BACKGROUND CONTEXT Patient-reported outcome measures (PROMs), including the Oswestry Disability Index (ODI), EQ-5D, and PROMIS instruments, are widely used to evaluate functional status in patients undergoing spine surgery. However, PROMs primarily reflect patient perception and may not fully capture changes in real-world physical activity before and after surgery. Smartphone-collected step counts provide objective, longitudinal measures of daily activity and offer complementary insight into functional change, yet their relationship with PROM changes remains incompletely characterized, particularly across different lumbar spine procedures. PURPOSE To evaluate changes in smartphone-collected step counts and PROMs before and after lumbar spine surgery, and to examine relationships between changes in objective activity and patient-reported outcomes, including differences between fusion and decompression procedures. STUDY DESIGN/SETTING Retrospective cohort study. PATIENT SAMPLE Eighty-eight patients undergoing lumbar spine surgery (45 decompression, 43 fusion). OUTCOME MEASURES Changes in smartphone-collected daily step counts and PROMs (ODI, EQ-5D, PROMIS), and associations between objective activity and PROM changes. METHODS Smartphone step count data and PROMs were retrospectively collected following IRB approval. Preoperative PROM status was defined as the lowest value within three months prior to surgery, and postoperative status as the most distal value within three months after surgery. Step counts were averaged within ±7- and ±14-day windows around PROM assessments, and changes were calculated between pre- and postoperative periods. Associations between changes in step counts and PROMs were evaluated using descriptive and correlational analyses, stratified by procedure type. RESULTS Postoperative step counts increased in both fusion and decompression cohorts. PROM changes varied by domain and were not consistently aligned with step count improvements. Decompression patients demonstrated more consistent agreement between increased step counts and improved PROMs, whereas fusion patients showed greater variability. Correlational analyses revealed procedure- and domain-specific relationships between objective activity changes and PROMs. CONCLUSIONS Objective physical activity changes, measured via step counts, demonstrate procedure-specific relationships with PROM changes after lumbar spine surgery. While step counts generally increased postoperatively, PROM responses varied, highlighting incomplete concordance. Smartphone-derived activity data provide complementary insights into functional recovery and may enhance interpretation of postoperative outcomes when integrated with PROMs. FDA Device/Drug Status This abstract does not discuss or include any applicable devices or drugs.
OBJECTIVE Malalignment following cervical spine deformity (CSD) surgery can negatively impact outcomes and increase complications. Despite the growing ability to plan alignment, it remains unclear whether preoperative goals are achieved with surgery. The objective of this study was to assess how good surgeons are at achieving their preoperative goal alignment following CSD surgery. METHODS Adult patients with CSD were prospectively enrolled into a multicenter registry. Surgeons documented alignment goals prior to surgery, including C2–7 sagittal vertical axis (SVA), C2–7 sagittal Cobb angle, T1 slope minus cervical lordosis (TS-CL), and C7–S1 SVA. Goals were compared with achieved alignment, and the offsets (achieved goal) were calculated. General linear models were created for offset magnitude for each alignment parameter, controlling for baseline deformity and surgical factors. RESULTS The 88 enrolled patients had a mean age of 63.6 ± 13.0 years. The mean number of anterior and posterior instrumented levels was 3.5 ± 1.0 and 10.6 ± 4.5, respectively. Surgeons failed to achieve their preoperative alignment goals by an average of 17.2 (range 0.1–75.4) mm for C2–7 SVA, 10.3° (range 0.1°–45.5°) for C2–7 sagittal Cobb angle, 15.6° (range 0.0°–42.9°) for TS-CL, and 34.2 (range 0.3–113.7) mm for C7–S1 SVA. The sagittal alignment parameters with the highest rate of extreme outliers were TS-CL and C7–S1 SVA, with 32.2% exceeding 20° and 60.8% exceeding 20 mm from goal alignment, respectively. After controlling for baseline deformity and operative parameters, the only factor associated with achieving targeted alignment for C2–7 sagittal Cobb angle was greater baseline thoracic kyphosis (TK; B = −0.148, 95% CI −0.288 to −0.007, p = 0.040), and for TS-CL, the only associated factor was lower baseline TS-CL (B = 0.187, 95% CI 0.027–0.347, p = 0.022). Both lower TK and greater TS-CL may reflect increased baseline deformity through greater thoracic compensation and increased TS-CL mismatch, respectively. No significant associations were identified for C2–7 SVA and C7–S1 SVA. CONCLUSIONS Surgeons failed to achieve their preoperative alignment goals by an average of 17.2 mm for C2–7 SVA, 10.3° for C2–7 sagittal Cobb angle, 15.6° for TS-CL, and 34.2 mm for C7–S1 SVA. The few factors identified that were associated with offset between goal and achieved alignment suggest that achievement of goal alignment was most challenging for more severe deformities. Further advancements are needed to enable more consistent translation of preoperative alignment goals into the operating room for adult CSD correction. Clinical trial registration no.: NCT01588054 (ClinicalTrials.gov).
RATIONALE Burnout is prevalent throughout healthcare and critical care practitioners have some of the highest rates. Cross-sectional research suggests that professional relationships such as healthy nurse-physician communication may provide a buffer against burnout, but are unable to determine prospective relationships. At present, it is unclear if poor nurse-physician communication may elicit burnout, burnout undermines communication, or both enter into a reciprocal downward spiral. Understanding the direction of this association is important for informing team-based interventions and process-improvements. METHODS To explore this, a secondary analysis was conducted with data from a previously published communication intervention. In this study, care providers (nurses, advanced practice providers, and physicians) in an academic, tertiary-care ICU were asked to complete monthly assessments of burnout and collaboration throughout 3-month pre-intervention and 3-month intervention periods. Burnout was assessed using the Maslach Burnout Inventory (MBI) which measures emotional exhaustion, depersonalization, and personal accomplishment. Collaboration and communication were assessed using the Nurse-Physician Collaboration Scale (NPCS) which measures joint decision-making, sharing patient information, and collaboration. Linear mixed effects models were computed to assess prospective relationships between change in NPCS scores and subsequent change in facets of burnout. During the intervention period, brief and simplified written patient updates were provided daily by the physician or advanced practice provider. These updates were sent to the patients’ families and posted in the electronic medical record so it was viewable to all team members. RESULTS When averaged across the entire study, participants who reported higher levels of joint decision making (r =.34, p =.006) and collaboration ( r =.29, p =.018) tended to report lower levels of depersonalization. Lagged change in joint decision making was associated with reductions in later depersonalization (p =.014). Lagged change in collaboration was associated with reductions in later depersonalization (p =.039), and emotional exhaustion (p =.024). Lagged change in sharing information was associated with subsequent increase in personal accomplishment (p=.046). Tests of reciprocal relationships did not show an association between facets of burnout with subsequent NPCS change except a non-significant trend for decreases in depersonalization to predict subsequent improvement in collaboration ( p =.081) CONCLUSIONS Improvements in collaboration and communication between nurses and physicians preceded improvements in burnout, but not vice versa. Further work is needed to assess how systems-level processes such as collaboration can promote workplace well-being and buffer against burnout.
