Aubry C1,2,3, Mündermann A4,5
1Bethesda Hospital AG, Department of Physiotherapy, Basel, Switzerland, 2Bildungszentrum Gesundheit Basel-Stadt, Department of Physiotherapy, Basel, Switzerland, 3Zurich University of Applied Sciences / Institute of Physiotherapy, Winterthur, Switzerland, 4University Hospital Basel, Clinic for Orthopaedics and Traumatology, Basel, Switzerland, 5University of Basel, Department of Biomedical Engineering, Basel, Switzerland
Background: Severe lumbar radiculopathy is known to impair physical activity (PA) affecting physical aspect of quality of life (Boskovic et al., 2009). Physiotherapy (PT) has the potential to improve PA levels (Holm et al., 2015; Kunstler et al., 2017) and is a key feature in the patients' rehabilitation after surgical intervention. Past research showed a certain postoperative increase in PA (Mobbs et al., 2016; Schulte et al., 2010). However, it has never been identified clearly if PA resumes to a normal level after lumbar surgery.
Purpose: The main goal of this study was to quantify PA measured by steps per day (SPD) of patients before and after lumbar spine surgery in relation to healthy people's lower limit of SPD (=7000) (Tudor-Locke et al., 2011) and to determine the association of the surgery-induced change in SPD with the change in disability and health-related quality of life (HRQOL).
Methods: Twenty-nine consecutive patients aged 18 to 75 years undergoing their first lumbar spine surgery without stabilisation were recruited and assessed preoperatively (T1), 6 weeks (T2) and 12 weeks (T3) postoperatively between June 2017 and March 2018 in this single-centre prospective cohort study approved by the regional review board. Participants completed the Oswestry Disability Index (disability), Short Form 36 Health Survey Questionnaire, and a visual analogue scale (back and leg pain). SPD and moderate to vigorous PA were assessed using the ActiGraph GT3X+ (ActiGraph, Pensacola, FL, USA) for 3 to 7 days, and participants completed questionnaires on the number of PT sessions and the focus of these sessions. Data of 26 participants were analysed. The difference between SPD and 7000 SPD was determined using Wilcoxon tests. The association between changes in SPD, disability and HRQOL was determined using Spearman correlation calculation.
Results: The mean SPD in patients were significantly lower than the reference value of 7000 SPD at T1 (-1926; p=.001), T2 (-868; p=.020) and T3 (-1316; p=.004). 15.3% and 19.2% more participants surpassed the threshold value of recommended 21 minutes moderate to vigorous PA per day at T2 and T3 compared to T1. Correlations between changes of SPD and disability were from T1 to T2 r=-.495 (p=.010) and from T2 to T3 r=.069 (p=.739). The correlations between changes of SPD and HRQOL were from T1 to T2 r=.444 (p=.023) and from T2 to T3 r= .138 (p=.371).
Conclusion(s): Although mean SPD increased postoperatively, SPD at T2 or T3 did not reach the reference SPD. Because the changes in disability or HRQOL did not represent the change in PA, PA appears to be an additional outcome parameter in lumbar spine surgery that should be considered for therapy planning.
Implications: Postoperative PA assessment provides valuable and additional information on surgery outcome. Physiotherapists should include the goal of increasing PA in their therapy and educate patients regarding the effects and importance of PA.
Keywords: Lumbar spine surgery, physical activity, accelerometry
Funding acknowledgements: There is no conflict of interest. No funding was received for this study and it has not been published previousl.
Purpose: The main goal of this study was to quantify PA measured by steps per day (SPD) of patients before and after lumbar spine surgery in relation to healthy people's lower limit of SPD (=7000) (Tudor-Locke et al., 2011) and to determine the association of the surgery-induced change in SPD with the change in disability and health-related quality of life (HRQOL).
Methods: Twenty-nine consecutive patients aged 18 to 75 years undergoing their first lumbar spine surgery without stabilisation were recruited and assessed preoperatively (T1), 6 weeks (T2) and 12 weeks (T3) postoperatively between June 2017 and March 2018 in this single-centre prospective cohort study approved by the regional review board. Participants completed the Oswestry Disability Index (disability), Short Form 36 Health Survey Questionnaire, and a visual analogue scale (back and leg pain). SPD and moderate to vigorous PA were assessed using the ActiGraph GT3X+ (ActiGraph, Pensacola, FL, USA) for 3 to 7 days, and participants completed questionnaires on the number of PT sessions and the focus of these sessions. Data of 26 participants were analysed. The difference between SPD and 7000 SPD was determined using Wilcoxon tests. The association between changes in SPD, disability and HRQOL was determined using Spearman correlation calculation.
Results: The mean SPD in patients were significantly lower than the reference value of 7000 SPD at T1 (-1926; p=.001), T2 (-868; p=.020) and T3 (-1316; p=.004). 15.3% and 19.2% more participants surpassed the threshold value of recommended 21 minutes moderate to vigorous PA per day at T2 and T3 compared to T1. Correlations between changes of SPD and disability were from T1 to T2 r=-.495 (p=.010) and from T2 to T3 r=.069 (p=.739). The correlations between changes of SPD and HRQOL were from T1 to T2 r=.444 (p=.023) and from T2 to T3 r= .138 (p=.371).
Conclusion(s): Although mean SPD increased postoperatively, SPD at T2 or T3 did not reach the reference SPD. Because the changes in disability or HRQOL did not represent the change in PA, PA appears to be an additional outcome parameter in lumbar spine surgery that should be considered for therapy planning.
Implications: Postoperative PA assessment provides valuable and additional information on surgery outcome. Physiotherapists should include the goal of increasing PA in their therapy and educate patients regarding the effects and importance of PA.
Keywords: Lumbar spine surgery, physical activity, accelerometry
Funding acknowledgements: There is no conflict of interest. No funding was received for this study and it has not been published previousl.
Topic: Outcome measurement; Musculoskeletal: spine; Orthopaedics
Ethics approval required: Yes
Institution: Swissethics
Ethics committee: Ethics Committee Northwest/Central Switzerland (EKNZ)
Ethics number: BASEC-No. 2017-00672
All authors, affiliations and abstracts have been published as submitted.
