Introduction <p>Closed-loop spinal cord stimulation (CL-SCS) uses evoked compound action potential (ECAP) feedback to dynamically adjust stimulation amplitude, reducing under- and overstimulation during postural and activity changes. This manuscript reports 12-month patient-reported stimulation and pain outcomes from the Closed-Loop Australia study.</p> Methods <p>This multicenter, prospective, single-arm study used randomized in-clinic crossover testing to investigate the primary outcome of overstimulation in patients using CL-SCS versus open-loop (OL) SCS during protocol-specified movements. Secondary outcomes included patient-reported stimulation characteristics for patient-informed, at-home therapy and pain intensity.</p> Results <p>At 12&#xa0;months, patients randomized to CL-SCS reported lower rates of overstimulation (median 0.4; IQR 0.0, 1.0) compared with OL-SCS (median 3; IQR 2.6, 4.0). Participants described the stimulation characteristics of their predominant at-home SCS therapy in terms of comfort and ability to perform activities. Eighty-five percent of participants (<i>n</i> = 39) reported being comfortable performing physical activity while their stimulation therapy was engaged, while 19.6% (<i>n</i> = 9) indicated needing to turn their therapy down or off to do certain activities. Pain intensity decreased from baseline by 60&#xa0;mm and remained stable through 12&#xa0;months, with 78% (<i>n</i> = 36) of participants achieving ≥ 50% pain relief.</p> Conclusions <p>These findings suggest that adaptable stimulation strategies are important in supporting comfort and sustained pain relief.</p> Trial Registration Number <p>ClinicalTrials.gov, NCT05177354.</p>