Preoperative Walking Research Articles

Association of Preoperative Walking Speed With 1-Year Outcomes After Hip Arthroscopy for Femoroacetabular Impingement Syndrome.

Previous studies have identified demographic, radiographic, and intraoperative predictors of outcomes after hip arthroscopy for femoroacetabular impingement syndrome, yet few studies have identified whether preoperative gait metrics can predict outcomes. Increased preoperative step count, walking speed, step length, and gait symmetry will be associated with better outcomes after surgery. Retrospective cohort study. Level 4. Patients who underwent hip arthroscopy between 2019 and 2022 and downloaded the smartphone app rHip, allowing for retroactive access of gait metric data, were identified. Preoperative gait metrics, age, sex, body mass index (BMI), and exercise participation were analyzed via multivariate stepwise linear regression for a relationship with 1-year postoperative patient-reported outcomes (PROs), including Hip Outcome Scale-Activities of Daily Living (HOS-ADL); HOS-Sports Subscale (HOS-SS), and 12-item international Hip Outcome Tool (iHOT-12). Thresholds for preoperative gait metrics were analyzed via receiver operator characteristic curve. A subgroup analysis was performed to compare those who did and did not reach this threshold. A total of 43 patients (86% female; age, 33.1 ± 13.7 years; BMI, 23.9 ± 4.4 kg/m2) met inclusion criteria. Multivariate regression found that preoperative walking speed was significantly associated with postoperative HOS-ADL, HOS-SS, and iHOT-12 (P ≤ .01). A preoperative walking speed threshold of 1.065 m/s was predictive of outcome achievement. Those who failed to achieve this threshold were significantly older, of greater BMI, and less active (P ≤ .04). They also showed significantly worse 1-year postoperative scores (P ≤ .02) and lower PASS achievement for HOS-ADL, HOS-SS, and iHOT-12 (P ≤ .04). Preoperative walking speed is significantly associated with 1-year outcomes after hip arthroscopy. Patients who averaged <1.065 m/s show significantly worse outcomes after surgery. Assessment of preoperative walking speed may allow physicians to better counsel patients regarding expected outcomes after hip arthroscopy.

Role of Epidural Electrode Stimulation in Three Patients with Incomplete AIS D Spinal Cord Injury.

Background/Objectives: To determine whether epidural electrical stimulation (EES) improves sensory recovery and walking function in patients with chronic spinal cord injury (SCI) with a grade on the American Spinal Cord Injury Association impairment scale (AIS) of C or D at the cervical level. Methods: Three individuals with cervical-level chronic AIS D SCI were enrolled in the study. The mean injury duration and age were 4.8 ± 4.5 (range: 1.5-10) and 56.7 ± 9 years, respectively. The participants received personalized electrical stimulation for 36 weeks and were evaluated for their SCI characteristics, the result of an AIS assessment according to the lower extremity sensorimotor scale, their muscle activity, and preoperative walking ability parameters, initially as well as at weeks 8 and 36 of the EES intervention. Results: Participants receiving EES significantly increased the muscle activity in most lower limb muscles. Regarding the AIS assessment of the lower extremities, one participant fully regained a light touch sensation, while two fully recovered their pinprick sensation (AIS sensory scores increased from 14 to 28). One participant achieved a full motor score, whereas the others' scores increased by 19 and 7 points. Compared with preoperative gait parameters, two participants showed improvements in their walking speed and cadence. Walking symmetry, an important parameter for assessing walking function, improved by 68.7%, 88%, and 77% in the three participants, significantly improving the symmetry index (p = 0.003). Conclusions: Thus, EES may be an effective strategy for sensory impairment recovery, as well as muscular activity and strength improvement. These findings may facilitate stable walking in subjects with chronic incomplete SCI, but larger clinical trials are warranted. Clinical trial: NCT05433064.

Exploring the impact of exercise on women with ovarian cancer: A call for more methodologically standardized RCTs to enable a realistic systematic review.

Ovarian cancer remains a leading cause of mortality among gynecological malignancies, often diagnosed at advanced stages due to nonspecific symptoms and limited screening tools. Standard treatment, including cytoreductive surgery and chemotherapy, can cause fatigue, physical dysfunction, and psychological distress, impacting quality of life. Exercise interventions have shown potential to mitigate these effects, but inconsistent methodologies in randomized controlled trials (RCTs) limit reliable conclusions and clinical integration. A systematic review was conducted following PRISMA guidelines. RCTs assessing physical exercise effects on women with ovarian cancer were included, excluding pilot trials, reviews, and combined therapies. Data extraction and GRADE assessments were performed by two independent reviewers, and a narrative synthesis was conducted due to study heterogeneity. Eleven RCTs were analyzed, covering aerobic, resistance, and yoga interventions. Findings indicated improvements in physical function, fatigue, and psychological outcomes, such as reduced depressive symptoms and cognitive enhancements. Patients adhering to ≥150 min of moderate-intensity exercise per week experienced the most consistent benefits. Preoperative walking expedited recovery, though significant heterogeneity in study protocols precluded meta-analysis. Evidence supports the feasibility and benefits of exercise across ovarian cancer stages. However, inconsistency in exercise intensity, duration, and reporting hinders the development of standardized protocols. Compared to cardiological rehabilitation, ovarian cancer exercise guidelines remain underdeveloped, emphasizing the need for tailored, evidence-based interventions. Exercise interventions can improve physical and mental health in ovarian cancer patients. Standardized RCTs are urgently needed to establish robust exercise protocols and enable clinical implementation, enhancing survivorship outcomes and quality of life.

Validation of the Geriatrics at Risk Score (GeRi-Score) on 120-day follow-up, the influence of preoperative geriatric visits, and the time to surgery on the outcome of hip fracture patients: an analysis from the Registry for Geriatric Trauma (ATR-DGU).

Numerous tools predict mortality among patients with hip fractures, but they include many variables, require time-consuming assessment, and are difficult to calculate. The GeRi-Score provides a quick method of pre-operative assessment. The aim of this study is to validate the score in the 120-day follow-up and determine the impact of a pre-operative visit by a geriatrician and timing of surgery on the patient outcome. A retrospective analysis of the AltersTraumaRegister DGU® from 2017 to 2021 was conducted, including all proximal femur fractures. The patients were divided into low-, moderate-, and high-risk groups based on the GeRi-Score. Mortality was analyzed using logistic regression. To determine the influence of the time to surgery and the preoperative visit by a geriatrician, matching was performed using the exact GeRi-Score, preoperative walking ability, type of fracture, and the time to surgery. The study included 38,570 patients, divided into 12,673 low-risk, 18,338 moderate-risk, and 7,559 high-risk patients. The moderate-risk group had three times the mortality risk of the low-risk group (OR 3.19 (95% CI 2.68-3.79; p<0.001)), while the high-risk group had almost eight times the mortality risk than the low-risk group (OR 7.82 (95% CI 6.51-9.93; p<0.001)). No advantage was found for surgery within the first 24 h across all groups. There was a correlation of a preoperative geriatric visit and mortality showing an increase in the moderate and high-risk group on in-house mortality. The GeRi-Score has predictive value for 120-day mortality. No advantage was found for surgery within 24 h. The analysis did not demonstrate a benefit of the preoperative geriatric visit, but more data are needed.

Preoperative walking exercise to improve prognosis in patients with supratentorial brain tumours after craniotomy: protocol for a randomised controlled trial

IntroductionCardiopulmonary complications and cognitive impairment following craniotomy have a significantly impact on the general health of individuals with brain tumours. Observational research indicates that engaging in walking is linked to...

Prevalence of canine cranial cruciate ligament rupture and prognosis depending on tibial plateau angle: A retrospective study.

This study aimed to evaluate the prevalence of cranial cruciate ligament rupture (RCCL) and the efficacy of tibial plateau angle (TPA) as a prognostic indicator in small breed dogs diagnosed with RCCL. For this study, 53 dogs with RCCL were selected based on their medical data. The Tibial plateau angle (TPA) was calculated by analyzing the radiographic images of the stifle joint region. The dogs were categorized based on their body weight, sex, age, breed, and RCCL. Subsequently, clinical outcomes of dogs were evaluated based on their pre- and postoperative TPAs. The prevalence of RCCL was higher in neutered dogs, especially those neutered before 6 months of age. The preoperative TPAs of all dogs diagnosed with RCCL were lowered with TPLO. Preoperative walking time in the higher pre-operative TPA (>25°) group (13.58 ± 1.53 days) was significantly (p < 0.05) longer than the lower pre-operative TPA (≤25°) group (10.09 ± 0.84). The lower pre-operative TPA (≤ 25°) group showed better prognoses without any more complications than the higher pre-operative TPA (> 25°) group. Furthermore, post-operative walking time in the higher post-operative TPA dogs (>10°) group (18.08 ± 2.22 days) was significantly (p < 0.05) longer than the lower post-operative TPA dogs (≤10°) group (10.20 ± 0.90 days). Likewise, the TPA (≤10°) group showed better prognoses with lowered complications. Therefore, pre- and post-operative TPA plays an important prognostic factor, and post-operative TPA should be kept at<10° to get better clinical outcomes.

Outpatient surgery postoperative ambulation and emergency department utilization.

The ability to ambulate is an important indicator for wellness and quality of life. A major health event, such as a surgery, can derail this ability, and return to preoperative walking ability is a marker for recovery. Self-reported walking measurements by patients are subject to bias, thus wearable technology such as activity monitors have risen in popularity. We evaluated postoperative ambulation using an accelerometer in outpatient general surgery procedures with the hypothesis that those patients with less postoperative ambulation were at risk for adverse outcomes. A retrospective review of patients undergoing outpatient abdominal surgeries from November 2016 to July 2019 at a Veteran Affairs Medical Center. Patients wore an accelerometer preoperatively and postoperatively to measure their ambulation (steps/day). Outcome measures were 30-day readmissions and Emergency Department (ED) utilization. Postoperative ambulation was defined as daily percentages of their preoperative baseline. Patients without preoperative baseline data, > 3 missing days or any missing days prior to reaching baseline were excluded. One-hundred-six patients underwent outpatient abdominal surgery. Twenty-two patients were excluded. Patients stratified into adult (18-64 years, 44 patients, 52%) and geriatric (≥ 65 years, 40 patients, 48%) cohorts. Geriatric patients were less likely to meet their preoperative baseline by postoperative day 7, 35% vs 61%, p = 0.016. Adult patients who failed to meet their preoperative baseline in first postoperative week had higher ED utilization; 4 (24%) vs 1 (4%), p = 0.04. Geriatric patients who failed to meet their baseline trended toward increased ED utilization; 5 (19%) vs. 1 (7%), p = 0.31. Patients aged < 65 who fail to return to their preoperative daily step count within one week of outpatient abdominal surgery are 6× more likely to be seen in the ED. Postoperative ambulation may be able to predict ED utilization and recovery after outpatient surgery.

Impact of surgical treatment on lipid metabolism in patients with lumbar spinal disorders: Prospective observational study

PurposeIt is still unclear how lumbar spinal surgery affects the lipid metabolism of patients with lumbar spinal disorders (LSDs) such as lumbar spinal canal stenosis and lumbar disk herniation. The present study aimed to assess the impact of lumbar spinal surgery on lipid metabolism in patients with LSDs and clarify the factors associated with changes in visceral fat (VF) accumulation before and after lumbar spinal surgery.MethodsConsecutive patients with lumbar spinal surgery for LSDs were prospectively included. Abdominal computed tomography images and blood examination of the participants were evaluated before surgery and at 6 months and 1 year after surgery. The cross-sectional VF area (VFA) was measured at the level of the navel using computed tomography images. Blood examination items included triglycerides and high-density lipoprotein (HDL).ResultsThe study enrolled a total of 138 patients. Female patients with LSDs had significantly increased VFA and serum triglyceride levels after lumbar spinal surgery. On multivariable analysis, the group with > 100 cm2 of preoperative VFA and a postoperative decrease in VFA had a significantly worse preoperative walking ability based on the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (relative risk 2.1; 95% confidence intervals 1.1–4.1).ConclusionsThe present study demonstrated that patients with LSDs did not necessarily improve their lipid metabolism after lumbar spinal surgery. Instead, female patients with LSDs had significantly deteriorated lipid metabolism after lumbar spinal surgery. Finally, a worse preoperative walking ability was associated with the improvement in excess VF accumulation after lumbar spinal surgery.

Factors associated with maintaining walking ability postoperation for hip fractures and the predictive value of the CGA7 score for postoperative walking ability.

Patients with hip fractures have a high rate of mortality or decreased mobility, despite early operative treatment and rehabilitation. The first aim of this study was to investigate the factors of decreased walking ability after hip fracture based on whether walking ability was or was not maintained postoperatively. The second aim was to examine the usefulness of the Comprehensive Geriatric Assessment 7 (CGA7), modified from the conventional Comprehensive Geriatric Assessment, for predicting postoperative walking ability. This study included patients who were treated surgically for hip fractures. We divided patients by whether they did or did not maintain their walking ability postoperatively. We registered the following demographic data: walking ability preadmission and at discharge, CGA7 score, cognitive impairment, the patient's prefracture status, fracture type, surgical waiting time, hospital stay duration, limitation of weight-bearing, postoperative complications, transfer to rehabilitation hospital, final living place, and follow-up period. The characteristics of the two groups were compared using Wilcoxon's rank-sum test, the chi-squared test, or Fisher's exact test. Among 855 patients, 616 (73.0%) patients maintained walking ability and 239 (27.0%) patients did not. Multivariate logistic regression revealed that the factors of age, sex, preoperative walking ability, and postoperative complications were significantly associated with maintaining postoperative walking ability. Furthermore, the higher the CGA7 score, the more likely were patients to maintain their walking ability (odds ratio, 0.72; 95% confidence interval, 0.61-0.85; P < 0.001). Patients who had a low CGA7 score had the potential risk of decreased walking ability. Geriatr Gerontol Int 2023; 23: 830-835.

Exercise prehabilitation for patients with end-stage liver disease: a best practice implementation project.

This study aimed to promote exercise prehabilitation in patients with end-stage liver disease during their waiting period for liver transplantation. End-stage liver disease indirectly contributes to the development of sarcopenia and affects survival after liver transplantation because of low physiological reserves and insufficient aerobic capacity while awaiting transplantation. Exercise prehabilitation could reduce postoperative complications and promote postoperative recovery. Following the JBI Practical Application of Clinical Evidence System, this study used six audit criteria derived from the JBI Evidence Summary. A baseline audit of six patients and nine nurses was conducted, analyzed barriers, established a prehabilitation process and improved interventions, followed by the implementation of exercise prehabilitation and follow-up audit. In the baseline audit, the results of the six criteria [(1) multimodal prehabilitation that includes exercise and other interventions where appropriate is offered to patients scheduled for abdominal surgery; (2) prior to the commencement of an exercise program an assessment of exercise contraindications, health status, treatments, physical activity level, functional capacity and quality of life is completed; (3) exercise programs are designed by appropriately qualified personnel; (4) exercise is delivered and supervised by appropriately qualified personnel; (5) exercise prescription is tailored to each individual patient; and (6) patient response to exercise is monitored throughout prehabilitation] were 0-22%. After implementing the best-practice strategies, all six criteria were set to 100%. Patients were aware of and had high compliance with exercise prehabilitation, nurses' and patients' knowledge of exercise rehabilitation improved, and nurses' implementation rate was significantly higher than before implementation ( P < 0.05). The differences in the 6 min walking distance and Borg Fatigue Score between the preimplementation and postimplementation were statistically significant (all P < 0.05). This best-practice implementation project is feasible. These results indicate that exercise prehabilitation could improve the preoperative walking capacity and fatigue of patients with end-stage liver disease. Ongoing best practices will be expected to develop in the future.

Examination Of Preoperative Walking Count, Physical Activity, And Length Of Stay

Examination Of Preoperative Walking Count, Physical Activity, And Length Of Stay

Early Phase Functional Recovery after Spinal Intramedullary Tumor Resection Could Predict Ambulatory Capacity at 1 Year after Surgery.

This is a single-center retrospective cohort study with a university hospital setting. This study aims to evaluate the short-term course of physical function and walking ability after intramedullary spinal cord tumor (ISCT) resection and predict walking independence 1 year after surgery. Although several reports have shown the postoperative functional prognosis of spinal intramedullary tumors with long-term follow-up, no reports have identified the predictors associated with the functional outcome at an early stage. A total of 79 individuals who underwent ISCT resection at our institute between 2014 and 2019 were enrolled in the study, whose preoperative walking state was independent ambulator regardless of cane support with the Functional Independence Measure Locomotor Scale (FIM-L) score of ≥6. The FIM-L, the American Spinal Injury Association (ASIA) motor and sensory scores in the lower extremities, and the Walking Index for Spinal Cord Injury II (WISCI II) were assessed for walking independence, lower-limb function, and walking ability, respectively. These evaluations were performed at 4 time points: preoperatively, 1 week (1W), 2 weeks (2W), and 1 year after surgery. In the early phase after surgery, 71% and 43% of the participants were nonindependent ambulators at 1W and 2W, respectively. Histopathology indicated that patients with solid tumors (ependymoma, astrocytoma, or lipoma) showed significantly lower indices at 1W and 2W than those with vascular tumors (hemangioblastoma or cavernous hemangioma). Regarding tumor location, thoracic cases exhibited poorer lower-limb function at 1W and 2W and poorer walking ability at 2W than cervical cases. According to the receiver operating characteristic (ROC) analysis, 2 WISCI II points at 2W had the highest sensitivity (100%) and specificity (92.2%) in predicting the level of walking independence at 1 year postoperatively (the area under the ROC curve was 0.99 (95% confidence interval, 0.93-1.00). The higher the lower-limb function scores in the early phase, the better the improvement in walking ability is predicted 1 year after ISCT resection.

Gait deviation index to quantify the effect of functional surgery on walking kinematics in stroke patients

The Gait Deviation Index (GDI) summarizes on a 0-100 basis the distance of a patient’s kinematic from the normal reference pattern [1]. It has been developed and used to assess the effect of functional surgery (FS) supported by gait analysis (GA) in large cohorts of children with cerebral palsy [2]. The use of GDI and the computation of effect sizes are suggested to allow for the conduction of systematic reviews on the impact of GA on treatment outcomes [3]. Despite of the increasing use of FS in adults with acquired joint deformities consequent to a stroke, there are no studies in literature using the GDI to investigate the effects FS on walking kinematics in these patients. The databases of two laboratories were retrospectively analyzed to extract data from patients with the following inclusion criteria: hemiparesis consequent to ischemic or hemorrhagic stroke, referral to the laboratories for clinical and instrumental assessment – gait analysis (GA) with EMG – preliminary to FS, lower limb FS performed by the same surgeon (author PZ), available GA data before and three months after FS, available informed consent. Gait kinematics was acquired using a commercial system (BTS Smart DX, BTS Bioengineering) and the so-called Conventional Protocol. GDI was computed by the GA system as in [1]. GDI values of the affected side were compared before and three months after surgery using the paired t-test. The Cohen’s d (effect size) with its 95% confidence interval was computed. Preliminary results are presented, related to a two-year period. Twenty-nine patients met the inclusion criteria. Of these, 8 needed an orthosis to walk and had a presurgical EMG assessment only. The remaining 21 patients, 56.4(10.3) years, 6/15 M/F, 19/2 L/R affected side, were included in the study. Preoperative walking speed was 0.30(0.18) m/s. Median FAC was 4 (range 2-7), WHS was 4 (2-6), and RMI was 11 (5-14). Three to eight gait trials per session were used for GDI computation. At the three- months mark, GDI significantly increased from 72(11) to 75(11) (p=0.004), with a moderate effect size of 0.71 (95%IC 0.22–1.12). The relationship between pre- and post-operative values is presented in Fig. 1. A subgroup of subjects had an increase in GDI, irrespective of their initial condition, a subgroup of patients had no variations in GDI while a few patients had a worsening in GDI. For the first time in literature, we used the GDI to investigate the effect of FS on gait kinematics in adults with stroke. Our results confirm, on average, the efficacy of FS in improving walking ability. GDI allowed easily merging data from different laboratories. It could be used to identify clusters of improved/not improved patients to further investigate their characteristics. In clinical trials, GDI could be used to compare the efficacy of different of different treatments, e.g. FS v. focal inhibition or of different surgical approaches, e.g. with and without preoperative GA, as in [4]. Positive results would promote the use of GA in the assessment of stroke patients and support its reimbursement by both national health systems and private insurances.

Predicting post-total ankle arthroplasty walking speed based on preoperative gait mechanics.

Decreased walking speed is associated with impaired physical performance and function in older adults. Following total ankle arthroplasty (TAA), walking speed continues to be slower than age matched controls. The purpose of this study was to determine if patients 1 year post-TAA can achieve walking speed benchmarks and investigate if gait metrics are predictive of achieved benchmarks. 191 TAA patients were recruited and assessed pre-TAA and 1 year post-TAA. Kinetic and kinematic data were collected during seven self-selected speed barefoot walking trials along a 30-mwalkway. Receiver operator curveswere generated for each variable to determine threshold values needed to achieve walking speeds of 0.8, 0.9, 1.1, and 1.3 m/s. Each variable's predictive ability was classified according to the area under the curve. Ninety one percent of participants achieved a walking speed > 0.8 m/s, 85.3% achieved ≥0.9 m/s, 64.9% walked at ≥1.1 m/s, and 24.1% achieved a walking speed of 1.3 m/s by 1 year post-TAA. Walking speed pre-TAA was the strongest predictor with ankle moment, power and GRF data showing mixed results. Clinical Significance: 75.9% of participants were unable to walk at 1.3 m/s-a speed indicative of safely crossing a street. Variables predictive of postoperative walking speed benchmarks could be useful in developing interventions for the TAA population. The strongest predictor across all walking speed benchmarks was preoperative walking speed. A walking speed > 0.71 m/s was predictive of achieving 0.8 m/s 1 year post-TAA, while >1.09 m/s predicted 1.3 m/s 1 year post-TAA.

Preoperative walking intervention did not appear to improve patient-reported postoperative recovery in older adults with frailty traits: Randomized trial.

Objectives:To assess the impact of a preoperative walking intervention on improving postoperative recovery in at-risk frail older adult patients.Study Type:Unblinded, randomized controlled trial which assigned patients to intervention versus control.Population:Patients aged 60+ scheduled for surgery 3–8 weeks from randomization scoring 4+ on the Edmonton Frail Scale.Intervention:Preoperative walking enhanced by goal setting with an activity monitor and telephonic coaching.Main Outcomes:Quality of Recovery 9-item instrument total score and a modified version of the Abdominal Surgery Impact Scale total scoreResults:A total of 83 patients were analyzed. Postoperative recovery scores were similar in intervention vs control – Quality of Recovery-9 item instrument total score 14.1 vs. 14.1 (P = .94) and modified Abdominal and Surgery Impact Scale total score 82.8 vs. 79.2 (P = .93). Few intervention patients met their daily step count goals. Despite this, intervention patients improved average daily step counts significantly.Conclusions:Preoperative walking bolstered with activity monitor and remote coaching did not appear to lead to improved postoperative recovery in older adults with frailty traits. Further research is necessary to see if a similar intervention in specific surgery types or a more intense version of the intervention can improve recovery.

Effects of preoperative walking on bowel function recovery for patients undergoing gynecological malignancy laparoscopy

AbstractTo investigate effects of preoperative walking on bowel function recovery for patients after gynecological malignancy laparoscopy. The 156 patients with gynecoligical cancers after laparoscopy in Jiangsu from June 2020 to September 2021 were selected as research subjects, who were randomized into an experimental group (n = 78) and a control group (n = 78). Both of the groups received routine nursing care during the study. In addition, the experimental group underwent low‐moderate intensity walking exercise 1 week before surgery. The bowel function (including the time of first defecation, the time of first passage of flatus/”gas‐out time” and the recovery time of bowel sound), adverse events (nausea, vomiting abdominal distension and abdominal pain), as well as postoperative complications (ileus symptoms, deep venous thrombosis, infections and etc.), were measured daily. The time of first defecation, the time of first passage of flatus and the recovery time of bowel sound in experimental group were less than the control group after treatment (p &lt; .05). Repeated measures analysis of variance showed that the adverse reactions (nausea, vomiting, abdominal distension, abdominal pain, and ileus symptoms) of the experimental group were weaker than those of the control group at different time points after the intervention (p &lt; .05). Walking before surgery can effectively promote the recovery of bowel function and reduce the adverse reactions, as well as the risk of ileus related to gynecological malignancy laparoscopy.

Supervised preoperative walking on increasing early postoperative stamina and mobility in older adults with frailty traits: A pilot and feasibility study.

Background and AimsFrail older adults are more than twice as likely to experience postoperative complications. Preoperative exercise may better prepare these patients through improved stamina and mobility experienced in the days following surgery. We measured the impact of a walking intervention using an activity tracker and coaching on postoperative stamina, and mobility in older adults with frailty traits.MethodsWe included patients aged 60+ and scoring 4+ on the Edmonton Frailty Scale. We then randomized patients to intervention versus control stratified by anticipated hospital stay (1 night vs. 2+ night) and baseline stamina (i.e., 6‐min walk distance [6MWD]). Intervention patients received an activity tracker and linked smart phone. An athletic trainer (AT) prescribed a daily step count goal and titrated this up after checking in with patients during weekly telephone calls. Controls received general walking recommendations. We then measured postoperative 6MWD 1–3 days after surgery. We also assessed postoperative mobility by measuring steps walked the day after surgery using a thigh‐worn monitor. Because many patients could not walk postoperatively, we compared intervention‐control difference in both 6MWD and steps using Wilcoxon rank testing and Tobit and ordinal logistic regression adjusting for several patient characteristics.ResultsWe randomized 104 eligible patients; 80 patients remained for final analysis. There was no difference in intervention versus control postoperative 6MWD (median 72 vs. 74 m Wilcoxon p = 0.54) or postoperative steps taken (median 128 vs. 51 steps Wilcoxon p = 0.76). Analysis adjusting for patient characteristics was consistent with these findings.ConclusionOur intervention consisting of goal setting with an activity tracker and telephonic coaching by an AT did not appear to improve stamina or mobility measured in the days after surgery. Small sample size limited our ability to examine this impact in subsets defined by surgical specialty or baseline stamina.

Risk Factors for Venous Thrombosis after Spinal Surgery: A Systematic Review and Meta-analysis.

Background Venous thrombosis, comprising DVT and PE, is an orthopedic condition that may be fatal after surgery. This study's purpose was to analyze risk factors for venous thrombosis following spine surgery to help guide treatment prophylaxis. Methods A computer searched English databases such as PubMed, Web of Science, Embase, Cochrane Library, and Google Academic for relevant publications after spinal surgery. Preoperative walking difficulties, hypertension, diabetes, heart disease, preoperative bleeding volume, etc., were all examined using the NOS scale. Data were analyzed using Review Manager 5.3 software. An analysis was done. Due to the study's differences, the data was compiled using fixed effects or random effects models. Results A total of 25 studies were considered, with a total of 1,927,781 individuals after spine surgery, including 7843 patients with venous thrombosis. The included literatures had NOS scores ranging from 5 to 8. According to the findings of the meta-analysis, the age of patients with venous thrombosis after spinal surgery (OR = 7.53, 95% CI (6.73, 8.33)), blood loss (OR = −141.79, 95% CI (-154.68, -128.9), P = 0.00001), and operation time (OR = 76.93, 95% CI (73.17, 80.86), P = 0.00001) were higher than those without; diabetes mellitus (OR =1.23, 95% CI (1.12, 1.34), P = 0.00001) and walking disability history (OR = 2.97, 95% CL (1.77, 4.98), P = 0.0001) increased the incidence of postoperative venous thrombosis. Conclusion High age, female, spinal fusion, big volume blood loss patients, operation time, and hypertension, diabetes, and walking issue are all risk factors for venous thrombosis following surgery.

Serum creatinine to cystatin C ratio reflects preoperative and early postoperative walking ability in older patients with hip fracture.

BackgroundThe sarcopenia index (SI), calculated as the ratio of serum creatinine to cystatin C levels, reflects skeletal muscle mass and strength. Patients with hip fracture (HF) and sarcopenia have poor functional outcomes, and many require long‐term care after surgery. We hypothesized that the SI can predict preoperative and early postoperative functional outcomes.MethodsPreoperative serum creatinine and cystatin C were measured to calculate the SI for patients with surgically treated HF (n = 130, mean age: 87.8 ± 6.9 years). Walking ability before and 2 weeks after surgery was assessed, and patients were dichotomized into independent and assistance groups. To assess the validity of the SI, we examined its correlation with the quality [computed tomography (CT) value] and quantity (cross‐sectional area) of the muscles around the hip on the non‐operated side, which were preoperatively measured using CT. Receiver operating characteristic (ROC) analysis was performed to evaluate the prognostic value of the SI.ResultsThe SI of the preoperative independent (n = 77) and assistance groups (n = 53) significantly differed (70.2 ± 12.4 and 60.1 ± 9.8, respectively, P < 0.000001). At 2 weeks after surgery, the SI was significantly higher in the independent group (n = 31, 73.0 ± 14.9) than in the assistance group (n = 99, 64.0 ± 10.7, P = 0.0003). In the preoperative independent group, 28 could walk independently after surgery (SI: 74.8 ± 14.0) while 49 required assistance (SI: 67.7 ± 10.6, P = 0.01). For patients with femoral neck fracture (FNF), the SIs were significantly higher in the postoperative independent group (78.6 ± 15.7) than in the postoperative assistance group (63.2 ± 10.9, P = 0.002). Logistic regression analysis showed that the odds ratio (95% confidence interval) of the SI for postoperative walking ability was 0.95 (0.91–0.99, P = 0.03). The correlations of SIs with CT values and cross‐sectional areas were as follows: iliopsoas at the apex of the femoral head, r = 0.40, P < 0.001 and r = 0.49, P < 0.001, respectively; rectus femoris at the level of the lessor trochanter, r = 0.26, P = 0.007 and r = 0.37, P < 0.001, respectively. ROC analysis for predicting postoperative walking ability in preoperative independent patients with HF and FNF revealed areas under the curve (95% confidence interval) of 0.63 (0.50–0.76) and 0.80 (0.65–0.96), respectively.ConclusionsIn patients with HF, the SI correlated with preoperative walking ability and could predict postoperative walking ability. Among patients who could walk independently before surgery, those with high SIs could walk independently early in the postoperative period. The SI is beneficial for estimating walking ability in patients with HF.

Preoperative Factors Affecting Patient-reported Outcome Measures for Total Knee Arthroplasty.

ABSTRACTObjectives:The aim of this study was to investigate the preoperative factors affecting health-related quality of life (HRQOL) at 3 and 12 months after total knee arthroplasty (TKA).Methods:In total, 156 patients who underwent unilateral TKA for knee osteoarthritis were included in the study. The Knee Injury and Osteoarthritis Outcome Score (KOOS) was used as a measure of HRQOL before surgery and 3 and 12 months post-TKA. The Modified Gait Efficacy Scale (mGES) score, tibiofemoral angle, rest pain, walking pain, knee joint range of motion, knee joint extensor strength, and walking speed were recorded preoperatively. Pearson’s correlation coefficient and the correlation ratio were used to calculate the correlation between KOOS and preoperative factors at 3 and 12 months post-TKA. Multiple regression analysis was performed using the stepwise method with the five postoperative KOOS subscales as dependent variables and the other preoperative factors as independent variables.Results:Preoperative mGES scores were significantly correlated with KOOS Activities of Daily Living, Sport/Rec, and QOL subscores at 3 months post-TKA and with all five KOOS subscales at 12 months post-TKA. Multiple regression analysis identified mGES as an influencing factor for all KOOS subscales except Pain at 3 months post-TKA and all KOOS subscales except Symptoms at 12 months post-TKA.Conclusions:Preoperative walking self-efficacy influenced HRQOL at 3 and 12 months post-TKA. Psychological factors such as self-efficacy should be considered when predicting postoperative outcomes.