189. SpineTrak: the first randomized controlled trial using the Apple Watch to objectively track spine surgical patients

Early mobilization after surgery is associated with reduced complications, decreased length of hospitalization, and greater psychological well-being. Current methods for evaluating spine surgery outcomes are limited and rely on patient-reported outcome measures (PROMs), which are subjective and may be influenced by psychiatric comorbidities and chronic pain. Wearable activity monitors, including the Apple Watch (AW), allow for real-time tracking of objective activity, including steps, distance traveled, flights climbed, etc. The AW is one of the most widely available commercial monitors (representing 51% of global market share), and prior studies have shown its activity data to be reliable and reproducible. The goals of our study are (1) To determine the feasibility of wearing the AW before/after surgery; (2) To determine whether objective metrics correlate with PROMs before/after surgery; (3) To evaluate whether surgery improves AW objective measures; (4) To investigate whether patients are more satisfied with their care and have a better understanding of their recovery using the AW; and (5) To determine a novel composite metric combining objective and subjective measures to better predict postoperative spine surgery recovery. Single-site randomized controlled trial. Eligibility was restricted to all English-speaking adult patients who have iPhones and are undergoing elective spine surgery (excluding patients with spine trauma, tumors, or infection) at Stanford University Hospital across five spine surgeons. Our target enrollment was 100 intervention and 100 control patients. Our outcome measures include patient-reported quality-of-life surveys: SF-36, EQ-5D, PROMIS-29, ODI or NDI, and VAS Pain Scale. We also assessed Apple Watch activity metrics, including watch wear time and daily steps, distance travelled, flights climbed, and standing time. Patients were randomized 1:1 to the intervention vs control group. All patients complete PROMs preoperatively and at 6-weeks, 3-months, 6-months, and 1-year postoperatively. At each follow-up visit, all patients complete a study-specific questionnaire regarding satisfaction and understanding of recovery. Only intervention patients receive an AW to wear 2-6 weeks preoperatively and for one year after surgery. AW health measures are collected via a study-specific app and visualized in objective progress reports provided to patients and surgeons at follow-up visits. To date, we have enrolled 198 patients (n=98 intervention; n=100 control). On average, intervention patients (n=92) have worn the AW 81.5%±21.8% of the days since enrollment for 14.5±4.7 hours/day. At 6-weeks postoperation, 74% of patients responded that they were very or extremely satisfied with using the AW in their spine care. 62% found seeing their AW activity data helpful. In total, 95% of neurosurgeons agreed that AW reports help them understand their patients’ recovery. Preliminary analyses of patient recovery profiles have predicted the requirement for revision surgery in some participants. Preliminary results indicate patients are compliant with wearing the AW, and both patients and surgeons are satisfied with its use in their spine care. Initial analyses suggest poor correlation between AW measures and PROMs, emphasizing the need for a metric that combines objective and subjective measures to better track spine surgery recovery. This abstract does not discuss or include any applicable devices or drugs.