J Korean Neurosurg Soc.  2019 Sep;62(5):561-566. 10.3340/jkns.2018.0131.

The Usefulness of a Wearable Device in Daily Physical Activity Monitoring for the Hospitalized Patients Undergoing Lumbar Surgery

• Kim DH
• Nam KH
• Choi BK
• Han IH
• Jeon TJ
• Park SY

• KMID: 2457946
• DOI: http://doi.org/10.3340/jkns.2018.0131

Abstract

OBJECTIVE
Functional outcomes have traditionally been evaluated and compared using subjective surveys, such as visual analog scores (VAS), the Oswestry disability index (ODI), and Short Form-36 (SF-36), to assess symptoms and quality of life. However, these surveys are limited by their subjective natures and inherent bias caused by differences in patient perceptions of symptoms. The Fitbit Charge® (Fitbit Inc., San Francisco, CA, USA) provides accurate and objective measures of physical activity. The use of this device in patients after laminectomy would provide objective physical measures that define ambulatory function, activity level, and degree of recovery. Therefore, the present study was conducted to identify relationships between the number of steps taken by patients per day and VAS pain scores, prognoses, and postoperative functional outcomes.
METHODS
We prospectively investigated 22 consecutive patients that underwent laminectomy for spinal stenosis or a herniated lumbar disc between June 2015 and April 2016 by the same surgeon. When patients were admitted for surgery and first visited after surgery, preoperative and postoperative functional scores were recorded using VAS scores, ODI scores, and SF-36. The VAS scores and physical activities were recorded daily from postoperative day (POD) 1 to POD 7. The relationship between daily VAS scores and daily physical activities were investigated by simple correlation analysis and the relationship between mean number of steps taken and ODI scores after surgery was subjected to simple regression analysis. In addition, Wilcoxon's signed-rank test was used to investigate the significance of pre-to-postoperative differences in VAS, ODI, and SF-36 scores.
RESULTS
Pre-to-postoperative VAS (p<0.001), ODI (p<0.001), SF-36 mental composite scores (p=0.009), and SF-36 physical composite scores (p<0.001) scores were found to be significantly different. Numbers of steps taken from POD 1 to POD 7 were negatively correlated with daily VAS scores (r=-0.981, p<0.001). In addition, the mean number of steps from POD 3 to POD 7 and the decrease in ODI conducted one month after surgery were statistically significant (p=0.029).
CONCLUSION
Wearable devices are not only being used increasingly by consumers as lifestyle devices, but are also progressively being used in the medical area. This is the first study to demonstrate the usefulness of a wearable device for checking patient physical activity and predicting pain and prognosis after laminectomy. Based on our experience, the wearable device used to provide measures of physical activity in the present study has the potential to provide objective information on pain severity and prognosis.

Keyword

Wearable electronic device; Visual analog scale; Laminectomy; Exercise

MeSH Terms

Bias (Epidemiology)
Humans
Laminectomy
Life Style
Motor Activity*
Prognosis
Prospective Studies
Quality of Life
Spinal Stenosis
Visual Analog Scale

Figure

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  Fig. 1. Negative linear correlation of mean value of VAS and number of steps from POD 1 to POD 7. VAS : visual analog scores, POD : postoperative day.

Reference

References

1. Adam Noah J, Spierer DK, Gu J, Bronner S. Comparison of steps and energy expenditure assessment in adults of Fitbit tracker and ultra to the actical and indirect calorimetry. J Med Eng Technol. 37:456–462. 2013.

2. Berlin JE, Storti KL, Brach JS. Using activity monitors to measure physical activity in free-living conditions. Phys Ther. 86:1137–1145. 2006.

3. Cadmus-Bertram LA, Marcus BH, Patterson RE, Parker BA, Morey BL. Randomized trial of a Fitbit-based physical activity intervention for women. Am J Prev Med. 49:414–418. 2015.

4. Chapman JR, Norvell DC, Hermsmeyer JT, Bransford RJ, DeVine J, McGirt MJ, et al. Evaluating common outcomes for measuring treatment success for chronic low back pain. Spine (Phila Pa 1976). 36(21 Suppl):S54–S68. 2011.

5. Chen KY, Bassett DR Jr. The technology of accelerometry-based activity monitors: current and future. Med Sci Sports Exerc. 37(11 Suppl):S490–S500. 2005.

6. Culhane KM, O’Connor M, Lyons D, Lyons GM. Accelerometers in rehabilitation medicine for older adults. Age Ageing. 34:556–560. 2005.

7. Diaz KM, Krupka DJ, Chang MJ, Peacock J, Ma Y, Goldsmith J, et al. Fitbit^®: an accurate and reliable device for wireless physical activity tracking. Int J Cardiol. 185:138–140. 2015.

8. Dimitrov DV. Medical internet of things and big data in healthcare. Healthc Inform Res. 22:156–163. 2016.

9. Gershenfeld N, Krikorian R, Cohen D. The internet of things. Sci Am. 291:76–81. 2004.

10. Hao A, Wang L. Medical device integration model based on the internet of things. Open Biomed Eng J. 9:256–261. 2015.

11. Iversen MD, Katz JN. Examination findings and self-reported walking capacity in patients with lumbar spinal stenosis. Phys Ther. 81:1296–1306. 2001.

12. Metcalf D, Milliard ST, Gomez M, Schwartz M. Wearables and the internet of things for health: wearable, interconnected devices promise more efficient and comprehensive health care. IEEE Pulse. 7:35–39. 2016.

13. Mobbs RJ, Phan K, Maharaj M, Rao PJ. Physical activity measured with accelerometer and self-rated disability in lumbar spine surgery: a prospective study. Global Spine J. 6:459–464. 2016.

14. Noorkõiv M, Rodgers H, Price CI. Accelerometer measurement of upper extremity movement after stroke: a systematic review of clinical studies. J Neuroeng Rehabil. 11:144. 2014.

15. Pantelopoulos A, Bourbakis NG. A survey on wearable sensor-based systems for health monitoring and prognosis. IEEE Trans Syst Man Cybern. 40:1–12. 2010.

16. Park S, Jayaraman S. Enhancing the quality of life through wearable technology. IEEE Trans Inf Technol Biomed. 22:41–48. 2003.

17. Pryce R, Johnson M, Goytan M, Passmore S, Berrington N, Kriellaars D. Relationship between ambulatory performance and self-rated disability in patients with lumbar spinal stenosis. Spine (Phila Pa 1976). 37:1316–1323. 2012.

18. Scheer JK, Bakhsheshian J, Keefe MK, Lafage V, Bess S, Protopsaltis TS, et al. Initial experience with real-time continuous physical activity monitoring in patients undergoing spine surgery. Clin Spine Surg. 30:E1434–E1443. 2017.

19. Takacs J, Pollock CL, Guenther JR, Bahar M, Napier C, Hunt MA. Validation of the Fitbit one activity monitor device during treadmill walking. J Sci Med Sport. 17:496–500. 2014.