Effect of a Digital Health Exercise Program on the Intention for Spinal Surgery in Adult Spinal Deformity: Exploratory Cross-Sectional Survey
Background: Adult spinal deformity (ASD) is a prevalent condition estimated at 38%. Symptomatic ASD is associated with substantial healthcare costs. The role of nonoperative interventions in the management of ASD remains elusive. The National Scoliosis Clinic’s (NSC) Scoliosis Realignment Therapy (SRT) is a personalized digital health exercise program for the nonoperative management of ASD. Objective: The purpose of this exploratory study was two-fold: (1) To evaluate the effect of the SRT program on users’ intention of having spinal fusion; and (2) From a US payer perspective, to estimate the annual cost savings per 100,000 beneficiaries by averting spinal surgery. Methods: Individuals were enrolled in the SRT study from October 1, 2023 to September 1, 2024. Participants completed a web-based, cross-sectional survey about history of prior scoliosis surgery and intent of having surgery before and after use of SRT (on a 4-point Likert scale, where 1 = “No Intent for Surgery” and 4 = “High Intent for Surgery”). Intent for surgery before and after participation in SRT was compared using a non-parametric Wilcoxon signed-rank test for paired data. Annual cost savings per 100,000 beneficiaries by averting spinal fusions were estimated separately for commercial payers and Medicare using published literature and public data sources. Payer expenditures were inflation-adjusted to 2024 US dollars using the Hospital Services component of the Consumer Price Index. Results: A total of 62 NSC members (38.8%) responded to the survey and were enrolled in the SRT program for an average of 17 weeks (SD 12). The mean age was 65.3 (SD 13.5) years and the majority were female (98%) and white (98%). Among the SRT users who did not have prior scoliosis surgery (N=56), 14% (8/56) reported a decrease in intent for surgery (that is, a lower Likert score) with use of SRT. The mean intent for surgery scores before compared to after SRT were 1.29 (SD 0.53) and 1.14 (SD 0.35), respectively (mean difference 0.15 [P=.006]). Participants with “No Intent for Surgery” pre- versus post-use of SRT (42/56 versus 48/56, respectively) corresponds to an absolute risk reduction (ARR) of 11% and a number needed to treat (NNT) of 9 to avert one spinal fusion. Among the six participants who transitioned to “No Intent” for spinal surgery with use of SRT, three were
