Current and future applications of mobile health technology for evaluating spine surgery patients: a review

Jacob K. GreenbergDepartments of Neurological Surgery,
Department of Neurological Surgery, Cleveland Clinic, Cleveland, Ohio;

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Saad JaveedDepartments of Neurological Surgery,

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Justin K. ZhangDepartments of Neurological Surgery,

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Braeden BenedictDepartments of Neurological Surgery,

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Madelyn R. FrumkinPsychology and Brain Sciences,

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Ziqi XuComputer Science and Engineering, and

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Jingwen ZhangComputer Science and Engineering, and

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Thomas L. RodebaughPsychology and Brain Sciences,

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Chenyang LuComputer Science and Engineering, and

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Jay F. PiccirilloOtolaryngology, Washington University, St. Louis, Missouri;

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Michael SteinmetzDepartment of Neurological Surgery, Cleveland Clinic, Cleveland, Ohio;

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Zoher GhogawalaDepartment of Neurological Surgery, Lahey Clinic, Burlington, Massachusetts; and

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Mohamad BydonDepartment of Neurological Surgery, Mayo Clinic, Rochester, Minnesota

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Wilson Z. RayDepartments of Neurological Surgery,

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Mobile health (mHealth) technology has assumed a pervasive role in healthcare and society. By capturing real-time features related to spine health, mHealth assessments have the potential to transform multiple aspects of spine care. Yet mHealth applications may not be familiar to many spine surgeons and other spine clinicians. Consequently, the objective of this narrative review is to provide an overview of the technology, analytical considerations, and applications of mHealth tools for evaluating spine surgery patients. Reflecting their near-ubiquitous role in society, smartphones are the most commonly available form of mHealth technology and can provide measures related to activity, sleep, and even social interaction. By comparison, wearable devices can provide more detailed mobility and physiological measures, although capabilities vary substantially by device. To date, mHealth evaluations in spine surgery patients have focused on the use of activity measures, particularly step counts, in an attempt to objectively quantify spine health. However, the correlation between step counts and patient-reported disease severity is inconsistent, and further work is needed to define the mobility metrics most relevant to spine surgery patients. mHealth assessments may also support a variety of other applications that have been studied less frequently, including those that prevent postoperative complications, predict surgical outcomes, and serve as motivational aids to patients. These areas represent key opportunities for future investigations. To maximize the potential of mHealth evaluations, several barriers must be overcome, including technical challenges, privacy and regulatory concerns, and questions related to reimbursement. Despite those obstacles, mHealth technology has the potential to transform many aspects of spine surgery research and practice, and its applications will only continue to grow in the years ahead.

ABBREVIATIONS

EHR = electronic health record; EMA = ecological momentary assessment; GPi = gait posture index; GPS = global positioning system; mHealth = mobile health; PROM = patient-reported outcome measure.
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