This study aimed to evaluate long-term changes in physical capacity over two years following lumbar fusion surgery and identify preoperative factors predicting these changes in patients with LBP and degenerative disc disorder.
One hundred eighteen patients with LBP and degenerative disc disorder scheduled for lumbar fusion surgery were included. Physical capacity was measured at baseline and at 3, 6, 12, and 24 months post-surgery with 4 physical capacity tasks: the five-minute walk, 15-meter fast walk, one-minute stair-climbing, and timed up-and-go (TUG). Changes in physical capacity were analyzed with parametric tests for repeated measurements. To identify predictors of change from baseline to the two-year follow-up, four regression models were developed, one for each physical capacity task. Preoperative predictors included age, gender, body mass index, smoking status, back-related disability, back pain intensity, pain-related catastrophizing, kinesiophobia, self-efficacy, depressive symptoms, and baseline performance of the physical capacity tasks. Stepwise multiple linear regression was used to identify significant predictors in each model.
All physical tasks improved significantly within the first three months, with continued improvement in the 15-meter fast walk, one-minute stair-climbing, and TUG up to one year post-surgery. Across all tasks, the mean improvements from baseline to each follow-up exceeded the thresholds for minimal important change. No adverse events occurred during the tasks. In the predictive models, baseline performance on each physical capacity task was a significant predictor, indicating that better preoperative capacity was associated with smaller post-surgical improvements. Self-efficacy was a significant predictor for both the one-minute stair-climbing and TUG tests, with higher levels of self-efficacy associated with greater improvements in physical capacity. Additionally, for the five-minute walk, more intense back pain at baseline predicted lesser improvement.
The study demonstrated that significant and clinically meaningful improvements in physical capacity occurred following lumbar fusion surgery in patients with LBP and degenerative disc disorder, particularly within the first three months post-surgery. No adverse events occurred during any of the physical tasks, reinforcing their safety for use in postoperative evaluations. Baseline physical capacity and self-efficacy were key predictors of postoperative outcomes.
The findings suggest that physical capacity tasks can be incorporated into assessments for patients with LBP and DDD undergoing lumbar fusion surgery, given their safety and effectiveness in tracking post-operative capacity. Since improvements continued for up to one year for most tasks, extending evaluations beyond the early postoperative phase is essential. Baseline capacity and self-efficacy predicted recovery, highlighting the need for preoperative assessments. Patients with higher baseline capacity may experience less improvement post-surgery, which could be considered when setting expectations for recovery. Future research should explore ways to boost preoperative self-efficacy to potentially optimize rehabilitation outcomes.
Physical Capacity
Lumbar Fusion Surgery
