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Minetama M1, Nakagawa M1, Yamamoto Y1, Matsuo S1, Koike Y1, Sakon N1, Nakatani T1, Sumiya T1, Nakagawa Y1, Teraguchi M1, Kagotani R1, Mera Y1, Kitano T1, Kawakami M1
1Wakayama Medical University Kihoku Hospital, Spine Care Center, Katsuragi-cho, Ito-gun, Japan
Background: Patients with lumbar spinal stenosis (LSS) often avoid walking and may have reduced walking distance and physical activity because of neurogenic claudication. It has been reported that body mass index, pain, female sex, and age predict physical activity in patients with LSS. However, no reports have examined the psychological factors associated with physical activity in patients with LSS.
Purpose: The purpose of this study was to use psychological assessment to identify factors associated with physical activity in patients with LSS.
Methods: This study was a cross-sectional analysis of a randomized clinical trial of patients with LSS. Patients presenting with symptoms of neurogenic claudication caused by LSS, which was confirmed by magnetic resonance imaging (MRI), were enrolled from September 2014 to May 2018. All patients completed the Zurich Claudication Questionnaire (ZCQ), the self-paced walking test (SPWT), a numerical rating scale (NRS) of low back pain, leg pain, and leg numbness, the Hospital Anxiety and Depression Scale (HADS), the Pain Catastrophizing Scale (PCS), the Pain Anxiety Symptoms Scale (PASS-20), and the Tampa Scale for Kinesiophobia (TSK) at baseline. Physical activity was measured by pedometer as the average number of daily steps. In the first week, patients were asked to carry on their normal life while wearing the pedometer. Spearman correlational analyses were used to identify relationships between physical activity and demographic data, MRI findings, and physical and psychological factors. Stepwise multiple regression analysis was performed to analyze the relationships between physical activity and physical and psychological variables at P 0.1. A P-value 0.05 was considered significant.
Results: Seventy-one patients (35 men and 36 women, average age 71.6 years) were included in this study. Significant correlations were observed between physical activity and age (r = -0.543), severity of stenosis at L3/4 (r = 0.279), walking distance on the SPWT (r = 0.338), HADS depression score (r = -0.245), PASS-20 total score (r = -0.327), cognitive anxiety (r = -0.352), escape/avoidance (r = -0.235), fear (r = -0.284), and TSK score (r = -0.246) (P 0.05). Gender, ZCQ symptom severity, ZCQ physical function, NRS of leg numbness, and PASS-20 physiological anxiety score (P 0.1) were included as dependent variables in the stepwise multiple regression analysis. Multiple regression analysis revealed that age, severity of stenosis at L3/4, walking distance on the SPWT, and PASS-20 fear predicted physical activity (r2 = 0.448).
Conclusion(s): In patients with LSS, anxiety and fear avoidance beliefs about pain, kinesiophobia, and depression are more strongly related to physical activity than back and leg pain. Age, MRI findings, neurogenic claudication, and fear of pain predict physical activity. Further studies should confirm whether psychological interventions can help to increase physical activity in patients with LSS.
Implications: Fear-avoidance models might provide important information for devising physical therapy programs for patients with LSS. Assessment and treatment of psychological factors may help to increase physical activity in patients with LSS.
Keywords: lumbar spinal stenosis, physical activity, psychological factors
Funding acknowledgements: We have no funding in this study.
Purpose: The purpose of this study was to use psychological assessment to identify factors associated with physical activity in patients with LSS.
Methods: This study was a cross-sectional analysis of a randomized clinical trial of patients with LSS. Patients presenting with symptoms of neurogenic claudication caused by LSS, which was confirmed by magnetic resonance imaging (MRI), were enrolled from September 2014 to May 2018. All patients completed the Zurich Claudication Questionnaire (ZCQ), the self-paced walking test (SPWT), a numerical rating scale (NRS) of low back pain, leg pain, and leg numbness, the Hospital Anxiety and Depression Scale (HADS), the Pain Catastrophizing Scale (PCS), the Pain Anxiety Symptoms Scale (PASS-20), and the Tampa Scale for Kinesiophobia (TSK) at baseline. Physical activity was measured by pedometer as the average number of daily steps. In the first week, patients were asked to carry on their normal life while wearing the pedometer. Spearman correlational analyses were used to identify relationships between physical activity and demographic data, MRI findings, and physical and psychological factors. Stepwise multiple regression analysis was performed to analyze the relationships between physical activity and physical and psychological variables at P 0.1. A P-value 0.05 was considered significant.
Results: Seventy-one patients (35 men and 36 women, average age 71.6 years) were included in this study. Significant correlations were observed between physical activity and age (r = -0.543), severity of stenosis at L3/4 (r = 0.279), walking distance on the SPWT (r = 0.338), HADS depression score (r = -0.245), PASS-20 total score (r = -0.327), cognitive anxiety (r = -0.352), escape/avoidance (r = -0.235), fear (r = -0.284), and TSK score (r = -0.246) (P 0.05). Gender, ZCQ symptom severity, ZCQ physical function, NRS of leg numbness, and PASS-20 physiological anxiety score (P 0.1) were included as dependent variables in the stepwise multiple regression analysis. Multiple regression analysis revealed that age, severity of stenosis at L3/4, walking distance on the SPWT, and PASS-20 fear predicted physical activity (r2 = 0.448).
Conclusion(s): In patients with LSS, anxiety and fear avoidance beliefs about pain, kinesiophobia, and depression are more strongly related to physical activity than back and leg pain. Age, MRI findings, neurogenic claudication, and fear of pain predict physical activity. Further studies should confirm whether psychological interventions can help to increase physical activity in patients with LSS.
Implications: Fear-avoidance models might provide important information for devising physical therapy programs for patients with LSS. Assessment and treatment of psychological factors may help to increase physical activity in patients with LSS.
Keywords: lumbar spinal stenosis, physical activity, psychological factors
Funding acknowledgements: We have no funding in this study.
Topic: Musculoskeletal: spine; Older people; Pain & pain management
Ethics approval required: Yes
Institution: Wakayama Medical University
Ethics committee: Institutional Review Board of Wakayama Medical University
Ethics number: 1426
All authors, affiliations and abstracts have been published as submitted.
