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Drossopoulos PN, Sharma A, Ononogbu-Uche FC, Tabarestani TQ, Bartlett AM, Wang TY, Huie D, Gottfried O, Blitz J, Erickson M, Lad SP, Bullock WM, Shaffrey CI, Abd-El-Barr MM. Pushing the Limits of Minimally Invasive Spine Surgery-From Preoperative to Intraoperative to Postoperative Management. J Clin Med 2024; 13:2410. [PMID: 38673683 PMCID: PMC11051300 DOI: 10.3390/jcm13082410] [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: 02/26/2024] [Revised: 04/05/2024] [Accepted: 04/16/2024] [Indexed: 04/28/2024] Open
Abstract
The introduction of minimally invasive surgery ushered in a new era of spine surgery by minimizing the undue iatrogenic injury, recovery time, and blood loss, among other complications, of traditional open procedures. Over time, technological advancements have further refined the care of the operative minimally invasive spine patient. Moreover, pre-, and postoperative care have also undergone significant change by way of artificial intelligence risk stratification, advanced imaging for surgical planning and patient selection, postoperative recovery pathways, and digital health solutions. Despite these advancements, challenges persist necessitating ongoing research and collaboration to further optimize patient care in minimally invasive spine surgery.
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Affiliation(s)
- Peter N. Drossopoulos
- Division of Spine, Department of Neurosurgery, Duke University, Durham, NC 27710, USA; (A.S.); (T.Q.T.); (C.I.S.)
| | - Arnav Sharma
- Division of Spine, Department of Neurosurgery, Duke University, Durham, NC 27710, USA; (A.S.); (T.Q.T.); (C.I.S.)
| | - Favour C. Ononogbu-Uche
- Division of Spine, Department of Neurosurgery, Duke University, Durham, NC 27710, USA; (A.S.); (T.Q.T.); (C.I.S.)
| | - Troy Q. Tabarestani
- Division of Spine, Department of Neurosurgery, Duke University, Durham, NC 27710, USA; (A.S.); (T.Q.T.); (C.I.S.)
| | - Alyssa M. Bartlett
- Division of Spine, Department of Neurosurgery, Duke University, Durham, NC 27710, USA; (A.S.); (T.Q.T.); (C.I.S.)
| | - Timothy Y. Wang
- Division of Spine, Department of Neurosurgery, Duke University, Durham, NC 27710, USA; (A.S.); (T.Q.T.); (C.I.S.)
| | - David Huie
- Division of Spine, Department of Neurosurgery, Duke University, Durham, NC 27710, USA; (A.S.); (T.Q.T.); (C.I.S.)
| | - Oren Gottfried
- Division of Spine, Department of Neurosurgery, Duke University, Durham, NC 27710, USA; (A.S.); (T.Q.T.); (C.I.S.)
| | - Jeanna Blitz
- Department of Anesthesiology, Duke University, Durham, NC 27710, USA (W.M.B.)
| | - Melissa Erickson
- Division of Spine, Department of Orthopedic Surgery, Duke University Medical Center, Durham, NC 27710, USA
| | - Shivanand P. Lad
- Division of Spine, Department of Neurosurgery, Duke University, Durham, NC 27710, USA; (A.S.); (T.Q.T.); (C.I.S.)
| | - W. Michael Bullock
- Department of Anesthesiology, Duke University, Durham, NC 27710, USA (W.M.B.)
| | - Christopher I. Shaffrey
- Division of Spine, Department of Neurosurgery, Duke University, Durham, NC 27710, USA; (A.S.); (T.Q.T.); (C.I.S.)
| | - Muhammad M. Abd-El-Barr
- Division of Spine, Department of Neurosurgery, Duke University, Durham, NC 27710, USA; (A.S.); (T.Q.T.); (C.I.S.)
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Kirsch EP, Kunte SA, Wu KA, Kaplan S, Hwang ES, Plichta JK, Lad SP. Digital Health Platforms for Breast Cancer Care: A Scoping Review. J Clin Med 2024; 13:1937. [PMID: 38610702 PMCID: PMC11012307 DOI: 10.3390/jcm13071937] [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: 02/28/2024] [Revised: 03/12/2024] [Accepted: 03/23/2024] [Indexed: 04/14/2024] Open
Abstract
Breast cancer is a significant global health concern affecting millions of women each year. Digital health platforms are an easily accessible intervention that can improve patient care, though their efficacy in breast cancer care is unknown. This scoping review aims to provide an overview of existing research on the utilization of digital health platforms for breast cancer care and identify key trends and gaps in the literature. A comprehensive literature search was conducted across electronic databases, including Ovid MEDLINE, Elsevier EMBASE, and Elsevier Scopus databases. The search strategy incorporated keywords related to "digital health platforms", "breast cancer care", and associated terminologies. After screening for eligibility, a total of 25 articles were included in this scoping review. The identified studies comprised mobile applications and web-based interventions. These platforms demonstrated various functionalities, including patient education, symptom monitoring, treatment adherence, and psychosocial support. The findings indicate the potential of digital health platforms in improving breast cancer care and patients' overall experiences. The positive impact on patient outcomes, including improved quality of life and reduced psychological distress, underscores the importance of incorporating digital health solutions into breast cancer management. Additional research is necessary to validate the effectiveness of these platforms in diverse patient populations and assess their impact on healthcare-resource utilization.
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Affiliation(s)
- Elayna P. Kirsch
- Department of Neurosurgery, Duke University Medical Center, Durham, NC 27710, USA
| | - Sameer A. Kunte
- Department of Neurosurgery, Duke University Medical Center, Durham, NC 27710, USA
| | - Kevin A. Wu
- Department of Neurosurgery, Duke University Medical Center, Durham, NC 27710, USA
| | - Samantha Kaplan
- Medical Center Library & Archives, Duke University School of Medicine, Durham, NC 27710, USA
| | - E. Shelley Hwang
- Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA (J.K.P.)
| | - Jennifer K. Plichta
- Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA (J.K.P.)
| | - Shivanand P. Lad
- Department of Neurosurgery, Duke University Medical Center, Durham, NC 27710, USA
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van der Horst A, Meijer L, van Os-Medendorp H, Jukema JS, Bohlmeijer E, Schreurs KM, Kelders S. Benefits, Recruitment, Dropout, and Acceptability of the Strength Back Digital Health Intervention for Patients Undergoing Spinal Surgery: Nonrandomized, Qualitative, and Quantitative Pilot Feasibility Study. JMIR Form Res 2024; 8:e54600. [PMID: 38324374 PMCID: PMC10882475 DOI: 10.2196/54600] [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: 11/16/2023] [Revised: 12/21/2023] [Accepted: 12/22/2023] [Indexed: 02/08/2024] Open
Abstract
BACKGROUND Patients undergoing spinal surgery report high levels of insecurity, pain, stress, and anxiety before and after surgery. Unfortunately, there is no guarantee that surgery will resolve all issues; postsurgical recovery often entails moderate to severe postoperative pain, and some patients undergoing spinal surgery do not experience (long-term) pain relief after surgery. Therefore, focusing on sustainable coping skills and resilience is crucial for these patients. A digital health intervention based on acceptance and commitment therapy (ACT) and positive psychology (PP) was developed to enhance psychological flexibility and well-being and reduce postsurgical pain. OBJECTIVE The objective of this study was 3-fold: to explore the potential benefits for patients undergoing spinal surgery of the digital ACT and PP intervention Strength Back (research question [RQ] 1), explore the feasibility of a future randomized controlled trial in terms of recruitment and dropout (RQ 2), and assess the acceptability of Strength Back by patients undergoing spinal surgery (RQ 3). METHODS We used a nonrandomized experimental design with an intervention group (n=17) and a control group (n=20). To explore the potential benefits of the intervention, participants in both groups filled out questionnaires before and after surgery. These questionnaires included measurements of pain intensity (Numeric Pain Rating Scale), pain interference (Multidimensional Pain Inventory), anxiety and depression (Hospital Anxiety and Depression Scale), valued living (Engaged Living Scale), psychological flexibility (Psychological Inflexibility in Pain Scale), and mental well-being (Mental Health Continuum-Short Form). Semistructured interviews combined with log data and scores on the Twente Engagement With eHealth Technologies Scale were used to assess the acceptability of the intervention. RESULTS A significant improvement over time in emotional (V=99; P=.03) and overall (V=55; P=.004) well-being (Mental Health Continuum-Short Form) was observed only in the intervention group. In addition, the intervention group showed a significantly larger decline in pain intensity (Numeric Pain Rating Scale) than did the control group (U=75; P=.003). Of the available weekly modules on average 80% (12/15) was completed by patients undergoing spinal fusion and 67% (6/9) was completed by patients undergoing decompression surgery. A total of 68% (17/25) of the participants used the intervention until the final interview. Most participants (15/17, 88%) in the intervention group would recommend the intervention to future patients. CONCLUSIONS This pilot feasibility study showed that combining ACT and PP in a digital health intervention is promising for patients undergoing spinal surgery as the content was accepted by most of the participants and (larger) improvements in pain intensity and well-being were observed in the intervention group. A digital intervention for patients undergoing (spinal) surgery can use teachable moments, when patients are open to learning more about the surgery and rehabilitation afterward. A larger randomized controlled trial is now warranted.
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Affiliation(s)
- Annemieke van der Horst
- Research Group Smart Health, Saxion University of Applied Sciences, Deventer, Netherlands
- Department of Psychology, Health and Technology, Centre for eHealth & Well-being Research - Behavioural, Management and Social Sciences, University of Twente, Enschede, Netherlands
| | - Laura Meijer
- Research Group Smart Health, Saxion University of Applied Sciences, Deventer, Netherlands
| | | | - Jan S Jukema
- Research Group Smart Health, Saxion University of Applied Sciences, Deventer, Netherlands
| | - Ernst Bohlmeijer
- Department of Psychology, Health and Technology, Centre for eHealth & Well-being Research - Behavioural, Management and Social Sciences, University of Twente, Enschede, Netherlands
| | - Karlein Mg Schreurs
- Department of Psychology, Health and Technology, Centre for eHealth & Well-being Research - Behavioural, Management and Social Sciences, University of Twente, Enschede, Netherlands
- Roessingh Research & Development, Enschede, Netherlands
| | - Saskia Kelders
- Department of Psychology, Health and Technology, Centre for eHealth & Well-being Research - Behavioural, Management and Social Sciences, University of Twente, Enschede, Netherlands
- Optentia Research Focus Area, North-West University, Vanderbijlpark, South Africa
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Venkatraman V, Heo H, Kaplan S, Parente BA, Lad SP. Digital Health for Patients Undergoing Spine Surgery: A Systematic Review. World Neurosurg 2024; 182:70-82. [PMID: 37967741 DOI: 10.1016/j.wneu.2023.11.035] [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: 07/12/2023] [Revised: 11/07/2023] [Accepted: 11/08/2023] [Indexed: 11/17/2023]
Abstract
OBJECTIVE Digital health tools, including smartphone applications (apps), websites, and online search engines, are increasingly being utilized for health data collection and patient education. Studies have shown that these tools can help disseminate information widely and even help guide patients through acute surgical episodes. We aimed to search the literature to summarize available studies on using digital health tools for patients undergoing spine surgery. METHODS We conducted a systematic review of PubMed MEDLINE, Elsevier EMBASE, and Elsevier Scopus databases, as well as ClinicalTrials.gov up to March 11, 2022. RESULTS Forty-four full-text articles were included and qualitatively analyzed. Studies were broadly grouped into those that analyzed the quality of web-based materials for patients, the quality of YouTube videos for spine surgery, the development, feasibility, and implementation of mobile apps for patients, and randomized controlled trials for integrating mobile apps into perioperative care. CONCLUSIONS We presented a systematic review analyzing the current landscape of digital health for patients undergoing spine surgery. Internet patient education materials in searchable websites and YouTube videos are of poor quality, lacking in readability to the average patient and robustness of information needed for patients to make informed decisions about pursuing spine surgery. However, there lies promise in digital apps developed to guide patients through surgery and collect postoperative outcomes.
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Affiliation(s)
- Vishal Venkatraman
- Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA
| | - Helen Heo
- Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA
| | - Samantha Kaplan
- Medical Center Library & Archives, Duke University School of Medicine, Durham, NC, USA
| | - Beth A Parente
- Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA
| | - Shivanand P Lad
- Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA.
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Venkatraman V, Bharmi R, Coletti F, Gellad ZF, Lempel N, Amit R, Blank N, Brown J, Kumar C, Fishman M, Vallejo R, Datta D, Reeve BB, Chakravarthy K, Sharan AD, Lad SP. Real World Characterization of Chronic Pain, Success Rates and Implant Rates: Evidence from a Digital Health Platform of Patients Undergoing Spinal Cord Stimulation Evaluations. THE JOURNAL OF PAIN 2023; 24:2228-2239. [PMID: 37541604 PMCID: PMC11225030 DOI: 10.1016/j.jpain.2023.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 06/17/2023] [Accepted: 07/06/2023] [Indexed: 08/06/2023]
Abstract
Spinal cord stimulation is an effective treatment for those experiencing chronic back and leg pain but requires a temporary evaluation period (SCSeval) before permanent implantation. We present real-world data from 7,000 patients who underwent SCSeval while utilizing a mobile digital health platform for education, feedback, and outcomes collection during their surgical journey. We analyzed preoperative patient demographics, characterized patient pain profiles using the patient-reported outcomes measurement information system-29 surveys, and calculated the rates of conversion from temporary to permanent spinal cord stimulation (SCS) implantation. Between August 1, 2021, and March 2, 2023, 7,000 patients (mean age 59.1, 59.6% female) underwent SCSeval procedures while utilizing a mobile application. Patients commonly experienced aching, sharp, stabbing, tingling, numb, and burning pain. Patients had tried multiple prior therapies and wanted to reduce their use of opioids and pain medications. Overall, 90.1% of the patients had a successful SCSeval, and 80.4% of those converted to permanent implant, with the highest rates among those who underwent SCSeval in a hospital setting. There was a significant improvement in all domains of pain as evaluated by pre and postoperative patient-reported outcomes measurement information system-29 surveys. This study supports the use of digital health technology as part of the SCS journey to improve the patient experience and allow for robust patient-reported outcomes collection. The overall rate of SCSeval to permanent SCS in our study of 72.4% was higher than national rates of 64%, suggesting that an app may allow clinicians to better quantify changes in chronic pain and provide more insight into choosing to implant SCS permanently. PERSPECTIVE: This article presents real-world evidence from a digital health platform for therapy education and outcomes collection from patients undergoing spinal cord stimulation evaluation procedures. Such tools could allow for better pain characterization and allow for more nuanced tracking of patient outcomes among those with chronic pain.
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Affiliation(s)
- Vishal Venkatraman
- Department of Neurosurgery, Duke University School of Medicine, Durham, NC, USA
| | | | | | - Ziad F. Gellad
- Division of Gastroenterology, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Noa Lempel
- Nutrino Health, Medtronic, Tel Aviv, Israel
| | - Roy Amit
- Nutrino Health, Medtronic, Tel Aviv, Israel
| | | | - Jason Brown
- Medtronic Neuromodulation, Minneapolis, MN, USA
| | | | - Michael Fishman
- Center for Interventional Pain and Spine, Exton, Pennsylvania, USA
| | | | | | - Bryce B. Reeve
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Krishnan Chakravarthy
- Coastal Pain and Spinal Diagnostics, San Diego, CA, USA
- Department of Anesthesiology, UC San Diego School of Medicine, La Jolla, CA, USA
| | | | - Shivanand P. Lad
- Department of Neurosurgery, Duke University School of Medicine, Durham, NC, USA
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