(154) Preoperative Physical Activity in Pediatric Posterior Spinal Fusion: An Observational Feasibility Study

Abstract

Pediatric surgeries and postoperative pain interventions with opioids pose risks for functional recovery and analgesic dependence. Prehabilitation, optimizing of physical functioning prior to surgery, is a possibly efficacious intervention with minimal adverse effects not yet assessed among children. Little is known about typical physical activity patterns of children undergoing orthopedic surgeries, or whether measurement with commercial accelerometry is feasible. This pilot study aimed to determine the feasibility of actigraphy assessment in children undergoing posterior spinal fusion (PSF) and assess the variability of their pre-operative activity. Children and adolescents undergoing PSF (n=15) wore a Fitbit Flex for approximately two weeks between their preoperative clinic appointment and surgery date, with no instructed change to activity level. Daily step counts were obtained from the Fitbit account for each participant. Of 15 participants, two dropped out (surgery or postoperative visit canceled). Overall, 73% of data was obtained from the pre-surgical period. The median number of data points per day was 11 [IQR:4-13]. The median average steps per day was 5,423 [IQR:4222-8060], the median maximum was 11,513 [IQR:6862-16142] and the median difference between highest and lowest step counts was 10,680 [IQR:4,886-15,662]. Four participants had consistently lower counts, defined as ≥50% of the recorded day total th percentile of the population average (4,222 steps). No participants had consistently higher counts preoperatively, defined as ≥50% of the recorded day total >75 th percentile of the population average (8,060 steps). Results demonstrate that assessing children's physical activity preoperatively is feasible and provides a description of the typical patterns of physical activity among children undergoing posterior spinal fusion. These findings support the possibility for implementation of prehabilitation in children. Prehabilitation can help prevent poor post-surgical outcomes among adults undergoing orthopedic surgeries and holds promise for possible preventative intervention for children to reduce risks associated with surgeries and opioid use.