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.
Keywords
List of abbreviations:
AUC (area under curve), CBPT (cognitive-behavioral–based physical therapy), CI (confidence interval), ROC (receiver operating characteristic)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: June 24, 2021
Accepted:
June 8,
2021
Received in revised form:
May 28,
2021
Received:
February 2,
2021
Footnotes
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.
Identification
Copyright
© 2021 The American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
