Multidomain postoperative recovery trajectories after lumbar and thoracolumbar spine surgery

BACKGROUND CONTEXT: Understanding early postoperative recovery is crucial for improving perioperative care and long-term outcomes. Traditional recovery assessments relying primarily on cross-sectional patient-reported measures may not fully capture the complexity of the recovery process. PURPOSE: Our study evaluates early postoperative recovery using mobile health assessment and explores the relationship between early recovery patterns, multidomain recovery, and long-term outcomes. STUDY DESIGN/SETTING: A prospective observational study. PATIENT SAMPLE: A total of 129 patients were included in the analysis. OUTCOME MEASURES: Patient-reported outcome measures (PROMs) of pain, physical function, and disability at 1, 6 and 12 months postoperatively. METHODS: This study recruited patients aged 21 to 85 undergoing lumbar/thoracolumbar surgery for degenerative diseases. During the first month postoperatively, patients completed daily Ecological Momentary Assessment (EMA) surveys assessing pain, depression, and physical function and were passively monitored with Fitbit. EMA and Fitbit data (steps per minute, Maximum 30-minute cadence, and activity bout number) were clustered using functional principal component analysis. RESULTS: 129 patients were included (median age: 62; 56% female). Two dominant recovery patterns were identified across all domains. At 12 months, patients with more favorable recovery across all domains except for activity bout number and depression, showed better outcomes. Favorable recovery in pain intensity and steps per minute was associated with greater improvements in all outcomes, while favorable recovery in maximum 30-minute cadence was associated with greater improvement in disability and physical function. Patients with less favorable pain recovery had a significantly higher complication rate (23% vs. 7%). A greater number of favorable recovery domains was associated with better 12-month outcomes improvement and demonstrated superior prognostic value compared to traditional patient assessment methods. CONCLUSION: Early postoperative recovery patterns and multidomain recovery, captured using mHealth tools, provide valuable insights into long-term outcomes. With further validation, these findings highlight the potential of integrating mHealth into clinical practice to personalize rehabilitation strategies, improve resource allocation, and enhance patient care.