51. Fostering physical activity after complex lumbar spine surgery: a randomized trial

Abstract

BACKGROUND CONTEXT Patients are instructed to restrict activity for several months after lumbar surgery to safely recuperate. However, after recuperation many patients continue sedentary lifestyles because of fear of spine injury, persistent pain, deconditioning, and habit. Lack of activity has serious long-term adverse consequences for spine health and other physical and mental diagnoses (ie, Sedentary Death Syndrome). Because surgeons comprehensively understand the spine condition and extent of surgery, they and their surgical team are uniquely positioned to address apprehensions and advise/encourage prudent activity. Thus programs to foster physical activity that can be integrated into the busy postop spine care setting are needed. PURPOSE To determine whether an intervention encompassing major psychosocial tenets of behavior change would be effective in increasing prudent physical activity, primarily walking, after 4-6 months. STUDY DESIGN/SETTING Randomized controlled trial, tertiary spine center. PATIENT SAMPLE A total of 225 patients 3 months after complex lumbar surgery, cleared by surgeons to increase physical activity. OUTCOME MEASURES Paffenbarger Physical Activity and Exercise Index (PAEI). METHODS During routine 3-month postop visits, 111 intervention patients received (1) a booklet about benefits of physical activity and national activity guidelines, (2) instruction on how to increase lifestyle walking, (3) a pedometer calibrated to stride length, (4) made a self-contract specifying walking goals, and (5) received interval telephone contract-directed encouragement from study personnel. A total of 114 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. The national recommended threshold overall total is ≥2000 Kcal/week. Operative records were reviewed and a Surgical Invasiveness Index (SII) value was calculated (maximum 10 points per vertebral level); higher is greater complexity. The primary outcome was change in Kcal/week in the PAEI walking domain at 4-6 months post enrollment; a secondary outcome was change in overall total Kcal/week. RESULTS At enrollment, intervention and control groups were similar in mean age (64 vs 64), women (44% vs 50%), median SII value (11 vs 10), PAEI walking Kcal/week (1447 vs 1246), PAEI overall total Kcal/week (1826 vs 1631), and percent meeting the recommended activity threshold total (37% vs 30%) (all p>.05). Mean post-enrollment follow-up was 4.2±0.6 months. The within-patient mean increase in PAEI walking was 1132 vs 582 Kcal/week (p=.03) and the mean increase in PAEI overall total was 1713 vs 1067 Kcal/week (p=.04). In multivariable analysis with change in PAEI walking as the dependent variable, intervention group (p=.02), younger age (p=.01), and female sex (p=.05) were associated, but more complex surgery was not (p=.24). Similar results were found for the PAEI overall total as the dependent variable. At the follow-up more patients in the intervention group met the ≥2000 Kcal/week threshold (63% vs 46%) (OR 2.0, CI 1.2-3.5, p=.009). CONCLUSIONS A psychosocial intervention in the spine care setting was successful in increasing physical activity after recuperation from lumbar surgery. Our study highlights the need to guide patients in regaining prudent activity that will promote subsequent spine and overall health. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.