195. Fostering physical activity after complex lumbar spine surgery: long-term results of a randomized trial

Abstract

BACKGROUND CONTEXT Many patients maintain sedentary lifestyles after lumbar surgery because of fear of spine injury, pain, deconditioning and habit, and thus incur potential serious long-term adverse consequences (ie, sedentary death syndrome). The surgical team is uniquely positioned to institute behavioral interventions that both protect the spine and foster prudent physical activity. However, beneficial effects of physical activity interventions often are noted in the short-term, and extinguish with time. We previously showed the effectiveness of an intervention in an RCT to increase prudent physical activity at the 4-month short-term follow-up. PURPOSE To determine the sustainability of an intervention to increased physical activity, primarily walking, after 12 months STUDY DESIGN/SETTING RCT, tertiary spine center PATIENT SAMPLE A total of 230 patients, enrolled 3 months after complex lumbar surgery, cleared by surgeons to increase physical activity, followed for 12 months OUTCOME MEASURES Paffenbarger Physical Activity and Exercise Index (PAEI) at 12 months METHODS During routine 3-month postop visits, 110 intervention patients received 1) a booklet about benefits of physical activity and national activity guidelines 2) instruction on how increase lifestyle walking 3) a calibrated pedometer 4) made a self-contract specifying walking goals and 5) received periodic telephone encouragement early in the trial. 120 controls received information about safe physical activity. At enrollment all patients completed the valid 3-domain PAEI measuring number of blocks walked and stairs climbed daily and sports during the past week. Kcal/week were calculated for each domain and for an overall total. Operative records were reviewed and a Surgical Invasiveness Index (SII) value (reflecting surgical complexity) was calculated (max 10 points/vertebral level). Multivariable analyses considered within-patient enrollment to 12-month follow-up change in Kcal/week, controlling for demographic and clinical characteristics. RESULTS At enrollment intervention and control groups were similar in mean age (64 vs 63), men (55% vs 51%), median SII value (11 vs 11), PAEI walking Kcal/week (1,418 vs 1,311), and PAEI overall total Kcal/week (1,786 vs 1,754) (all p>.05). Mean time from surgery to enrollment was 2.9 months, and from enrollment to long-term follow-up was 12.6 months. The within-patient mean increase in PAEI walking was 860 vs 365 Kcal/week; in multivariable analysis with change in PAEI walking as the dependent variable and controlling for age, sex and surgical complexity, intervention group remained associated (estimate 563, 95% CI 70-1057, p=.03). The increase in PAEI overall total was 1,294 vs 758 Kcal/week; in similar multivariable analysis intervention group remained associated (estimate 642, 95% CI 75-1209, p=.03). CONCLUSIONS A psychosocial intervention in the spine care setting was successful in increasing and then sustaining gains in physical activity up to 12 months after lumbar surgery. Our study highlights the potential for interventions to foster new physical activity habits that diminish sedentary lifestyles and thus promote long-term spine and overall health. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.