wearables and Gait Analysis Research Group (WAGAR), Sydney, Australia
| | - Monish M Maharaj
- Faculty of Medicine, University of New South Wales, Sydney, Australia
- NeuroSpine Surgery Research Group (NSURG), Sydney, Australia
- Wearables and Gait Analysis Research Group (WAGAR), Sydney, Australia
- Department of Neurosurgery, Prince of Wales Hospital, Sydney, Australia
| | - Kaitlin Rooke
- NeuroSpine Surgery Research Group (NSURG), Sydney, Australia
- Wearables and Gait Analysis Research Group (WAGAR), Sydney, Australia
| | - Ralph J Mobbs
- Faculty of Medicine, University of New South Wales, Sydney, Australia
- NeuroSpine Surgery Research Group (NSURG), Sydney, Australia
- Wearables and Gait Analysis Research Group (WAGAR), Sydney, Australia
- Department of Neurosurgery, Prince of Wales Hospital, Sydney, Australia
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Choy WJ, Chen L, Quel De Oliveira C, Verhagen AP, Damodaran O, Anderson DB. Gait assessment tools for degenerative cervical myelopathy: a systematic review. JOURNAL OF SPINE SURGERY (HONG KONG) 2022; 8:149-162. [PMID: 35441108 PMCID: PMC8990400 DOI: 10.21037/jss-21-109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 03/16/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Degenerative cervical myelopathy (DCM) is a common progressive neurological disorder which may affect one's activities of daily living or even result in paraplegia/tetraplegia if left untreated. Currently, there is lack of consensus of the gait assessment tools for DCM. This systematic review aims to (I) provide an appraisal of the psychometric properties of the available gait assessment tools for DCM, (II) to assess their methodological quality according to The Consensus-based Standards for the selection of health Measurement COSMIN risk of bias checklist and (III) to assess each measurement property result against externally validated criteria. METHODS Six electronic full-text databases [PubMed (via NLM® database], Medline (via OvidSP), CINAHL (via Ebsco), EMBASE (via Ovid), PsycINFO (via CSA) and Web of Science (via Thomson Reuters)] were systematically searched from inception to June 2020. The methodological quality of each study was analysed using the COSMIN risk of bias checklist. The measurement property result and methodological quality of each study were evaluated. RESULTS Twenty studies were included from 3,339 citations retrieved. Twelve assessment tools for assessing gait in DCM were identified. According to COSMIN criteria, only five studies (25%) included in this review were found to have "very good" methodological quality. For construct validity, five tools had "sufficient" quality. For reliability, two assessment tools [the Total modified Japanese Orthopaedic Association Score (Italian Translation) (mJOA-ITTotal) and the modified Japanese Orthopaedic Association (Italian Translation) Motor dysfunction of the Lower Extremity (mJOA-ITMDLE)] were rated as "sufficient" for interobserver reliability while six assessment tools (the 10 second step test (10 sec ST), 30 minute walk test (30MWT), foot tapping test, mJOA-ITTotal, mJOA-ITMDLE and the Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire) were rated as "sufficient" for test-retest reliability. The JOA (6 scores) received a "sufficient" rating for internal consistency. No assessment was available for responsiveness, as only the effect size was available. DISCUSSION Based upon current evidence, the mJOA in combination with an objective functional test (i.e., 30MWT) is recommended for clinicians assessing gait in DCM, although this may change with an increase in the number of studies completed. Given the importance of assessment tools possessing adequate measurement properties, a focus on studies in this area is warranted.
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Affiliation(s)
- Wen Jie Choy
- NeuroSpine Surgery Research Group (NSURG), Sydney, Australia
- Department of Neurosurgery, Nepean Hospital, Sydney, Australia
| | - Lingxiao Chen
- Faculty of Medicine and Health, The Back Pain Research Team, Sydney Musculoskeletal Health, The Kolling Institute, School of Health Sciences, University of Sydney, Sydney, Australia
| | - Camila Quel De Oliveira
- Discipline of Physiotherapy, Graduate School of Health, University of Technology Sydney, Sydney, Australia
| | - Arianne P. Verhagen
- Discipline of Physiotherapy, Graduate School of Health, University of Technology Sydney, Sydney, Australia
| | | | - David B. Anderson
- Faculty of Medicine and Health, School of Health Sciences, University of Sydney, New South Wales, Australia
- Sydney Spine Institute, Burwood, Sydney, Australia
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Fonseka RD, Natarajan P, Mobbs RJ. Inter-bout and intra-bout gait variability-proposed objective measures of gait deterioration during prolonged walking in spine care. JOURNAL OF SPINE SURGERY (HONG KONG) 2022; 8:180-184. [PMID: 35441111 PMCID: PMC8990389 DOI: 10.21037/jss-21-88] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 09/29/2021] [Indexed: 06/14/2023]
Affiliation(s)
- R. Dineth Fonseka
- Faculty of Medicine, University of New South Wales, Sydney, Australia
- NeuroSpine Surgery Research Group (NSURG), Sydney, Australia
- Wearables and Gait Analysis Research Group (WAGAR), Sydney, Australia
| | - Pragadesh Natarajan
- Faculty of Medicine, University of New South Wales, Sydney, Australia
- NeuroSpine Surgery Research Group (NSURG), Sydney, Australia
- Wearables and Gait Analysis Research Group (WAGAR), Sydney, Australia
| | - Ralph J. Mobbs
- Faculty of Medicine, University of New South Wales, Sydney, Australia
- NeuroSpine Surgery Research Group (NSURG), Sydney, Australia
- Wearables and Gait Analysis Research Group (WAGAR), Sydney, Australia
- Department of Neurosurgery, Prince of Wales Hospital, Sydney, Australia
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Mobbs RJ, Fonseka RD, Natarajan P. Wearable sensor technology in spine care. JOURNAL OF SPINE SURGERY (HONG KONG) 2022; 8:84-86. [PMID: 35441106 PMCID: PMC8990390 DOI: 10.21037/jss-21-113] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 11/12/2021] [Indexed: 06/01/2023]
Affiliation(s)
- Ralph J Mobbs
- Faculty of Medicine, University of New South Wales, Sydney, Australia
- NeuroSpine Surgery Research Group (NSURG), Sydney, Australia
- Wearables and Gait Analysis Research Group (WAGAR), Sydney, Australia
- Department of Neurosurgery, Prince of Wales Hospital, Sydney, Australia
| | - R Dineth Fonseka
- Faculty of Medicine, University of New South Wales, Sydney, Australia
- NeuroSpine Surgery Research Group (NSURG), Sydney, Australia
- Wearables and Gait Analysis Research Group (WAGAR), Sydney, Australia
| | - Pragadesh Natarajan
- Faculty of Medicine, University of New South Wales, Sydney, Australia
- NeuroSpine Surgery Research Group (NSURG), Sydney, Australia
- Wearables and Gait Analysis Research Group (WAGAR), Sydney, Australia
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Mobbs RJ. From the Subjective to the Objective era of outcomes analysis: how the tools we use to measure outcomes must change to be reflective of the pathologies we treat in spinal surgery. JOURNAL OF SPINE SURGERY (HONG KONG) 2021; 7:456-457. [PMID: 34734150 PMCID: PMC8511557 DOI: 10.21037/jss-2021-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 09/23/2021] [Indexed: 11/06/2022]
Affiliation(s)
- Ralph J. Mobbs
- NeuroSpine Surgery Research Group (NSURG), Sydney, Australia
- NeuroSpine Clinic, Prince of Wales Private Hospital, Randwick, Australia
- Faculty of Medicine, University of New South Wales, Sydney, Australia
- Wearables and Gait Assessment Group (WAGAR), Sydney, Australia
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Proposed objective scoring algorithm for walking performance, based on relevant gait metrics: the Simplified Mobility Score (SMoS™)-observational study. J Orthop Surg Res 2021; 16:419. [PMID: 34210345 PMCID: PMC8247222 DOI: 10.1186/s13018-021-02546-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 06/08/2021] [Indexed: 11/10/2022] Open
Abstract
Background Walking is a fundamental part of living, and its importance is not limited by age or medical status. Reduced walking speed (WS), or gait velocity, is a sign of advancing age, various disease states, cognitive impairment, mental illness and early mortality. Activity levels, as defined in the literature as “daily step count” (DSC), is also a relevant measure of health status. A deterioration in our walking metrics, such as reduced WS and DSC, is associated with poor health outcomes. These objective measures are of such importance, that walking speed has been dubbed “the 6th vital sign”. We report a new objective measure that scores walking using the relevant metrics of walking speed and daily step count, into an easy-to-understand score from 0 (nil mobility) to 100 (excellent mobility), termed the Simplified Mobility Score (SMoS™). We have provided equal weighting to walking speed and daily step count, using a simple algorithm to score each metric out of 50. Methods Gait data was collected from 182 patients presenting to a tertiary hospital spinal unit with complaints of pain and reduced mobility. Walking speed was measured from a timed walk along an unobstructed pathway. Daily step count information was obtained from patients who had enabled step count tracking on their devices. The SMoS of the sample group were compared to expected population values calculated from the literature using 2-tailed Z tests. Results There were significantly reduced SMoS in patients who presented to the spinal unit than those expected at each age group for both genders, except for the 50–59 age bracket where no statistically significant reduction was observed. Even lower scores were present in those that went on to have surgical management. There was a significant correlation of SMoS scores with subjective disability scores such as the Oswestry Disability Index (ODI) and Visual Analogue Scale (VAS) in this cohort. Conclusions The SMoS is a simple and effective scoring tool which is demonstrably altered in spinal patients across age and gender brackets and correlates well with subjective disability scores. The SMoS has the potential to be used as a screening tool in primary and specialised care settings. Supplementary Information The online version contains supplementary material available at 10.1186/s13018-021-02546-8.
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Amin T, Mobbs RJ, Mostafa N, Sy LW, Choy WJ. Wearable devices for patient monitoring in the early postoperative period: a literature review. Mhealth 2021; 7:50. [PMID: 34345627 PMCID: PMC8326951 DOI: 10.21037/mhealth-20-131] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 12/13/2020] [Indexed: 12/20/2022] Open
Abstract
The early postoperative period is a crucial stage in a patient's recovery as they are susceptible to a range of complications, with detection and management the key to avoiding long term consequences. Wearable devices are an innovative way of monitoring patient's post-intervention and may translate into improved patient outcomes, and reduced strain on healthcare resources, as they may facilitate safer and earlier discharge from the hospital setting. Several recent studies have investigated the use of wearable devices in postoperative monitoring. This review outlines the current literature including the range of wearable devices used for postoperative monitoring, the variety of surgeries investigated, and the outcomes assessed. A search of five electronic databases was performed. Data on the range of wearable devices, outcomes and surgeries investigated were extracted and synoptically analysed. Twenty-four articles were retrieved. Data on several different types of surgery were available and discussed. Most studies used wrist-mounted wearable devices and accelerometers or pedometers to assess physical activity metrics, including step counts and physical activity intensity (PAI), as markers of recovery. Wearable devices can provide objective data capture in the early postoperative phase to remotely monitor patients using various metrics including temperature, cardiac monitoring and physical activity. The majority of current research is focussed on wrist-mounted accelerometers and pedometers used to assess physical activity as a marker of postoperative function. Further research is required to demonstrate improved safety and cost-effectiveness of this technology.
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Affiliation(s)
- Tajrian Amin
- NeuroSpine Surgery Research Group (NSURG), Sydney, Australia
- Neuro Spine Clinic, Prince of Wales Private Hospital, Randwick, Australia
- Faculty of Medicine, University of New South Wales (UNSW), Sydney, Australia
- Wearables and Gait Assessment Research (WAGAR) Group, Prince of Wales Private Hospital, Randwick, Australia
| | - Ralph J. Mobbs
- NeuroSpine Surgery Research Group (NSURG), Sydney, Australia
- Neuro Spine Clinic, Prince of Wales Private Hospital, Randwick, Australia
- Faculty of Medicine, University of New South Wales (UNSW), Sydney, Australia
- Wearables and Gait Assessment Research (WAGAR) Group, Prince of Wales Private Hospital, Randwick, Australia
| | - Niyaz Mostafa
- Faculty of Medicine, University of New South Wales (UNSW), Sydney, Australia
| | - Luke W. Sy
- Wearables and Gait Assessment Research (WAGAR) Group, Prince of Wales Private Hospital, Randwick, Australia
- School of Biomedical Engineering, University of New South Wales, Sydney, Australia
| | - Wen Jie Choy
- NeuroSpine Surgery Research Group (NSURG), Sydney, Australia
- Neuro Spine Clinic, Prince of Wales Private Hospital, Randwick, Australia
- Faculty of Medicine, University of New South Wales (UNSW), Sydney, Australia
- Wearables and Gait Assessment Research (WAGAR) Group, Prince of Wales Private Hospital, Randwick, Australia
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15
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Cornwall GB, Davis A, Walsh WR, Mobbs RJ, Vaccaro A. Innovation and New Technologies in Spine Surgery, Circa 2020: A Fifty-Year Review. Front Surg 2020; 7:575318. [PMID: 33330605 PMCID: PMC7732641 DOI: 10.3389/fsurg.2020.575318] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 10/27/2020] [Indexed: 12/18/2022] Open
Abstract
Spine surgery (lumbar, cervical, deformity, and entire spine) has increased in volume and improved in outcomes over the past 50 years because of innovations in surgical techniques and introduction of new technologies to improve patient care. Innovation is described as a process to add value or create change in an enterprise's economic or social potential. This mini review will assess two of three assessments of innovation in spine surgery: scientific publications and patents issued. The review of both scientific publications and issued patents is a unique assessment. The third assessment of innovation: regulatory clearances of medical devices and equipment for spine surgery and their evolution over time, will also be discussed.
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Affiliation(s)
- G. Bryan Cornwall
- Shiley-Marcos School of Engineering, University of San Diego, San Diego, CA, United States
- Surgical Orthopaedic Research Laboratory, Prince of Wales Hospital, University of New South Wales, Sydney, NSW, Australia
| | | | - William R. Walsh
- Surgical Orthopaedic Research Laboratory, Prince of Wales Hospital, University of New South Wales, Sydney, NSW, Australia
| | - Ralph J. Mobbs
- Surgical Orthopaedic Research Laboratory, Prince of Wales Hospital, University of New South Wales, Sydney, NSW, Australia
| | - Alexander Vaccaro
- Rothman's Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA, United States
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Mobbs RJ, Betteridge C. Daily step count and walking speed as general measures of patient wellbeing. JOURNAL OF SPINE SURGERY 2020; 6:635-636. [PMID: 33102903 DOI: 10.21037/jss-2020-03] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Ralph J Mobbs
- NeuroSpine Surgery Research Group (NSURG), Sydney, Australia.,NeuroSpine Clinic, Prince of Wales Private Hospital, Randwick, Australia.,Faculty of Medicine, University of New South Wales, Sydney, Australia.,Wearables and Gait Assessment Group (WAGAR), Sydney, Australia
| | - Callum Betteridge
- NeuroSpine Surgery Research Group (NSURG), Sydney, Australia.,NeuroSpine Clinic, Prince of Wales Private Hospital, Randwick, Australia.,Faculty of Medicine, University of New South Wales, Sydney, Australia.,Wearables and Gait Assessment Group (WAGAR), Sydney, Australia
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17
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Mobbs RJ, Ho D, Choy WJ, Betteridge C, Lin H. COVID-19 is shifting the adoption of wearable monitoring and telemedicine (WearTel) in the delivery of healthcare: opinion piece. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1285. [PMID: 33209865 PMCID: PMC7661877 DOI: 10.21037/atm-20-3678] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Ralph J Mobbs
- Faculty of Medicine, University of New South Wales, Sydney, Australia.,NeuroSpine Surgery Research Group (NSURG), Sydney, Australia.,Neurospine Clinic, Prince of Wales Private Hospital, Randwick, NSW 2031, Australia
| | - Daniel Ho
- Faculty of Medicine, University of New South Wales, Sydney, Australia.,NeuroSpine Surgery Research Group (NSURG), Sydney, Australia.,Neurospine Clinic, Prince of Wales Private Hospital, Randwick, NSW 2031, Australia
| | - Wen Jie Choy
- Faculty of Medicine, University of New South Wales, Sydney, Australia.,NeuroSpine Surgery Research Group (NSURG), Sydney, Australia.,Neurospine Clinic, Prince of Wales Private Hospital, Randwick, NSW 2031, Australia
| | - Callum Betteridge
- Faculty of Medicine, University of New South Wales, Sydney, Australia.,NeuroSpine Surgery Research Group (NSURG), Sydney, Australia.,Neurospine Clinic, Prince of Wales Private Hospital, Randwick, NSW 2031, Australia
| | - Henry Lin
- Department of Neurosurgery, Prince of Wales Hospital, Randwick, NSW 2031, Australia
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Mobbs RJ. Gait velocity (walking speed) is an indicator of spine health, and objective measure of pre and post intervention recovery for spine care providers. JOURNAL OF SPINE SURGERY (HONG KONG) 2020; 6:353-355. [PMID: 32656370 PMCID: PMC7340824 DOI: 10.21037/jss-20-602] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Affiliation(s)
- Ralph J. Mobbs
- NeuroSpine Surgery Research Group (NSURG), Sydney, Australia
- Neurospine Clinic, Prince of Wales Private Hospital, Randwick, Australia
- Faculty of Medicine, University of New South Wales, Sydney, Australia
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Yoong NKM, Perring J, Mobbs RJ. Commercial Postural Devices: A Review. SENSORS (BASEL, SWITZERLAND) 2019; 19:E5128. [PMID: 31771130 PMCID: PMC6929158 DOI: 10.3390/s19235128] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Revised: 11/20/2019] [Accepted: 11/21/2019] [Indexed: 12/19/2022]
Abstract
Wearables are devices worn on the human body and are able to measure various health parameters, such as physical activity, energy expenditure and gait. With the advancement of technology, the general population are now spending more hours craning our necks and slouching over smartphones, tablets and computers, et cetera. Bodily posture is representative of physical and mental health. Poor posture can lead to spinal complications and the same can be said vice versa. As the standard of living increases, there is an increase in consumerism and the expectation to maintain such a lifestyle even in the aging population. Therefore, many are able to afford small luxuries in life, such as a piece of technology that could potentially improve their health in the long run. Wearable technology is a promising alternative to laboratory systems for movement and posture analysis. This article reviews commercial wearable devices with a focus on postural analysis. The clinical applicability of posture wearables, particularly in preventing, monitoring and treating spinal and musculoskeletal conditions, along with other purposes in healthcare, will be discussed.
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Affiliation(s)
- Nicole Kah Mun Yoong
- Faculty of Medicine, University of New South Wales, Sydney 2052, Australia; (J.P.); (R.J.M.)
- NeuroSpine Surgery Research Group (NSURG), Sydney 2052, Australia
| | - Jordan Perring
- Faculty of Medicine, University of New South Wales, Sydney 2052, Australia; (J.P.); (R.J.M.)
- NeuroSpine Surgery Research Group (NSURG), Sydney 2052, Australia
| | - Ralph Jasper Mobbs
- Faculty of Medicine, University of New South Wales, Sydney 2052, Australia; (J.P.); (R.J.M.)
- NeuroSpine Surgery Research Group (NSURG), Sydney 2052, Australia
- Department of Neurosurgery, Prince of Wales Hospital, Sydney 2052, Australia
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