Predictors of substantial improvement in physical function six months after lumbar surgery: is early post-operative walking important? A prospective cohort study.
Study Goal
The researchers aimed to determine whether post-operative walking time, along with other variables, predicts substantial improvement in physical function six months after lumbar surgery.
Results Summary
Participants who walked more in the first post-operative week were more likely to have substantially improved function at six months. Other predictors of improved function included shorter pre-operative pain duration, lower pre-operative function, and younger age.
Population
Adults undergoing lumbar surgery (discectomy, decompression, fusion).
Effective Dosage
Not specified
Duration
Walking time was measured in the first post-operative week; outcomes were assessed at six months.
Interactions
None mentioned
| Intervention | Direction | Endpoint | Population | Dosage | Impact | Claim # |
|---|---|---|---|---|---|---|
increased walking time in the first post-operative week | increase | function on the Oswestry Disability Questionnaire at six months | Participants undergoing lumbar surgery (discectomy, decompression, fusion) | OR 1.18, 95%CI 1.02-1.37 | were more likely to have substantially improved function | #1 |
- | increase | function on the Oswestry Disability Questionnaire at six months | participants with < 12 months pre-operative pain | OR 2.71, 95%CI 1.28-5.74 | were more likely to have substantially improved function | #2 |
- | increase | function on the Oswestry Disability Questionnaire at six months | those with lower pre-operative function | OR 4.02, 95%CI 2.33-6.93 | were more likely to have substantially improved function | #3 |
- | increase | SF-36 Physical Component Summary | Age < 65 years | OR 2.36, 95%CI 1.14-4.85 | predicted substantial improvement | #4 |
- | increase | SF-36 Physical Component Summary | participants with < 12 months pre-operative pain | OR 3.52 95%CI 1.69-7.33 | predicted substantial improvement | #5 |
- | no change | leg pain | Participants undergoing lumbar surgery | - | no significant predictors for substantial improvement | #6 |
- | no change | back pain | Participants undergoing lumbar surgery | - | no significant predictors for substantial improvement | #7 |
BACKGROUND: Resuming walking after lumbar surgery is a common focus of early post-operative rehabilitation, however there is no knowledge about whether increased walking is associated with better functional outcomes. This study aimed to determine whether time spent walking in the week after lumbar surgery, along with co-morbidities, pre-operative pain duration, pre-operative physical activity or function, or surgical variables predict substantial improvement in physical function six months after lumbar surgery. METHODS: A prospective cohort study design was utilized. Participants undergoing lumbar surgery (discectomy, decompression, fusion) were recruited between April and November 2016. Predictor variables were collected pre-operatively (age, sex, smoking status, obesity, diabetes, depression, anxiety, pre-operative pain duration, neurological deficit, physical activity levels, mobility restriction, function) and early post-operatively (post-operative walking time, surgical procedure, single/multi-level surgery). Outcome variables (physical function, back pain and leg pain severity) were measured pre-operatively and six-months post-operatively. Logistic regression analysis was used to establish prediction of substantial improvement in outcome at six months. RESULTS: Participants (N = 233; 50% female; age 61 (SD = 14) years) who walked more in the first post-operative week were more likely to have substantially improved function on the Oswestry Disability Questionnaire at six months (OR 1.18, 95%CI 1.02-1.37), as were participants with < 12 months pre-operative pain (OR 2.71, 95%CI 1.28-5.74), and those with lower pre-operative function (OR 4.02, 95%CI 2.33-6.93). Age < 65 years (OR 2.36, 95%CI 1.14-4.85), and < 12 months pre-operative pain (OR 3.52 95%CI 1.69-7.33) predicted substantial improvement on the SF-36 Physical Component Summary. There were no significant predictors for substantial improvement in either leg or back pain. CONCLUSIONS: Walking time in the week after lumbar surgery is one of several predictors of substantial improvement in function at six months. Further research is required to determine whether intervention designed to increase walking early after lumbar surgery results in improved longer-term recovery of function. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry (ANZCTR), registration number 12616000747426 . Retrospectively registered on the 7th of June 2016.