Mobile-Based Digital Rehabilitation Program for Patients After Anterior Cervical Discectomy and Fusion: Prospective Cohort Study

Abstract

Background: Anterior cervical discectomy and fusion (ACDF) is a common treatment for degenerative cervical spine disease, yet its frequent postoperative follow-up places substantial demands on both patients and health care systems. A digital program integrating computer-vision-guided exercise, wearable posture monitoring, and cognitive behavioral therapy (CBT) could provide remote monitoring and rehabilitation to alleviate this burden.

Objective: This study aims to evaluate the clinical effectiveness and compliance of a 12-week digital rehabilitation program after ACDF compared with conventional in-person therapy.

Methods: In this prospective cohort study, 336 postoperative patients self-selected either a 12-week mobile-based program incorporating computer-vision-guided exercises, wearable posture sensors, and cognitive behavioral therapy (n=270), or in-person rehabilitation group (IRG, n=66) involving weekly therapist-supervised sessions and paper-based home exercises. Digital users were stratified into a digital rehabilitation completion group (DCG, n=192) and a digital rehabilitation noncompletion group (DNG, n=78). All participants were recruited at a single tertiary hospital and returned to the clinic for outcome assessments at 0, 12, and 24 weeks postoperatively. Outcomes-primarily pain (visual analog scale [VAS]) and disability (neck disability index [NDI]), as well as 36-item short form survey mental component summary (SF-36 MCS), 3-plane cervical range of motion (ROM), muscle endurance, and patient satisfaction-were recorded at 0, 12, and 24 weeks postoperatively. All statistical analyses were performed using SPSS (version 29.0; IBM Corporation). Results were reported as means, SDs, and 95% CIs.

Results: Both the DCG (n=192, who completed all digital sessions) and IRG (who completed 12 weeks of weekly in-person sessions and home exercises) demonstrated significant improvements in pain and disability at weeks 12 and 24, with no significant differences between groups (P>.05). At Week 12, VAS decreased by -2.5 (95% CI -3.0 to -2.0) in the DCG and -2.8 (-3.7 to -1.9) in the IRG; NDI decreased by -6.8 (-10.3 to -3.3) and -8.1 (-14.3 to -1.9), respectively. At Week 24, VAS and NDI reductions reached -4.0 (-4.5 to -3.5) and -13.3 (-17.4 to -9.2) in the DCG, and -4.1 (-5.0 to -3.2) and -14.2 (-21.3 to -7.1) in the IRG. In contrast, the DNG showed minimal improvements: VAS changes were -0.8 (-1.6 to 0.0) at week 12 and -1.3 (-2.1 to -0.5) at week 24; NDI changes were -2.2 (-8.2 to 3.8) and -6.4 (-13.0 to 0.2), respectively (P<.05 compared to DCG and IRG).

Conclusions: The digital rehab program led to comparable improvements in pain, function, and mental health as conventional in-person rehab. Higher adherence was linked to better outcomes, supporting digital rehab as an effective, patient-centered approach after ACDF.

Keywords: anterior cervical discectomy and fusion; computer vision; digital rehabilitation; postoperative rehabilitation; remote rehabilitation; wearable sensors.

Figure 1.. Computer vision–guided exercise and cognitive behavioral therapy modules. During each session, the front-facing cellphone camera works with a computer-vision-based software application to capture head-and-neck angles in real time for guided exercises. The cognitive behavioral therapy (CBT) module allows patients to access lessons and complete interactive homework assignments.

Figure 2.. Patient monitoring module and software module. The posture-monitoring module uses a 9-axis inertial measurement unit (IMU) paired with a notification alert system. Patients wear the IMU during daily activities; when abnormal cervical posture is detected, the system sends a warning message, encouraging proper postoperative posture.

Figure 3.. Experimental protocol.