Department of Neurosurgery, Stanford University Hospital and Clinics, Stanford , California , USA.
Department of Neurosurgery, University Hospital Zurich & Clinical Neuroscience Center, University of Zurich, Zurich , Switzerland.
Neurosurgery. 2024 Apr 1;94(4):788-796. doi: 10.1227/neu.0000000000002755. Epub 2023 Nov 13.
Degenerative thoracolumbar disorders (DTDs) typically cause pain and functional impairment. However, little is known regarding the DTD impact on patient's real-life physical activity. The objective of this study is to validate a wearable measure of physical activity monitoring in patients with DTD and to create gender- and sex-specific performance thresholds that are standardized to the mean of a control population.
A commercially available smartwatch (Apple Watch) was used to monitor preoperative physical activity in patients undergoing surgery for DTD. Mean preoperative physical activity 2 weeks before the scheduled surgery was expressed as raw step count. Standardized z-scores were referenced to age- and sex-specific values of a control population from a large public database. Step counts were assessed for convergent validity with established patient-reported outcome measures, and impairment in activity was stratified into performance groups based on z-score cutoff values.
Sixty-five patients (62% female) with a mean (±SD) age of 63.8 (±12.8) years had a mean preoperative daily step count of 5556 (±3978). Physical activity showed significant correlation with patient-reported outcome measures, including Oswestry disability index (r = -0.26, 95% CI: -0.47-0.01), 36-Item Short Form Survey Physical Component Summary score (r = 0.30, 95% CI: 0.06-0.51), and Patient-Reported Outcomes Measurement Information System Physical Function (r = 0.49, 95% CI: 0.27-0.65). "No," "Mild," "moderate," and "severe impairment" in activity performance were defined as corresponding z-scores of >0, 0 to -0.99, -1 to -1.99, and ≤-2, accounting for 22%, 34%, 40%, and 5% of the study population. Each one-step category increase in activity impairment resulted in increased subjective disability as measured by the Oswestry Disability Index, 36-Item Short Form Survey Physical Component Summary, and Patient-Reported Outcomes Measurement Information System Physical Function (all P -values <.05).
We establish the first wearable objective measure of real-life physical activity for patients with DTD, with the first age- and sex-adjusted standard scores to enable clinicians and researchers to set treatment goals and directly compare activity levels between individual patients with DTD and normal controls.
退行性胸腰椎疾病（DTDs）通常会引起疼痛和功能障碍。然而，对于 DTD 对患者实际身体活动的影响，人们知之甚少。本研究的目的是验证一种可穿戴的身体活动监测方法在 DTD 患者中的有效性，并创建针对特定性别和性别的性能阈值，这些阈值以大样本数据库中对照人群的平均值为标准。
使用市售的智能手表（Apple Watch）监测接受 DTD 手术患者术前的身体活动。术前 2 周的平均日常活动量以原始计步数表示。标准化 z 分数参考了来自大型公共数据库的年龄和性别特定的对照人群值。根据 z 分数截断值，将活动能力障碍分为不同的表现组。
65 名（62%为女性）患者的平均（±SD）年龄为 63.8（±12.8）岁，术前每日平均计步数为 5556（±3978）。身体活动与患者报告的结果测量指标有显著相关性，包括 Oswestry 残疾指数（r = -0.26，95%CI：-0.47-0.01）、36 项简短健康调查生理成分综合评分（r = 0.30，95%CI：0.06-0.51）和患者报告的结局测量信息系统生理功能（r = 0.49，95%CI：0.27-0.65）。活动表现的“无”“轻度”“中度”和“重度”障碍定义为相应的 z 分数＞0、0 至-0.99、-1 至-1.99 和≤-2，占研究人群的 22%、34%、40%和 5%。活动障碍每增加一个等级，Oswestry 残疾指数、36 项简短健康调查生理成分综合评分和患者报告的结局测量信息系统生理功能的主观残疾程度都会增加（所有 P 值均＜.05）。
我们建立了首个针对 DTD 患者真实生活身体活动的可穿戴客观测量方法，并首次制定了年龄和性别调整的标准分数，使临床医生和研究人员能够设定治疗目标，并直接比较 DTD 患者和正常对照个体之间的活动水平。
