Patients with severe low back pain exhibit a low level of physical activity before lumbar fusion surgery: a cross-sectional study

Hanna Lotzke, Max Jakobsson, Annelie Gutke, Maria Hagströmer, Helena Brisby, Olle Hägg, Rob Smeets, Mari Lundberg, Hanna Lotzke, Max Jakobsson, Annelie Gutke, Maria Hagströmer, Helena Brisby, Olle Hägg, Rob Smeets, Mari Lundberg

Abstract

Background: People with severe low back pain are at higher risk of poor health. Patients scheduled for lumbar fusion surgery are assumed to have low levels of physical activity, but few data exist. The aim of the study was firstly to investigate preoperative levels of objectively measured physical activity in patients with severe low back pain waiting for lumbar fusion surgery, and secondly to investigate whether factors in the fear-avoidance model were associated with these levels.

Methods: We included 118 patients waiting for lumbar fusion surgery (63 women and 55 men; mean age 46 years). Physical activity expressed as steps per day and total time spent in at least moderate-intensity physical activity was assessed with ActiGraph GT3X+ accelerometers. The data were compared to the WHO recommendations on physical activity for health. Whether factors in the fear-avoidance model were associated with physical activity was evaluated by two different multiple linear regression models.

Results: Ninety-six patients (83%) did not reach the WHO recommendations on physical activity for health, and 19 (16%) patients took fewer than 5000 steps per day, which indicates a sedentary lifestyle. On a group level, higher scores for fear of movement and disability were associated with lower numbers of steps per day.

Conclusion: A high proportion of the patients did not reach the WHO recommendations on physical activity and are therefore at risk of poor health due to insufficient physical activity. We also found a negative association between both fear of movement and disability, and the number of steps per day. Action needs to be taken to motivate patients to be more physically active before surgery, to improve health postoperatively. There is a need for interventions aimed at increasing physical activity levels and reducing barriers to physical activity in the prehabilitation phase of this patient group.

Trial registration: Current Controlled Trials ISCRTN 17115599 , retrospectively Registered 18 may 2015.

Keywords: Accelerometer; Chronic low back pain; Kinesiophobia; Lumbar surgery; Steps per day.

Conflict of interest statement

Ethics approval and consent to participate

The study has been approved by the Regional Ethical Review Board in Gothenburg (Dnr. 586–11, Dnr 7527–15).

All patients that agreed to participate signed an informed consent form provided with the independent observer.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Revised fear-avoidance model. VAS, Visual Analogue Scale; PCS, Pain Catastrophizing Scale; TSK, Tampa Scale for Kinesiophobia; SEES, Self-Efficacy for Exercise Scale; ODI, Oswestry Disability Index; HADS, Hospital Anxiety and Depression Scale; GT3X+, physical activity of least moderate-intensity, steps per day
Fig. 2
Fig. 2
Overview of the variables in the regression models. PCS, Pain Catastrophizing Scale; TSK, Tampa Scale for Kinesiophobia; SEES, Self-Efficacy for Exercise Scale; HADS, Hospital Anxiety and Depression Scale; ODI, Oswestry Disability Index; VAS, Visual Analogue Scale
Fig. 3
Fig. 3
Histogram of at least moderate- intensity physical activity per week (10-min bouts)
Fig. 4
Fig. 4
Histogram of steps per day

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