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?

Autor:	Master H; Department of Orthopaedic Surgery, Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, TN; Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, TN., Pennings JS; Department of Orthopaedic Surgery, Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, TN., Coronado RA; Department of Orthopaedic Surgery, Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, TN; Department of Physical Medicine and Rehabilitation, Osher Center for Integrative Medicine, Vanderbilt University Medical Center, Nashville, TN., Bley J; Department of Orthopaedic Surgery, Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, TN., Robinette PE; Department of Orthopaedic Surgery, Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, TN., Haug CM; Department of Orthopaedic Surgery, Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, TN., Skolasky RL; Department of Orthopaedic Surgery, Johns Hopkins Medicine, Baltimore, MD., Riley LH 3rd; Department of Orthopaedic Surgery, Johns Hopkins Medicine, Baltimore, MD., Neuman BJ; Department of Orthopaedic Surgery, Johns Hopkins Medicine, Baltimore, MD., Cheng JS; Department of Neurological Surgery, University of Cincinnati College of Medicine, Cincinnati, OH., Aaronson OS; Howell Allen Clinic, Saint Thomas Medical Partners, Nashville, TN., Devin CJ; Department of Orthopaedic Surgery, Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, TN; Steamboat Orthopedic and Spine Institute, Steamboat Springs, CO., Wegener ST; Department of Physical Medicine and Rehabilitation, Johns Hopkins Medicine, Baltimore, MD., Archer KR; Department of Orthopaedic Surgery, Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, TN; Department of Physical Medicine and Rehabilitation, Osher Center for Integrative Medicine, Vanderbilt University Medical Center, Nashville, TN. Electronic address: kristin.archer@vumc.org.
Jazyk:	angličtina
Zdroj:	Archives of physical medicine and rehabilitation [Arch Phys Med Rehabil] 2021 Oct; Vol. 102 (10), pp. 1873-1879. Date of Electronic Publication: 2021 Jun 25.
DOI:	10.1016/j.apmr.2021.06.002
Abstrakt:	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. (Copyright © 2021 The American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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