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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?

Publication ,  Journal Article
Master, H; Pennings, JS; Coronado, RA; Bley, J; Robinette, PE; Haug, CM; Skolasky, RL; Riley, LH; Neuman, BJ; Cheng, JS; Aaronson, OS ...
Published in: Arch Phys Med Rehabil
October 2021

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.

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Published In

Arch Phys Med Rehabil

DOI

EISSN

1532-821X

Publication Date

October 2021

Volume

102

Issue

10

Start / End Page

1873 / 1879

Location

United States

Related Subject Headings

  • Walking
  • Spinal Diseases
  • Rehabilitation
  • Prospective Studies
  • Postoperative Period
  • Patient Reported Outcome Measures
  • Pain, Postoperative
  • Pain Measurement
  • Middle Aged
  • Male
 

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Master, H., Pennings, J. S., Coronado, R. A., Bley, J., Robinette, P. E., Haug, C. M., … Archer, K. R. (2021). 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? Arch Phys Med Rehabil, 102(10), 1873–1879. https://doi.org/10.1016/j.apmr.2021.06.002
Master, Hiral, Jacquelyn S. Pennings, Rogelio A. Coronado, Jordan Bley, Payton E. Robinette, Christine M. Haug, Richard L. Skolasky, et al. “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?Arch Phys Med Rehabil 102, no. 10 (October 2021): 1873–79. https://doi.org/10.1016/j.apmr.2021.06.002.
Master H, Pennings JS, Coronado RA, Bley J, Robinette PE, Haug CM, et al. 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? Arch Phys Med Rehabil. 2021 Oct;102(10):1873–9.
Master, Hiral, et al. “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?Arch Phys Med Rehabil, vol. 102, no. 10, Oct. 2021, pp. 1873–79. Pubmed, doi:10.1016/j.apmr.2021.06.002.
Master H, Pennings JS, Coronado RA, Bley J, Robinette PE, Haug CM, Skolasky RL, Riley LH, Neuman BJ, Cheng JS, Aaronson OS, Devin CJ, Wegener ST, Archer KR. 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? Arch Phys Med Rehabil. 2021 Oct;102(10):1873–1879.
Journal cover image

Published In

Arch Phys Med Rehabil

DOI

EISSN

1532-821X

Publication Date

October 2021

Volume

102

Issue

10

Start / End Page

1873 / 1879

Location

United States

Related Subject Headings

  • Walking
  • Spinal Diseases
  • Rehabilitation
  • Prospective Studies
  • Postoperative Period
  • Patient Reported Outcome Measures
  • Pain, Postoperative
  • Pain Measurement
  • Middle Aged
  • Male