Clinical Utility and Patient Compliance With Mobile Applications for Home-based Rehabilitation Following Cervical Spine Fusion.

Abstract

Retrospective study. (1) To compare patient-reported outcome measures (PROMs) between postoperative patients who were the most and least compliant in using mobile-based rehabilitation programs, (2) compare PROMs between patients undergoing anterior cervical discectomy and fusion (ACDF) versus cervical posterior decompression and instrumented fusion (PDIF), and (3) quantify the overall compliance rate. Mobile applications for rehabilitation have been widely used following orthopedic procedures. There is limited data describing the utility and compliance with self-directed programs and their effects on PROMs following ACDF or PDIF. A retrospective review was performed identifying patients who underwent elective ACDF or cervical PDIF for degenerative pathology. Patient-Reported Outcomes Measurement Information System (PROMIS) and Neck Disability Index (NDI) scores were collected perioperatively and assessed longitudinally. Patients were separated into 2 study groups based on application compliance and fusion construct. Patient compliance and engagement were defined as those who downloaded the application (DL+) and set therapy session reminders (R+) on their mobile devices. Compliance rate was calculated as the difference between the number of active participants at the preoperative phase and final follow-up. Descriptive and inferential statistics were performed. A total of 775 patients (ACDF, n=571; PDIF, n=204) were included. No difference was found in ∆PROMIS overall (P=0.205) or ∆NDI (P=0.441) regardless of patient compliance and engagement to the therapy program. No difference was found in the improvement of outcomes scores between ACDF or PDIF cohorts as stratified by DL+/DL- and R+/R- at any postoperative point. Overall patient compliance rate to the program at final postoperative follow-up was 71% (ACDF: 71.8%, PDIF: 69.2%). Mobile applications for postoperative rehabilitation demonstrated low clinical utility following ACDF or PDIF for degenerative diseases, despite high patient compliance and growing popularity. Level III.