A Smartphone App With a Digital Care Pathway for Patients Undergoing Spine Surgery: Development and Feasibility Study

Abstract

Background: There is a great unmet clinical need to provide patients undergoing spinal surgery and their caregivers with ongoing, high-quality care before and after surgery in an efficiency-focused health care environment.

Objective: The objective of this study is to design, develop, and evaluate the acceptability and feasibility of a novel planning-, outcomes-, and analytics-based smartphone app called ManageMySurgery (MMS) in patients undergoing elective spine surgery (MMS-Spine).

Methods: The development process of the MMS app was conducted over 2 sequential stages: (1) an evidence-based intervention design with refinement from surgeon and patient feedback and (2) feasibility testing in a clinical pilot study. We developed a novel, mobile-based, Health Insurance Portability and Accountability Act-compliant platform for interventional and surgical procedures. It is a patient-centric mobile health app that streamlines patients' interactions with their care team. MMS divides the patient journey into phases, making it feasible to provide customized care pathways that meet patients' unique needs. Patient-reported outcomes are easily collected and conform to the National Institutes of Health Patient-Reported Outcomes Measurement Information System (PROMIS) standard.

Results: We tested the feasibility of the MMS-Spine app with patients undergoing elective spine surgery at a large academic health system. A total of 47 patients undergoing elective spine surgery (26 cervical spine and 21 lumbar spine surgeries) downloaded and used MMS-Spine to navigate their surgical journey, quantify their baseline characteristics and postoperative outcomes, and provide feedback on the utility of the app in preparing for and recovering from their spinal surgery. The median age was 59.0 (range 33-77) years, 22 of the 47 patients (47%) were women, and 26 patients (55%) had commercial insurance. Of the 47 patients, a total of 33 (70%) logged in on an iOS device, 11 (23%) on an Android device, and 3 (6%) on a computer or tablet. A total of 17 of the 47 patients (36%) added a caregiver, of which 7 (41%) logged in. The median number of sign-ins was 2. A total of 38 of 47 patients (81%) completed their baseline preoperative PROMIS-29 outcomes, and 14 patients (30%) completed at least one PROMIS-29 survey during the postoperative period. Of the 24 patients who completed the MMS survey, 21 (88%) said it was helpful during preparation for their procedure, 16 (67%) said it was helpful during the postoperative period, and 23 (96%) said that they would recommend MMS to a friend or family member.

Conclusions: We used a patient-centered approach based on proven behavior change techniques to develop a comprehensive smartphone app for patients undergoing elective spine surgery. The optimized version of the app is ready for formal testing in a larger randomized clinical study to establish its cost-effectiveness and effect on patients' self-management skills and long-term outcomes.

Keywords: behavior change; development; digital health; digital interventions; mHealth; mobile app; mobile phone; smartphone app; surgery; technology.

Figure 1

Development overview process of the creation and implementation of the MMS-Spine app. BCT: behavior change technique; MMS-Spine: ManageMySurgery spine surgery module; UX: user experience.

Figure 2

MMS-Spine features incorporating behavior change technique methods applicable to clinical care. FAQ: frequently asked question; MMS-Spine: ManageMySurgery spine surgery module.

Figure 3

Step-by-step road map of the MMS-Spine patient care pathway. ACDF: anterior cervical discectomy and fusion; MMS: ManageMySurgery; OLIF: oblique lateral interbody fusion; rehab: rehabilitation; TLIF: transforaminal lumbar interbody fusion.

Figure 4

Functionality of the MMS-Spine app. FAQs: frequently asked questions; PROs: patient-reported outcomes.

Figure 5

Screenshot of the MMS-Spine patient (mobile app) and provider (desktop, laptop, or tablet) interfaces.

Figure 6

PROMIS-29 outcome measures for social roles and activities and for physical function compared at baseline and 6-month time points for 16 members of the cohort. PROMIS: Patient-Reported Outcomes Measurement Information System.