Beyond one-time PROMs: high-frequency single-item mobile ePROM tracking of postoperative recovery in spine surgery—a prospective feasibility study

Purpose Between lumbar decompression and the first follow-up visit (~ 6 weeks post-op), the day-to-day course of recovery is not routinely captured in detail. We tested whether a single-item, smartphone well-being ePROM (“How are you today?”, 0–100 VAS; higher = better), sent every 2–3 days, could be deployed in routine care, what level of endpoint completion was achieved, whether it showed preliminary convergent validity when measured at the same visit as clinic PROMs (ODI, PHQ-9), and whether serial responses could illustrate postoperative recovery trajectories. Methods Consecutive patients with degenerative lumbar disease completed a digital baseline survey (Feb 1–Aug 31, 2025; n = 429). Patients with an operative indication for lumbar disc herniation or spinal canal stenosis who underwent lumbar decompression entered postoperative high-frequency well-being monitoring for 6 weeks. Patients were not included in the digital follow-up pathway when web-based participation was not feasible in routine care. The pathway generated electronic health record-accessible submissions but did not include automated alert thresholds or a mandated alert-to-action protocol. Results Of 183 operated patients invited to postoperative monitoring, 70/183 (38.3%) contributed an evaluable clinic ODI at ~ 6 weeks, 68/183 (37.2%) had a same-day PHQ-9, and 48/183 (26.2%) were endpoint-complete for both visit-day measures; this low endpoint-completion rate represents a major implementation barrier. In the pair-level timing dataset, same-day well-being versus reverse-coded ODI (100 − ODI; higher = less disability) showed moderate concordance (ρ = 0.54, 95% CI 0.37–0.68; n = 107 pairs), with similar moderate estimates at short lags (≤ 2 days ρ ≈ 0.46; ≤4 days ρ ≈ 0.42), while longer-lag estimates were exploratory and non-monotonic. On the visit day, well-being related inversely to depressive burden (PHQ-9 ρ = −0.25; n = 68). In a joint model using raw ODI and PHQ-9, higher disability and higher depressive burden were associated with lower concurrent well-being (standardized β: −0.35 for ODI; −0.20 for PHQ-9), although explained variance was limited (adjusted R² = 0.151). Conclusion Routine-care deployment was technically possible, and time-aligned measures showed preliminary convergent validity, but endpoint completion was low (26.2%) and prevents any claim of broad feasibility or universal scalability. The ePROM should be considered a hypothesis-generating trajectory signal that requires equity safeguards and prospective closed-loop alert-to-action testing before implementation as a clinical decision tool.