Department of Orthopaedic Surgery, Center for Musculoskeletal Research, Vanderbilt University Medical Center, 1215 21st Avenue South, Medical Center East - South Tower, Suite 4200, Nashville, TN, 37232, USA.
Department of Physical Medicine and Rehabilitation, Osher Center for Integrative Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
BMC Musculoskelet Disord. 2020 Nov 27;21(1):783. doi: 10.1186/s12891-020-03816-y.
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.
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.
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.
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.
本前瞻性病例系列研究旨在比较腰椎手术后 6 周、3 个月和 6 个月时早期术后体力活动和身体功能的变化。
53 例（平均[95%置信区间；CI]年龄=59.2[56.2，62.3]岁，64%为女性）因退行性腰椎疾病接受脊柱手术的患者在术后 6 周、3 个月和 6 个月时进行评估。结果采用加速度计客观测量体力活动和患者报告和客观身体功能。体力活动通过一周内的平均每日步数和中度至剧烈体力活动（MVPA）时间来评估。身体功能测量包括 Oswestry 残疾指数（ODI）、12 项简明健康调查（SF-12）、计时起立行走（TUG）和 10 米步行（10MW）。我们使用广义估计方程和稳健估计器以及一阶自回归协方差结构比较了体力活动和功能随时间的变化。在 3 个月和 6 个月时比较了进行有意义的体力活动（例如，每天至少行走 4400 步和 6000 步或每周至少进行 150 分钟 MVPA）和实现身体功能有临床意义改善的患者比例。
手术后，72%的患者在 6 周至 3 个月期间开始接受物理治疗（平均[95%CI]治疗次数=8.5[6.6，10.4]）。与术后 6 周相比，3 个月和 6 个月时每日步数或 MVPA/周时间没有变化。分别有 21%至 23%和 9%至 11%的参与者每天至少行走 4400 步和 6000 步，而在同一时间点没有参与者每周至少进行 150 分钟 MVPA。ODI、SF-12、TUG 和 10MW 显著改善（p<0.05），分别有 43%至 68%和 62%至 87%的参与者在 3 个月和 6 个月时在这些指标上达到有临床意义的改善。
尽管功能有较大幅度的改善，但在脊柱手术后 6 周至 6 个月期间，客观测量的体力活动仅略有改善。可能需要针对体力活动的术后早期物理治疗干预措施。
