Early postoperative physical activity and function: a descriptive case series study of 53 patients after lumbar spine surgery

Rogelio A Coronado, Hiral Master, Daniel K White, Jacquelyn S Pennings, Mackenzie L Bird, Clinton J Devin, Maciej S Buchowski, Shannon L Mathis, Matthew J McGirt, Joseph S Cheng, Oran S Aaronson, Stephen T Wegener, Kristin R Archer, Rogelio A Coronado, Hiral Master, Daniel K White, Jacquelyn S Pennings, Mackenzie L Bird, Clinton J Devin, Maciej S Buchowski, Shannon L Mathis, Matthew J McGirt, Joseph S Cheng, Oran S Aaronson, Stephen T Wegener, Kristin R Archer

Abstract

Background: The purpose of this prospective case series study was to compare changes in early postoperative physical activity and physical function between 6 weeks and 3 and 6 months after lumbar spine surgery.

Methods: Fifty-three patients (mean [95% confidence interval; CI] age = 59.2 [56.2, 62.3] years, 64% female) who underwent spine surgery for a degenerative lumbar condition were assessed at 6 weeks and 3- and 6-months after surgery. The outcomes were objectively-measured physical activity (accelerometry) and patient-reported and objective physical function. Physical activity was assessed using mean steps/day and time spent in moderate to vigorous physical activity (MVPA) over a week. Physical function measures included Oswestry Disability Index (ODI), 12-item Short Form Health Survey (SF-12), Timed Up and Go (TUG), and 10-Meter Walk (10 MW). We compared changes over time in physical activity and function using generalized estimating equations with robust estimator and first-order autoregressive covariance structure. Proportion of patients who engaged in meaningful physical activity (e.g., walked at least 4400 and 6000 steps/day or engaged in at least 150 min/week in MVPA) and achieved clinically meaningful changes in physical function were compared at 3 and 6 months.

Results: After surgery, 72% of patients initiated physical therapy (mean [95%CI] sessions =8.5 [6.6, 10.4]) between 6 weeks and 3 months. Compared to 6 weeks post-surgery, no change in steps/day or time in MVPA/week was observed at 3 or 6 months. From 21 to 23% and 9 to 11% of participants walked at least 4400 and 6000 steps/day at 3 and 6 months, respectively, while none of the participants spent at least 150 min/week in MVPA at these same time points. Significant improvements were observed on ODI, SF-12, TUG and 10 MW (p < 0.05), with over 43 to 68% and 62 to 87% achieving clinically meaningful improvements on these measures at 3 and 6 months, respectively.

Conclusion: Limited improvement was observed in objectively-measured physical activity from 6 weeks to 6 months after spine surgery, despite moderate to large function gains. Early postoperative physical therapy interventions targeting physical activity may be needed.

Keywords: Physical activity; Postoperative period; Spinal fusion; Spinal stenosis; Walking.

Conflict of interest statement

KRA is a member of the editorial board of this journal. The other authors declare that they have no other competing interests.

Figures

Fig. 1
Fig. 1
Change in early postoperative patient-reported outcomes (a and b) and objective physical function (c and d). Error bars are 95% confidence intervals. * indicates significant difference from 6 weeks. ✢ indicates significant difference from 3 months

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