ORIGINAL RESEARCH
How Many Steps Per Day During the Early Postoperative Period are Associated With Patient-Reported Outcomes of Disability, Pain, and Opioid Use After Lumbar Spine Surgery?

https://doi.org/10.1016/j.apmr.2021.06.002Get rights and content

Highlights

  • Steps/d at 6 weeks was associated with decreased disability and pain at 1 year.

  • Steps/d at 6 weeks was associated with no opioid use at 1 year after spine surgery.

  • Threshold of 3500 steps/d may serve as initial early postoperative recommendation after lumbar spine surgery.

Abstract

Objective

To investigate whether early postoperative walking is associated with “best outcome” and no opioid use at 1 year after lumbar spine surgery and establish a threshold for steps/day to inform clinical practice.

Design

Secondary analysis from randomized controlled trial.

Setting

Two academic medical centers in the United States.

Participants

We enrolled 248 participants undergoing surgery for a degenerative lumbar spine condition (N=248). A total of 212 participants (mean age, 62.8±11.4y, 53.3% female) had valid walking data at baseline.

Interventions

Not applicable.

Main Outcome Measures

Disability (Oswestry Disability Index), back and leg pain (Brief Pain Inventory), and opioid use (yes vs no) were assessed at baseline and 1 year after surgery. “Best outcome” was defined as Oswestry Disability Index ≤20, back pain ≤2, and leg pain ≤2. Steps/day (walking) was assessed with an accelerometer worn for at least 3 days and 10 h/d at 6 weeks after spine surgery, which was considered as study baseline. Separate multivariable logistic regression analyses were conducted to determine the association between steps/day at 6 weeks and “best outcome” and no opioid use at 1-year. Receiver operating characteristic curves identified a steps/day threshold for achieving outcomes.

Results

Each additional 1000 steps/d at 6 weeks after spine surgery was associated with 41% higher odds of achieving “best outcome” (95% confidence interval [CI], 1.15-1.74) and 38% higher odds of no opioid use (95% CI, 1.09-1.76) at 1 year. Walking ≥3500 steps/d was associated with 3.75 times the odds (95% CI, 1.56-9.02) of achieving “best outcome” and 2.37 times the odds (95% CI, 1.07-5.24) of not using opioids.

Conclusions

Walking early after surgery may optimize patient-reported outcomes after lumbar spine surgery. A 3500 steps/d threshold may serve as an initial recommendation during early postoperative counseling.

Section snippets

Study participants

A total of 248 English-speaking adults undergoing lumbar spine surgery were recruited from 2 academic medical centers in the United States. The detailed description of the recruitment of the study participants has previously been published.20 Patients underwent a laminectomy procedure (with or without fusion) for a lumbar degenerative condition, including spondylosis, degenerative spondylolisthesis, and spinal stenosis. Participants were excluded if they were primarily undergoing discectomy or

Results

Of 248 enrolled participants undergoing surgery for a degenerative lumbar spine condition, 212 wore accelerometer for ≥3 valid days, 10 wore it for <3 valid days, and 26 had missing physical activity data (table 1). Comparisons by accelerometer wear status (ie, ≥3 valid days vs <3 valid days or missing) found similar baseline characteristics, except for surgical fusion procedure (69.3% vs 47.2%, P=.01) (see table 1). Participants also had similar outcomes at all time points (table 2), except

Discussion

This study found that taking more steps/day during the early postoperative period was statistically associated with achieving the “best outcome” and no opioid use at 1 year after lumbar spine surgery. Specifically, walking at least 3500 steps/d best discriminated those who achieved these outcomes from those who did not. Our findings support a recommendation for walking early after surgery and provide an evidence-based steps/day threshold that rehabilitation professionals can use during early

Conclusions

Our study findings suggest that taking more steps/day during the early postoperative period may be associated with achieving a “best outcome” in disability and back and leg pain and lower opioid use in patients undergoing lumbar spine surgery. Walking at least 3500 steps/d was found to be an important threshold for achieving these outcomes and provides rehabilitation providers with an initial patient recommendation that can be used during early postoperative management. Given the observational

Suppliers

  • a.

    GT3X; ActiGraph.

  • b.

    SPSS, version 25; IBM Inc.

  • c.

    MedCalc statistical software; MedCalc Software.

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  • Cited by (9)

    • Worsening pain and quality of life for spine surgery patients during the COVID-19 pandemic: Roles of psychological distress and patient activation

      2022, North American Spine Society Journal
      Citation Excerpt :

      In the current study, average pain scores for the back and legs worsened significantly, whereas neck and arm pain scores did not change significantly between respondents’ latest clinic visit and the onset of the COVID-19 pandemic. Prior research has demonstrated the link between increased walking during post-operative recovery and higher odds of meaningful improvement in back and leg pain [29]. It is probable that, given pandemic restrictions on non-essential activities, walking and similar activities were curtailed among these patients.

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    Presented to the American Physical Therapy Association, February 22, 2021, virtual; North American Spine Society, October 10, 2020, virtual.

    Supported by a Patient-Centered Outcomes Research Institute award (award no. CER-1306-01970).

    Disclosures: Kristin R. Archer reports personal fees from Pacira outside the submitted work. Jacquelyn S. Pennings reports personal fees from ICZ International Surgical and Steamboat Orthopaedic and Spine Institute. Clinton J. Devin reports personal fees from Wright Medical, Stryker, and Medtronic. Brian J. Neuman reports personal fees from Medtronic and DePuy Synthes. Rogelio A. Coronado was supported by a Vanderbilt Faculty Research Scholars award during manuscript development. The other authors have nothing to disclose. The authors have no personal or institutional financial interest in drugs, materials, or devices described in their submissions.

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