How Many Steps Per Day During the Early Postoperative Period are Associated With Patient-Reported Outcomes of Disability, Pain, and Opioid Use After Lumbar Spine Surgery?

Abstract

OBJECTIVE:

To investigate whether early postoperative walking is associated with "best outcome" and no opioid use at 1 year after lumbar spine surgery and establish a threshold for steps/day to inform clinical practice.

DESIGN:

Secondary analysis from randomized controlled trial.

SETTING:

Two academic medical centers in the United States.

PARTICIPANTS:

We enrolled 248 participants undergoing surgery for a degenerative lumbar spine condition (N=248). A total of 212 participants (mean age, 62.8±11.4y, 53.3% female) had valid walking data at baseline.

INTERVENTIONS:

Not applicable.

MAIN OUTCOME MEASURES:

Disability (Oswestry Disability Index), back and leg pain (Brief Pain Inventory), and opioid use (yes vs no) were assessed at baseline and 1 year after surgery. "Best outcome" was defined as Oswestry Disability Index ≤20, back pain ≤2, and leg pain ≤2. Steps/day (walking) was assessed with an accelerometer worn for at least 3 days and 10 h/d at 6 weeks after spine surgery, which was considered as study baseline. Separate multivariable logistic regression analyses were conducted to determine the association between steps/day at 6 weeks and "best outcome" and no opioid use at 1-year. Receiver operating characteristic curves identified a steps/day threshold for achieving outcomes.

RESULTS:

Each additional 1000 steps/d at 6 weeks after spine surgery was associated with 41% higher odds of achieving "best outcome" (95% confidence interval [CI], 1.15-1.74) and 38% higher odds of no opioid use (95% CI, 1.09-1.76) at 1 year. Walking ≥3500 steps/d was associated with 3.75 times the odds (95% CI, 1.56-9.02) of achieving "best outcome" and 2.37 times the odds (95% CI, 1.07-5.24) of not using opioids.

CONCLUSIONS:

Walking early after surgery may optimize patient-reported outcomes after lumbar spine surgery. A 3500 steps/d threshold may serve as an initial recommendation during early postoperative counseling.

• Authors: Hiral Master, Jacquelyn S Pennings, Rogelio A Coronado, Jordan Bley, Payton E Robinette, Christine M Haug, Richard L Skolasky, Lee H Riley 3rd, Brian J Neuman, Joseph S Cheng, Oran S Aaronson, Clinton J Devin, Stephen T Wegener, Kristin R Archer
• Journal: Archives of physical medicine and rehabilitation (Arch Phys Med Rehabil) Vol. 102 Issue 10 Pg. 1873-1879 (10 2021) ISSN: 1532-821X [Electronic] United States
• PMID: 34175276 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2021 The American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Chemical References

• Analgesics, Opioid

Topics

• Accelerometry
• Aged
• Analgesics, Opioid (therapeutic use)
• Disability Evaluation
• Female
• Humans
• Laminectomy (methods)
• Lumbar Vertebrae (surgery)
• Male
• Middle Aged
• Pain Measurement
• Pain, Postoperative (drug therapy, rehabilitation)
• Patient Reported Outcome Measures
• Postoperative Period
• Prospective Studies
• Spinal Diseases (rehabilitation, surgery)
• Walking (statistics & numerical data)