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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?
- Source :
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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. - Publication Year :
- 2021
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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.<br />Design: Secondary analysis from randomized controlled trial.<br />Setting: Two academic medical centers in the United States.<br />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.<br />Interventions: Not applicable.<br />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.<br />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.<br />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.<br /> (Copyright © 2021 The American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.)
- Subjects :
- Accelerometry
Aged
Female
Humans
Laminectomy methods
Male
Middle Aged
Pain Measurement
Patient Reported Outcome Measures
Postoperative Period
Prospective Studies
Analgesics, Opioid therapeutic use
Disability Evaluation
Lumbar Vertebrae surgery
Pain, Postoperative drug therapy
Pain, Postoperative rehabilitation
Spinal Diseases rehabilitation
Spinal Diseases surgery
Walking statistics & numerical data
Subjects
Details
- Language :
- English
- ISSN :
- 1532-821X
- Volume :
- 102
- Issue :
- 10
- Database :
- MEDLINE
- Journal :
- Archives of physical medicine and rehabilitation
- Publication Type :
- Academic Journal
- Accession number :
- 34175276
- Full Text :
- https://doi.org/10.1016/j.apmr.2021.06.002