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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?

      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)
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