Physical Activity Measured with Accelerometer and Self-Rated Disability in Lumbar Spine Surgery: A Prospective Study

Ralph J Mobbs, Kevin Phan, Monish Maharaj, Prashanth J Rao, Ralph J Mobbs, Kevin Phan, Monish Maharaj, Prashanth J Rao

Abstract

Study design: Prospective observational study.

Objective: Patient-based subjective ratings of symptoms and function have traditionally been used to gauge the success and extent of recovery following spine surgery. The main drawback of this type of assessment is the inherent subjectivity involved in patient scoring. We aimed to objectively measure functional outcome in patients having lumbar spine surgery using quantitative physical activity measurements derived from accelerometers.

Methods: A prospective study of 30 patients undergoing spine surgery was conducted with subjective outcome scores (visual analog scale [VAS], Oswestry Disability Index [ODI] and Short Form 12 [SF-12]) recorded; patients were given a Fitbit accelerometer (Fitbit Inc., San Francisco, California, United States) at least 7 days in advance of surgery to record physical activity (step count, distance traveled, calories burned) per day. Following surgery, postoperative activity levels were reported at 1-, 2-, and 3-month follow-up.

Results: Of the 28 compliant patients who completed the full trial period, mean steps taken per day increased 58.2% (p = 0.008) and mean distance traveled per day increased 63% (p = 0.0004) at 3-month follow-up. Significant improvements were noted for mean changes in VAS back pain, VAS leg pain, ODI, and SF-12 Physical Component Summary (PCS) scores. There was no significant correlation between the improvement in steps or distance traveled per day with improvements in VAS back or leg pain, ODI, or PCS scores at follow-up.

Conclusions: High compliance and statistically significant improvement in physical activity were demonstrated in patients who had lumbar decompression and lumbar fusion. There was no significant correlation between improvements in subjective clinical outcome scores with changes in physical activity measurements at follow-up. Limitations of the present study include its small sample size, and the validity of objective physical activity measurements should be assessed in future larger, prospective studies.

Keywords: Fitbit; accelerometer; fusion; lumbar back pain; lumbar stenosis; objective measurement; physical activity; spine surgery.

Conflict of interest statement

Disclosures Ralph J. Mobbs, Speakers' bureau: Stryker Spine, Synthes; Royalties: Stryker Spine; Stock/stock options: Medtronic, J&J; Meeting expenses: Orthotec Kevin Phan, none Monish Maharaj, none Prashanth J. Rao, none

Figures

Fig. 1
Fig. 1
Screenshot of prospective data collection indicating (A) average steps per day and (B) average distance traveled per day from a patient recovering from a two-level fusion over 12-month periods. The initial month of data shown is the average number of steps per day or distance traveled per day preoperatively.
Fig. 2
Fig. 2
Change in number of steps per day taken at follow-up.
Fig. 3
Fig. 3
Change in distance traveled per day at follow-up.
Fig. 4
Fig. 4
Change in calories per day consumed at follow-up.
Fig. 5
Fig. 5
Preoperative and postoperative clinical outcomes following lumbar spine surgery: (A) visual analog scale (VAS) back pain; (B) VAS leg pain; (C) Oswestry Disability Index (ODI); (D) Short Form 12 (SF-12) Mental Component Summary (MCS) score; (E) SF-12 Physical Component Summary (PCS) score.

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