Research Division, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA.
Department of Medicine, Weill Cornell Medical College, New York, NY, USA.
Eur Spine J. 2021 Jan;30(1):200-207. doi: 10.1007/s00586-020-06508-2. Epub 2020 Jun 19.
Many patients retain sedentary lifestyles after lumbar surgery and incur increased risks of adverse health outcomes. The goal of this study was to assess patients' perspectives about postoperative physical activity.
During routine post-lumbar surgery visits in a tertiary care center, 260 patients were asked open-ended questions about their spine and physical activity. Three investigators reviewed responses and determined themed categories. Patients also completed surveys measuring disability, depressive symptoms, anxiety, and fear-avoidance of physical activity. Surgical complexity was assigned based on operative features.
Mean age was 63, and 53% were men. Thirty-nine percent thought walking was good for the spine, particularly among those with less fear-avoidance, less disability, and less complex surgery. Spine benefits were cited (42%) for the short-term ("faster recovery") and long-term ("decreases chances of another surgery"), particularly by younger patients. To increase activity, patients suggested spine-specific techniques (35%, "use railings") and advised caution (24%, "pace yourself"). The major deterrent was persistent back pain (36%) particularly for those with worse disability, and more depressive symptoms, anxiety, complex surgery, and fear-avoidance. Our findings consistently fit with the Social Cognitive Theory of health behavior which posits a dynamic three-way interaction of personal factors, environmental influences, and behavior.
Patients acknowledge short- and long-term benefits of physical activity for their spine and overall health; however, many are deterred from increasing activity by spine-related concerns. Interventions to improve physical activity should foster self-efficacy and self-direction and should be reinforced by members of the spine care team who are knowledgeable about prudent activities.
许多腰椎手术后的患者仍保持久坐不动的生活方式，增加了不良健康后果的风险。本研究旨在评估患者对术后体力活动的看法。
在三级护理中心的常规腰椎手术后就诊期间，向 260 名患者提出了有关脊柱和体力活动的开放性问题。三位研究人员审查了回复并确定了主题类别。患者还完成了衡量残疾、抑郁症状、焦虑和对体力活动的回避恐惧的调查。根据手术特点分配手术复杂性。
平均年龄为 63 岁，53%为男性。39%的人认为散步对脊柱有益，尤其是那些回避恐惧、残疾程度较低且手术复杂性较低的人。脊柱益处被引用（42%）有短期（“更快恢复”）和长期（“减少再次手术的机会”），特别是年轻患者。为了增加活动量，患者建议使用脊柱特异性技术（35%，“使用扶手”）并谨慎行事（24%，“自己把握节奏”）。主要的阻碍是持续的背痛（36%），尤其是那些残疾程度更严重、抑郁症状、焦虑、复杂手术和回避恐惧的患者。我们的发现与健康行为的社会认知理论一致，该理论假设个人因素、环境影响和行为之间存在动态的三向相互作用。
患者承认体力活动对脊柱和整体健康有短期和长期的益处；然而，许多人因与脊柱相关的问题而不愿增加活动量。旨在提高体力活动的干预措施应培养自我效能感和自我指导能力，并应由了解谨慎活动的脊柱护理团队成员加以强化。
