McIlroy Suzanne, Bearne Lindsay, Weinman John, Norton Sam
Physiotherapy Department, King's College Hospital, London, UK.
Health Psychology Section, King's College London, London, UK.
Sci Rep. 2025 Feb 10;15(1):4959. doi: 10.1038/s41598-025-87894-9.
Neurogenic claudication, caused by lumbar spinal stenosis, is the most common reason for spinal surgery in older adults, aiming to improve pain and walking. However, most people do not increase walking post-operatively. This study aimed to identify modifiable physical and psychosocial factors that could be targeted with rehabilitation. A prospective longitudinal study recruited 97 adults, aged > 50 years, awaiting surgery for neurogenic claudication. Walking measures (six-minute walk test, daily step count, self-rated maximum walking distance) were assessed pre-surgery and 12-weeks post-surgery. Modifiable variables, mapped to a behaviour change model (COM-B; e.g. falls, lower limb performance, fear of movement, illness perceptions), were evaluated using mixed-effects regression models. All walking measures demonstrated statistically significant improvements (p < .001). However, 50% did not achieve minimum clinically important differences. The strongest correlation with post-operative walking was pre-operative walking. Cross-sectionally, lower limb performance (b:.75; 95CI .64, .86 to b:.35; 95%CI .19, .52), pre-surgery history of falls (b:-.29; 95%CI-.44,-.13), fear of falling (b:-.55; 95%CI-.69,-.41 to b:-.32; 95%CI -.48, -.15), fear of movement (b:-.48; 95%CI-.63,-.33 to -.22; 95%CI -.40, -.03), coherence of condition (b:-.23; 95%CI -.41, -.05 to b:-.17; 95%CI-.33,-.01) and perceived personal control (b:.26; 95%CI .09, .43 to b:.14; 95%CI.02,.31), were significantly associated with pre-surgical walking (p < .05). Most pre-surgical variables were not longitudinally associated with change in walking post-surgery. Six-weeks post-surgery fear of falling (b:-.35; 95%CI -.57, -.13 to b:-.18; 95%CI-.33,-.02), fear of movement (b:-.32; 95%CI-.53,-.11 to b:-.19; 95%CI -.33, -.05), and emotional response (b-.24; 95%CI -.38, -.11 to b:-.22; 95%CI -.41, -.03) were significantly associated with less improvement in walking at 12-weeks post-surgery. Prehabilitation and post-operative rehabilitation targeting walking, balance, and psychosocial factors is recommended to optimise post-surgical walking.
由腰椎管狭窄症引起的神经源性间歇性跛行是老年人进行脊柱手术的最常见原因，目的是缓解疼痛并改善行走能力。然而，大多数人术后行走能力并未提高。本研究旨在确定可通过康复治疗来解决的身体和心理社会方面的可变因素。一项前瞻性纵向研究招募了97名年龄超过50岁、等待接受神经源性间歇性跛行手术的成年人。在手术前和术后12周评估行走指标（六分钟步行试验、每日步数、自我评估的最大行走距离）。使用混合效应回归模型评估映射到行为改变模型（COM-B；例如跌倒、下肢功能、运动恐惧、疾病认知）的可变因素。所有行走指标均显示出具有统计学意义的改善（p <.001）。然而，50%的人未达到最小临床重要差异。与术后行走相关性最强的是术前行走情况。横断面分析显示，下肢功能（b:.75；95%置信区间.64，.86至b:.35；95%置信区间.19，.52）、术前跌倒史（b:-.29；95%置信区间-.44，-.13）、跌倒恐惧（b:-.55；95%置信区间-.69，-.41至b:-.32；95%置信区间 -.48， -.15）、运动恐惧（b:-.48；95%置信区间-.63，-.33至-.22；95%置信区间 -.40， -.03）、病情连贯性（b:-.23；95%置信区间 -.41， -.05至b:-.17；95%置信区间-.33，-.01）和感知到的个人控制（b:.26；95%置信区间.0
