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Study Design: Retrospective analysis of prospectively collected data., Objective: To examine the combined influence of preoperative sleep disturbance and depression on 12-month patient-reported outcomes after lumbar spine surgery (LSS)., Summary of Background Data: Psychological and behavioral factors are considered major risk factors for poor outcomes after LSS. However, there is a need to explore the combined effects of preoperative factors such as sleep disturbance and depression. Understanding the influence of sleep disturbance and depression can inform evidence-based preoperative assessment and shared-decision making of preoperative and postoperative treatment., Methods: Data from 700 patients undergoing LSS were analyzed. Preoperative sleep disturbance and depression were assessed with PROMIS subscales. Established thresholds defined patients with moderate/severe symptoms. Outcomes for disability (Oswestry Disability Index) and back and leg pain (Numeric Rating Scales) were assessed preoperatively and at 12 months. Separate multivariable linear regressions examined the influence of each factor on 12-month outcomes with and without accounting for the other and in combination as a 4-level variable: (1) moderate/severe sleep disturbance alone, (2) moderate/severe depression alone, (3) both moderate/severe sleep disturbance and depression, (4) no moderate/severe sleep disturbance or depression., Results: Preoperative sleep disturbance and depression were associated with 12-month disability and pain ( P <0.05). After accounting for depression, preoperative sleep disturbance remained associated with disability, while preoperative depression adjusting for sleep disturbance remained associated with all outcomes ( P <0.05). Patients reporting both moderate/severe sleep disturbance and moderate/severe depression had 12.6 points higher disability and 1.5 points higher back and leg pain compared with patients without moderate/severe sleep disturbance or depression., Conclusions: The combination of sleep disturbance and depression impacts postoperative outcomes considerably. The high-risk group of patients with moderate/severe sleep disturbance and depression could benefit from targeted treatment strategies., Level of Evidence: Level II., Competing Interests: The authors report no conflicts of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

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.)

Study Design: Secondary analysis of randomized controlled trial data., Objective: The aim of this study was to examine whether preoperative physical performance is an independent predictor of patient-reported disability and pain at 12 months after lumbar spine surgery., Summary of Background Data: Patient-reported outcome measures (PROMs) are commonly used to assess clinical improvement after lumbar spine surgery. However, there is evidence in the orthopedic literature to suggest that PROMs should be supplemented with physical performance tests to accurately evaluate long-term outcomes., Methods: A total of 248 patients undergoing surgery for degenerative lumbar spine conditions were recruited from two institutions. Physical performance tests (5-Chair Stand and Timed Up and Go) and PROMs of disability (Oswestry Disability Index: ODI) and back and leg pain (Brief Pain Inventory) were assessed preoperatively and at 12 months after surgery., Results: Physical performance tests and PROMs significantly improved over 12 months following lumbar spine surgery (P < 0.01). Weak correlations were found between physical performance tests and disability and pain (ρ = 0.15 to 0.32, P < 0.05). Multivariable regression analyses controlling for age, education, preoperative outcome score, fusion, previous spine surgery, depressive symptoms, and randomization group found that preoperative 5-Chair Stand test was significantly associated with disability and back pain at 12-month follow-up. Each additional 10 seconds needed to complete the 5-Chair Stand test were associated with six-point increase in ODI (P = 0.047) and one-point increase in back pain (P = 0.028) scores. The physical performance tests identified an additional 14% to 19% of patients as achieving clinical improvement that were not captured by disability or pain questionnaires., Conclusion: Results indicate that physical performance tests may provide distinct information in both predicting and assessing clinical outcomes in patients undergoing lumbar spine surgery. Our findings suggest that the 5-Chair Stand test may be a useful test to include within a comprehensive risk assessment before surgery and as an outcome measure at long-term follow-up., Level of Evidence: 3.

Background: The purpose of this prospective case series study was to compare changes in early postoperative physical activity and physical function between 6 weeks and 3 and 6 months after lumbar spine surgery., Methods: Fifty-three patients (mean [95% confidence interval; CI] age = 59.2 [56.2, 62.3] years, 64% female) who underwent spine surgery for a degenerative lumbar condition were assessed at 6 weeks and 3- and 6-months after surgery. The outcomes were objectively-measured physical activity (accelerometry) and patient-reported and objective physical function. Physical activity was assessed using mean steps/day and time spent in moderate to vigorous physical activity (MVPA) over a week. Physical function measures included Oswestry Disability Index (ODI), 12-item Short Form Health Survey (SF-12), Timed Up and Go (TUG), and 10-Meter Walk (10 MW). We compared changes over time in physical activity and function using generalized estimating equations with robust estimator and first-order autoregressive covariance structure. Proportion of patients who engaged in meaningful physical activity (e.g., walked at least 4400 and 6000 steps/day or engaged in at least 150 min/week in MVPA) and achieved clinically meaningful changes in physical function were compared at 3 and 6 months., Results: After surgery, 72% of patients initiated physical therapy (mean [95%CI] sessions =8.5 [6.6, 10.4]) between 6 weeks and 3 months. Compared to 6 weeks post-surgery, no change in steps/day or time in MVPA/week was observed at 3 or 6 months. From 21 to 23% and 9 to 11% of participants walked at least 4400 and 6000 steps/day at 3 and 6 months, respectively, while none of the participants spent at least 150 min/week in MVPA at these same time points. Significant improvements were observed on ODI, SF-12, TUG and 10 MW (p <  0.05), with over 43 to 68% and 62 to 87% achieving clinically meaningful improvements on these measures at 3 and 6 months, respectively., Conclusion: Limited improvement was observed in objectively-measured physical activity from 6 weeks to 6 months after spine surgery, despite moderate to large function gains. Early postoperative physical therapy interventions targeting physical activity may be needed.

Objective: To evaluate the degree to which conservative care and failure were specifically defined in studies comparing nonoperative treatment versus surgery for low back pain (LBP) conditions in adults., Data Sources: A comprehensive literature search was conducted by an experienced librarian using MEDLINE (PubMed), Embase, Google Scholar, and CENTRAL from January 2003 to June 2014. Endnote bibliographic management application was used to remove duplicates and organize the citations., Study Selection: Prospective, randomized, or cohort trials comparing surgery versus conservative intervention for patients with LBP conditions. Study selection was conducted by 2 independent reviewers., Data Extraction: Three independent reviewers extracted data from each article using a structured data extraction form. Data extracted included type of study, participant characteristics, sample size, description, and duration of conservative care and whether failed conservative care criterion was defined., Data Synthesis: A total of 852 unique records were screened for eligibility; of those, 72 articles were identified for further full-text review. Thirty-four full texts were excluded based on the exclusion criteria, and 38 articles, representing 20 unique studies, were included for qualitative synthesis. Fifteen of the 20 studies defined the duration of conservative care. Only 3 studies defined the dosage of physical therapy sessions, including total number of visits and visit duration. Two studies described medication usage, including the duration and type. No studies specifically defined what constituted failed conservative therapy., Conclusions: This literature review suggests conservative care is poorly defined in randomized trials, which can lead to ambiguity of research procedures and unclear guidelines for clinicians. Future studies should increase transparency and explicitly define conservative care., (Copyright © 2016 American Congress of Rehabilitation Medicine. All rights reserved.)

Background: The United States has the highest rate of lumbar spine surgery in the world, with rates increasing over 200% since 1990. Medicare spends over $1 billion annually on lumbar spine surgery. Despite surgical advances, up to 40% of patients report chronic pain and disability following surgery. Our work has demonstrated that fear of movement is a risk factor for increased pain and disability and decreased physical function in patients following lumbar spine surgery for degenerative conditions. Cognitive-behavioral therapy and self-management treatments have the potential to address psychosocial risk factors and improve outcomes after spine surgery, but are unavailable or insufficiently adapted for postoperative care. Our research team developed a cognitive-behavioral based self-management approach to postoperative rehabilitation (Changing Behavior through Physical Therapy (CBPT)). Pilot testing of the CBPT program demonstrated greater improvement in pain, disability, physical and mental health, and physical performance compared to education. The current study compares which of two treatments provided by telephone - a CBPT Program or an Education Program about postoperative recovery - are more effective for improving patient-centered outcomes in adults following lumbar spine surgery for degenerative conditions., Methods/design: A multi-center, comparative effectiveness trial will be conducted. Two hundred and sixty patients undergoing lumbar spine surgery for degenerative conditions will be recruited from two medical centers and community surgical practices. Participants will be randomly assigned to CBPT or Education at 6 weeks following surgery. Treatments consist of six weekly telephone sessions with a trained physical therapist. The primary outcome will be disability and secondary outcomes include pain, general health, and physical activity. Outcomes will be assessed preoperatively and at 6 weeks, 6 months and 12 months after surgery by an assessor masked to group allocation., Discussion: Effective rehabilitation treatments that can guide clinicians in their recommendations, and patients in their actions will have the potential to effect change in current clinical practice., Trial Registration: NCT02184143.

Psychological and behavioral factors are considered major risk factors for poor outcomes after lumbar spine surgery. However, there is a need to explore the combined effects of preoperative factors such as sleep disturbance and depression. Understanding the influence of sleep disturbance and depression can inform evidence-based preoperative assessment and shared-decision making of preoperative and postoperative treatment. To examine the combined influence of preoperative sleep disturbance and depression on 12-month patient-reported outcomes after lumbar spine surgery. Retrospective analysis of prospectively collected registry data. A total of 700 patients (mean age = 60.9 years, 257 females) undergoing surgery for a primary diagnosis of disc herniation, stenosis, spondylolisthesis, pseudoarthrosis, symptomatic mechanical disc collapse, or adjacent segment disease. All patients had to have completed preoperative patient-reported measures for sleep disturbance and depression and preoperative and 12-month patient-reported outcomes. Patient-reported outcomes were disability (Oswestry Disability Index) and back and leg pain intensity (0-10 Numeric Rating Scale). Outcomes were assessed at baseline and at 12 months after surgery. Preoperative sleep disturbance and depression were assessed with 4-item PROMIS short form versions. Established thresholds defined patients with moderate/severe symptoms. We conducted separate regressions to examine the influence of preoperative sleep disturbance and depression on 12-month outcomes. Regressions examined each factor with and without accounting for the other, and in combination as a 4-level variable: 1) moderate/severe sleep disturbance alone, 2) moderate/severe depression alone, 3) both moderate/severe sleep disturbance and depression, 4) no moderate/severe sleep disturbance or depression. Covariates in regression models included age, sex, race, education, insurance, body mass index, smoking status, preoperative opioid use, fusion status, revision status, and preoperative outcome score. In independent models, preoperative sleep disturbance and depression were significantly associated with 12-month outcomes (p < 0.05). After accounting for depression, preoperative sleep disturbance remained associated with disability, while preoperative depression adjusting for sleep disturbance remained associated with all outcomes (p < 0.05). Patients reporting both moderate/severe sleep disturbance and moderate/severe depression had 12.6 points higher disability (95% CI: 7.4 to 17.8) and 1.5 points higher back (95% CI: 0.8 to 2.3) and leg pain (95% CI: 0.7 to 2.3) compared to patients without moderate/severe sleep disturbance or depression. Preoperative sleep disturbance and depression are independent predictors of 12-month disability and pain when considered in isolation. The combination of sleep disturbance and depression impacts postoperative outcomes considerably. The high-risk group of patients with moderate/severe sleep disturbance and depression could benefit from targeted treatment strategies. This abstract does not discuss or include any applicable devices or drugs. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study was to investigate the longitudinal postoperative relationship between physical activity, psychosocial factors, and physical function in patients undergoing lumbar spine surgery.Methods: We enrolled 248 participants undergoing surgery for a degenerative lumbar spine condition. Physical activity was measured using a triaxial accelerometer (Actigraph GT3X) at 6-weeks (6wk), 6-months (6M), 12-months (12M) and 24-months (24M) following spine surgery. Physical function (computerized adaptive test domain version of Patient-Reported Outcomes Measurement Information System) and psychosocial factors (pain self-efficacy, depression and fear of movement) were assessed at preoperative visit and 6wk, 6M, 12M and 24M after surgery. Structural equation modeling (SEM) techniques were utilized to analyze data, and results are represented as standardized regression weights (SRW). Overall SRW were computed across five imputed datasets to account for missing data. The mediation effect of each psychosocial factor on the effect of physical activity on physical function were computed [(SRW for effect of activity on psychosocial factor X SRW for effect of psychosocial factor on function) ÷ SRW for effect of activity on function]. Each SEM model was tested for model fit by assessing established fit indexes.Results: The overall effect of steps per day on physical function (SRW ranged from 0.08 to 0.19, p<0.05) was stronger compared to the overall effect of physical function on steps per day (SRW ranged from non-existent to 0.14, p<0.01 to 0.3). The effect of steps per day on physical function and function on steps per day remained consistent after accounting for psychosocial factors in each of the mediation models. Depression and fear of movement at 6M mediated 3.4% and 5.4% of the effect of steps per day at 6wk on physical function at 12M, respectively. Pain self-efficacy was not a statistically significant mediator.Conclusions: The findings of this study suggest that the relationship between physical activity and physical function is stronger than the relationship of function to activity. However, future research is needed to examine whether promoting physical activity during the early postoperative period may result in improvement of long-term physical function. Since depression and fear of movement had a very small mediating effect, additional work is needed to investigate other potential mediating factors such as pain catastrophizing, resilience and exercise self-efficacy. [ABSTRACT FROM AUTHOR]

Background Context: Positive psychosocial factors early after surgery, such as resilience and self-efficacy, may be important characteristics for informing individualized postoperative care.Purpose: To examine the association of early postoperative resilience and self-efficacy on 12-month physical function, pain interference, social participation, disability, pain intensity, and physical activity after lumbar spine surgery.Study Design/setting: Pooled secondary analysis of prospectively collected trial data from two academic medical centers.Patient Sample: Two hundred and forty-eight patients who underwent laminectomy with or without fusion for a degenerative lumbar condition.Outcome Measures: Physical function, pain inference, and social participation (ability to participate in social roles and activities) were measured using the Patient Reported Outcomes Measurement Information System. The Oswestry Disability Index, Numeric Rating Scale, and accelerometer activity counts were used to measure disability, pain intensity, and physical activity, respectively.Methods: Participants completed validated outcome questionnaires at 6 weeks (baseline) and 12 months after surgery. Baseline positive psychosocial factors included resilience (Brief Resilience Scale) and self-efficacy (Pain Self-Efficacy Questionnaire). Multivariable linear regression analyses were used to assess the associations between early postoperative psychosocial factors and 12-month outcomes adjusting for age, sex, study site, randomized group, fusion status, fear of movement (Tampa Scale for Kinesiophobia), and outcome score at baseline. This study was funded by Patient-Centered Outcomes Research Institute and Foundation for Physical Therapy Research. There are no conflicts of interest.Results: Resilience at 6 weeks after surgery was associated with 12-month physical function (unstandardized beta=1.85 [95% confidence interval [CI]: 0.29; 3.40]), pain interference (unstandardized beta=-1.80 [95% CI: -3.48; -0.12]), social participation (unstandardized beta=2.69 [95% CI: 0.97; 4.41]), and disability (unstandardized beta=-3.03 [95% CI: -6.04; -0.02]). Self-efficacy was associated with 12-month disability (unstandardized beta=-0.21 [95% CI: -0.37; -0.04].Conclusions: Postoperative resilience and pain self-efficacy were associated with improved 12-month patient-reported outcomes after spine surgery. Future work should consider how early postoperative screening for positive psychosocial characteristics can enhance risk stratification and targeted rehabilitation management in patients undergoing spine surgery. [ABSTRACT FROM AUTHOR]

Background. Clinical guidelines advocate the routine identification of depressive symptoms for patients with pain in the lumbar or cervical spine, but not for other anatomical regions. Objective. The purpose of this study was to investigate the prevalence and impact of depressive symptoms for patients with musculoskeletal pain across different anatomical regions. Design. This was a prospective, associational study. Methods. Demographic, clinical, depressive symptom (Symptom Checklist 90- Revised), and outcome data were collected by self-report from a convenience sample of 8,304 patients. Frequency of severe depressive symptoms was assessed by chisquare analysis for demographic and clinical variables. An analysis of variance examined the influence of depressive symptoms and anatomical region on intake pain intensity and functional status. Separate hierarchical multiple regression models by anatomical region examined the influence of depressive symptoms on clinical outcomes. Results. Prevalence of severe depression was higher in women, in industrial and pain clinics, and in patients who reported chronic pain or prior surgery. Lower prevalence rates were found in patients older than 65 years and those who had upperor lower-extremity pain. Depressive symptoms had a moderate to large effect on pain ratings (Cohen d0.55- 0.87) and a small to large effect on functional status (Cohen d0.28-0.95). In multivariate analysis, depressive symptoms contributed additional variance to pain intensity and functional status for all anatomical locations, except for discharge values for the cervical region. Conclusions. Rates of depressive symptoms varied slightly based on anatomical region of musculoskeletal pain. Depressive symptoms had a consistent detrimental influence on outcomes, except on discharge scores for the cervical anatomical region. Expanding screening recommendations for depressive symptoms to include more anatomical regions may be indicated in physical therapy settings. [ABSTRACT FROM AUTHOR]

Patient-Reported Outcomes Measurement Information System (PROMIS) tools offer alternatives to legacy outcome measures. The National Institutes of Health Task Force on Research Standards for Chronic Low Back Pain has encouraged use of PROMIS domains. Recent study findings suggest PROMIS tools may be appropriate for long-term outcome assessment in spine surgery populations. However, the dissemination of PROMIS into clinical practice has been limited and more work showing longitudinal congruence between PROMIS and spine legacy measures may increase adoption of PROMIS measures to assess patient reported outcomes. To compare the trajectory of patient reported outcomes (PROs) as reported by PROMIS to other legacy measures of disability and pain over time. To better understand the timelines for healing in patients with different lumbar procedures, we reported the outcome trajectories of laminectomy decompression with fusion vs without fusion. Secondary analysis from a randomized controlled trial comparing postoperative cognitive-behavioral based physical therapy (n=124) and an education program (n=124). A total of 248 patients were included. Of them, 164 (66%) patients had laminectomy with fusion and 84 (34%) had laminectomy without fusion. PROMIS CAT Physical Function (PF) and Pain Interference (PI); Oswestry Disability Index (ODI); Numeric Rating Scale leg (NRS-LP) and back pain (NRS-BP), Brief Pain Inventory (BPI). Participants completed PROs preoperatively, 6 weeks, 6-, 12-, and 24-months after surgery. Mean scores were plotted at each time point for all outcomes and patients were stratified by fusion status. T-scores were reported for PROMIS measures which are standardized with a mean of 50 (SD=10). Pearson's correlations across measures were done within each timepoint. The general pattern of trajectories for all outcomes showed significant improvements from preop to 6-weeks (p<0.001) and from 6-weeks to 6-months (p<0.001) with very little change between 6 and 24 months after surgery. Between preoperative and 24-months, PROMIS PF T-scores for both fusion (33±6 at baseline to 43±7 at 24mo) and decompression (34±6 at baseline to 43±7 at 24mo) groups improved from scores indicating moderate to mild problem. For PROMIS PI T-scores, fusion (66±6 at baseline to 53±7 at 24mo) and decompression (66±7 at baseline to 53±8 at 24mo) patients both improved from scores indicating moderate problems to normal levels. For both PROMIS outcomes, the fusion group showed less improvement at 6 weeks, but both groups had similar scores by 6 months after surgery and remained similar at 12 and 24 months. The ODI and pain score trajectories showed a similar pattern of responses over time. Correlations within timepoint ranged from r=-0.84 to -0.67 for PF and ODI and r=0.69 to 0.78 for PI with BPI. Back and leg pain correlations with PI were weaker (r=0.30 to 0.70). All correlations were significant (p<0.001). PROMIS PF and PI showed similar 24-month trajectories to ODI, NRS pain measures, and BPI following lumbar spine surgery with most change occurring in the first 6 months. Fusion patients tend to have slightly worse scores than decompression at 6 weeks but both groups have similar scores by 6 months postoperatively and remain similar through 24 months. These results support the use of PROMIS measures to assess outcomes in a degenerative spine population. This abstract does not discuss or include any applicable devices or drugs. [ABSTRACT FROM AUTHOR]

Patient-centered goal setting is an important component of behavioral interventions for chronic pain. Limited data exist on the relationship between goal attainment during cognitive-behavioral based physical therapy (CBPT) and pain-related outcomes. The purpose of this study was to examine the relationship between CBPT goal attainment and pain-related outcomes in a cohort of patients who completed a 6-week telephone-based CBPT intervention after lumbar spine surgery. Secondary analysis from a randomized trial comparing postoperative CBPT and an education program. The primary results of the trial showed superiority of CBPT in an intervention completers only analysis. This study included 108 participants (mean ± SD age = 63.5 ± 11.3 years, 54 [50%] female, 92 [85%] White) who completed the CBPT intervention were included. Six and 12-month outcomes included physical function (PROMIS), pain interference (PROMIS), and back and leg pain intensity (Brief Pain Inventory). At each session, CBPT participants used goal attainment scaling (GAS) to set goals and report goal attainment from the previous session. The number and type of goals and percentage of goals met were recorded. A GAS t-score for achievement of goals across all sessions was computed for each patient. Patients were grouped as high or low goal attainment based on a GAS t-score of 50, which indicates goals were met as expected. Outcome differences between groups at each follow-up time point were examined using linear regression analyses controlling for baseline outcome score. Alpha was set at the 0.05 level for statistical significance. Participants set a median of 3 goals (range: 1 to 6) at each CBPT session. The most common goals were related to participating in a physical/recreational activity (36%), adopting a cognitive or behavioral strategy (28%), exercising (11%), or performing activities of daily living (11%). The least common goals related to social activities (2%). Forty-six (43%) participants met criteria for high goal attainment (mean % goals met = 87% compared to 64% in the low goal attainment group, p<0.001). Greater improvements in the high goal attainment group were observed in physical function at 6 (unstandardized beta = 4.2, p < 0.05) and 12 months (unstandardized beta = 3.5, p < 0.05) and back pain intensity at 12 months (unstandardized beta = -0.9 p < 0.05). The attainment of personalized goals within a CBPT intervention was an important factor related to improvements in physical functioning after spine surgery. Implementing a structured process for setting personalized goals and tracking goal attainment may be an essential aspect of a biopsychosocial approach for addressing functional impairment following surgery. This abstract does not discuss or include any applicable devices or drugs. [ABSTRACT FROM AUTHOR]

Psychological factors such as fear of movement negatively influence outcomes after lumbar spine surgery. Positive psychological factors like resilience and self-efficacy are considered potential protective factors that can promote recovery. The purpose of this study was to examine the influence of early postoperative resilience and self-efficacy on 12-month physical function, disability, pain, and physical activity after lumbar spine surgery. Secondary analysis of prospectively-collected data from a randomized controlled trial. A total of 248 patients (mean (SD) age=62.2 (11.9) years; 51% female) who underwent laminectomy with or without fusion for a degenerative lumbar condition. The primary outcomes for this study were physical function (PROMIS Physical Function), disability (Oswestry Disability Index), pain interference (PROMIS Pain Interference), back pain intensity (Numeric Rating Scale), and physical activity (acceleromoter activity counts). This was a secondary analysis of data from a multisite randomized trial comparing a postoperative cognitive-behavioral physical therapy (n=124) and education program (n=124). The primary results of the trial showed no difference in 12-month outcomes in intent-to-treat analyses. Participants completed validated outcome questionnaires at 6 weeks (baseline) and 12 months after surgery. Positive psychological factors measured at baseline were resilience (Brief Resilience Scale) and self-efficacy (Pain Self-Efficacy Questionnaire). To determine the influence of each factor independently, separate multivariable regressions (semi-partial r) were conducted for each outcome and psychological factor. Covariates in analyses included baseline outcome score, age, sex, study site, randomized group, fusion status, and fear of movement. A combined multivariable regression model was conducted for determining the most influential positive psychological factor. In independent multivariable models, resilience was associated with 12-month physical function (r=0.19, p=0.001), disability (r=-0.14, p=0.009), pain interference (r=-0.16, p=0.006), back pain intensity (r=-0.14, p=0.02), and physical activity (r=0.12, p=0.01). Self-efficacy was associated with 12-month physical function (r=0.17, p=0.002), disability (r=-0.15, p=0.003), pain interference (r=-0.14, p = 0.01), and back pain intensity (r=-0.12, p=0.03). For both resilience and self-efficacy, higher levels were associated with higher physical function and lower disability and pain. In the combined multivariable model, only resilience was associated with 12-month physical function (r=0.12, p=0.02) and pain interference (r=-0.12, p=0.04). Both resilience (r=-0.10, p=0.05) and self-efficacy (r=-0.15, p=0.02) were associated with disability, with self-efficacy being the stronger predictor. Early postoperative resilience and self-efficacy are consistently associated with pain-related outcomes after lumbar spine surgery, even after controlling for covariates including baseline outcome and fear of movement. When considered in a single model, resilience was the only protective factor associated with physical function and pain interference, while self-efficacy was the stronger protective factor for disability. Future work should consider how multidimensional screening tools that consider negative and positive psychological factors can enhance prognosis and treatment decision-making in patients undergoing spine surgery. This abstract does not discuss or include any applicable devices or drugs. [ABSTRACT FROM AUTHOR]

Engaging in physical activity early after lumbar spine surgery has promising effects on long-term postoperative recovery, including improved physical function. However, whether this effect is mediated through improvement in psychosocial factors is yet to be established. The purpose of this study was to investigate the longitudinal postoperative relationship between physical activity, psychosocial factors, and physical function in patients undergoing lumbar spine surgery. Secondary analysis from randomized controlled trial. This study included 248 participants (mean ± SD; age=62.2±11.9 years; BMI=32.4±6.6 kg/m2 and 51% females) who underwent surgery for a degenerative lumbar spine condition. Physical activity, defined as steps per day, was measured using a triaxial accelerometer (Actigraph GT3X) worn for >10 hours for >1 day(s) at 6 weeks (6wk), 6 months (6M), 12 months (12M) and 24 months (24M) following spine surgery. Physical function, measured with Patient-Reported Outcomes Measurement Information System, and psychosocial factors pain self-efficacy [Pain Self-Efficacy Questionnare], depression [Patient Health Questionnaire-9] and fear of movement [Tampa Scale for Kinesiophobia]) were assessed at preoperative visit and 6wk, 6M, 12M and 24M after surgery. Structural equation modeling (SEM) was used to analyze data and compute standardized coefficients to determine the effects of physical activity, function and psychosocial factors. Multiple imputation accounted for missing data and pooled coefficients and p-values were calculated using Rubin's approach. The mediation effect of each psychosocial factor on the effect of physical activity on physical function were computed by dividing the direct effects with the indirect effects. All SEM models controlled for age, employment, comorbidities, prior spine surgery, and preoperative pain self-efficacy, depression, fear of movement, physical function, and back and leg pain. Each SEM models was tested for model fit by assessing the established fit indexes. The overall standardized direct effect of physical activity (ie, steps per day) on physical function ranged from 0.08 to 0.19 (p<0.05), while the overall effect of physical function on physical activity ranged from non-existent to 0.14 (p<0.01 to 0.3). The effect of physical activity on physical function remained consistent after accounting for psychosocial factors in each of the mediation models. Pain self-efficacy did not mediate but depression and fear of movement at 6M mediated 3.4% and 5.4% of the effect of physical actvity at 6Wk on physical function at 12M, respectively. The findings of this study support the use of early postoperative strategies to address physical activity in order to improve long-term physical function. Pain self-efficacy did not have a mediating effect while depression and fear of movement had a very small mediating effect; therefore, additional work is needed to investigate other potential mediating factors such as pain catastrophizing, resilience and exercise self-efficacy. This abstract does not discuss or include any applicable devices or drugs. [ABSTRACT FROM AUTHOR]