Rana Parimal, Brennan Jane C, Johnson Andrea H, Turcotte Justin J, Patton Chad M
Luminis Health Orthopedics, Anne Arundel Medical Center, Annapolis, United States.
Spine Surg Relat Res. 2024 Jun 10;9(1):71-77. doi: 10.22603/ssrr.2024-0047. eCollection 2025 Jan 27.
Previous studies have shown that early patient mobility and activity can improve patient outcomes after lumbar fusion procedures. This study aimed to explore the relationship between patient mobility and activity, measured by the Activity Measure for Post-acute Care (AM-PAC) "6-Clicks" assessment and postoperative outcomes in lumbar fusion patients.
A retrospective review of 306 lumbar fusions (105 with 6-Clicks mobility and 289 with 6-Clicks activity scores) was conducted. Statistical analyses were performed to evaluate the relationship between 6-Clicks scores and postoperative outcomes, such as prolonged length of stay (LOS), nonhome discharge, 30-day emergency department (ED) returns and readmissions, and minimal clinically important difference (MCID) achievement on the PROMIS-PF instrument at 3-12 months postoperatively.
After controlling for age, body mass index, sex, race, number of levels, and preoperative PROMIS-PF, higher 6-Clicks mobility scores decreased the likelihood of 3+ day LOS (OR: 0.72; p=0.010), non-home discharge (OR: 0.68; p<0.001), and 30-day ED return (OR: 0.78; p=0.022) and increased the likelihood of PROMIS MCID achievement (OR: 1.28; p=0.004). The odds of LOS 3+ days, non-home discharge, and ED return for each one-point increase in mobility scores all decreased by 28%, 32%, and 22%, respectively, while the odds of achieving PROMIS MCID for every one-point increase in mobility increased by 28%. After risk adjustment, higher 6-Clicks activity scores were protective against 3+ day LOS (OR: 0.78; p<0.001) and non-home discharge (OR: 0.69; p<0.001).
The AM-PAC 6-Clicks mobility and activity scores hold value as early indicators of prolonged LOS and nonhome discharge, while mobility scores may help identify patients who are at risk for ED returns and who fail to experience clinically significant improvement in physical function. These tools may be used to identify patients requiring additional resources and can inform discussions surrounding patient expectations.
先前的研究表明，腰椎融合手术后早期患者的活动能力和活动量可改善患者的预后。本研究旨在探讨通过急性后期护理活动量度（AM-PAC）“6次点击”评估所测量的患者活动能力和活动量与腰椎融合患者术后预后之间的关系。
对306例腰椎融合手术病例（105例有“6次点击”活动能力评分，289例有“6次点击”活动量评分）进行回顾性分析。进行统计分析以评估“6次点击”评分与术后预后之间的关系，如住院时间延长、非回家出院、30天内急诊复诊和再入院，以及术后3至12个月时患者报告结局测量信息系统-身体功能（PROMIS-PF）工具上最小临床重要差异（MCID）的达成情况。
在控制了年龄、体重指数、性别、种族、手术节段数和术前PROMIS-PF后，较高的“6次点击”活动能力评分降低了住院3天及以上（比值比：0.72；p=0.010）、非回家出院（比值比：0.68；p<0.001）和30天内急诊复诊（比值比：0.78；p=0.022）的可能性，并增加了达到PROMIS MCID的可能性（比值比：1.28；p=0.004）。活动能力评分每增加1分，住院3天及以上、非回家出院和急诊复诊的几率分别降低28%、32%和22%，而活动能力评分每增加1分，达到PROMIS MCID的几率增加28%。经过风险调整后，较高的“6次点击”活动量评分可预防住院3天及以上（比值比：0.78；p<0.001）和非回家出院（比值比：0.69；p<0.001）。
AM-PAC“6次点击”活动能力和活动量评分作为住院时间延长和非回家出院的早期指标具有价值，而活动能力评分可能有助于识别有急诊复诊风险以及身体功能未出现临床显著改善的患者。这些工具可用于识别需要额外资源的患者，并为围绕患者期望的讨论提供参考。
