Smart Nursing-Enabled Individualized Rehabilitation is Associated with Improved Outcomes After Posterior Lumbar Fusion: A Retrospective Cohort Study.

چکیده اصلی

Lumbar degenerative disease is highly prevalent among older adults, and posterior lumbar fusion is a common surgical treatment. However, chronic postoperative pain, paraspinal muscle atrophy, and related complications frequently impair functional recovery and long-term outcomes. Conventional continuing rehabilitation often relies on delayed responses and standardized management, limiting its ability to address individual recovery needs during home-based rehabilitation. This single-center retrospective comparative cohort study included 117 patients aged ≥60 years who underwent single- or two-level posterior lumbar interbody fusion at the Fourth Affiliated Hospital of Soochow University between January 1, 2024, and January 31, 2025. All patients received standardized perioperative care and baseline rehabilitation guidance before discharge. Post-discharge rehabilitation consisted of either a smart nursing-enabled individualized rehabilitation model delivered through a wearable smart nursing terminal (n = 54) or conventional continuing rehabilitation comprising routine telephone follow-up, outpatient review, and a fixed home rehabilitation program (n = 63). The smart nursing model incorporated standardized stepwise rehabilitation with individualized adjustments, real-time monitoring, graded alert-triggered interventions, and continuous supervision throughout the 12-month recovery period. The primary outcome was the between-group difference in the change in activity-related Numerical Rating Scale (NRS) pain score from baseline to 12 months. Group-by-time analysis showed a greater reduction in activity-related NRS scores in the smart nursing group than in the control group (interaction estimate: -1.10 points; 95% CI: -1.50 to -0.69; P < 0.001). At 12 months, the smart nursing group also demonstrated lower resting NRS scores (1.87 ± 0.80 vs 2.87 ± 0.77), greater erector spinae cross-sectional area (14.20 cm2 ± 1.13 cm2 vs 12.19 cm2 ± 0.56 cm2), higher maximum isometric paraspinal torque (82.84 Nm ± 7.58 Nm vs 66.75 Nm ± 4.57 Nm), and a lower incidence of chronic postsurgical pain (16.67% vs 63.49%) (all q < 0.001). Differences in fusion and complication outcomes were examined in an exploratory manner. Smart nursing-enabled individualized rehabilitation was associated with improved 12-month outcomes, although the retrospective, nonrandomized design precludes causal inference.

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