Spine Journal - 2026-07-15 - Journal Article; Review
Comparing patient-reported outcomes with objective surgical outcome measures using wearable technology in lumbar spine surgery: A systematic review and meta-analysis.
Slosar N, Carne P, Szerlip N, Bhowmick DA, Kazemi NJ
Topics
Key Takeaway
Wearable-derived mobility metrics correlate strongly with disability PROMs after lumbar spine surgery (r=0.646), moderately with pain (r=0.459), and weakly with health-related quality of life (r=0.357).
Summary Depth
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Summary
This PRISMA-compliant systematic review and meta-analysis screened 10,831 records to identify 14 studies reporting both wearable-derived gait metrics and PROMs following lumbar degenerative surgery. Fisher z-transformed correlations pooled under random-effects models demonstrated that changes in wearable metrics (step count, gait velocity, composite indices) correlated most strongly with disability outcomes (r=0.646), moderately with pain (r=0.459), and weakly with HRQL (r=0.357). Gait velocity and composite indices outperformed daily step counts across all PROM domains.
Key Limitation
Only 8 studies contributed to the meta-analysis with heterogeneous wearable devices, metric definitions, and postoperative timepoints, precluding conclusions about optimal measurement protocols or device-specific performance.
Original Abstract
BACKGROUND CONTEXT
Patient-reported outcome measures (PROMs) are considered the gold standard for assessing recovery following lumbar spine surgery, but they are subjective and may incompletely capture functional change. Wearable technologies, such as accelerometers and activity monitors, offer objective and continuous data. The extent to which wearable-derived metrics correlate with traditional PROMs remains uncertain.
PURPOSE
To characterize the association between wearable-derived mobility metrics and PROMs following lumbar spine surgery and quantify domain-specific correlations.
STUDY DESIGN
Systematic review and meta-analysis conducted according to PRISMA guidelines.
METHODS
A comprehensive search of PubMed/MEDLINE, Embase/Elsevier, and CINAHL was performed through August 2025, identifying 10,831 records. Eligible studies included patients undergoing lumbar surgery for degenerative conditions, reporting both PROMs and wearable-derived gait data, and providing correlation coefficients. For quantitative synthesis, studies reporting Pearson correlations of change in wearable-derived mobility metrics (e.g., step count, gait velocity) with change in PROMs were included. One effect per study per domain (disability, pain, health-related quality of life [HRQL]) was extracted at the first postoperative timepoint ≥6 weeks. Correlations were Fisher z-transformed and pooled under random-effects models.
RESULTS
Fourteen studies met inclusion criteria, eight of which contributed to the meta-analysis. Pooled change-change correlations showed a strong association with disability (r = 0.646, 95% CI 0.475-0.770), moderate association with pain (r = 0.459, 95% CI 0.235-0.637), and weaker association with HRQL (r = 0.357, 95% CI 0.066-0.592). Gait velocity and composite indices had stronger correlations with PROM changes than daily step counts, which were less consistent.
CONCLUSION
Wearable-derived mobility metrics significantly correlate with PROM changes following lumbar spine surgery, particularly for disability. These findings support the integration of wearables as complementary tools for postoperative outcome assessment and demonstrate the need for standardization of metrics, timing, and reporting to facilitate clinical adoption.