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Gustafsson MEAK, Schiøttz-Christensen B, Petersen TL, Jepsen R, Wedderkopp N, Brønd JC, O'Neill SFD. Walking performance in individuals with lumbar spinal stenosis-possible outcome measures and assessment of known-group validity. Spine J 2024; 24:1222-1231. [PMID: 38499067 DOI: 10.1016/j.spinee.2024.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 03/07/2024] [Accepted: 03/12/2024] [Indexed: 03/20/2024]
Abstract
BACKGROUND CONTEXT One of the primary goals of treatments received by individuals with lumbar spinal stenosis with neurogenic claudication is to improve walking ability. Thus, a thorough and valid assessment of walking ability in patients with lumbar spinal stenosis is needed. Duration of continuous walking and steps per day could be relevant when evaluating walking ability in daily living. PURPOSE To describe and evaluate a method for estimating continuous walking periods in daily living and to evaluate the known-group validity of steps per day in individuals with lumbar spinal stenosis. STUDY DESIGN This is a cross-sectional observational study. PATIENT SAMPLE The study contains three study groups: individuals with lumbar spinal stenosis, individuals with low back pain, and a background population from the Lolland-Falster Health Study (LOFUS). OUTCOME MEASURES Participants in all three study groups wore an accelerometer on the thigh for seven days. METHODS Accelerometer data were processed to summarize the continuous walking periods according to their length: the number of short (4-9 seconds), moderate (10-89 seconds), and extended (≥90 seconds) continuous walking periods per day, and the number of steps per day. Results from the three groups were compared using negative binomial regression with lumbar spinal stenosis as the reference level. RESULTS Continuous walking periods of moderate length were observed 1.48 (95% CI 1.27, 1.72) times more often in individuals from the background population than in individuals with LSS. Continuous walking periods of extended length were observed 1.53 (95% CI 1.13, 2.06) times more often by individuals with low back pain and 1.60 (95% CI 1.29, 1.99) times more often by individuals from the background population. The number of steps per day was 1.22 (95% CI 1.03, 1.46) times larger in individuals with LBP and 1.35 (95% CI 1.20, 1.53) times larger in individuals from background population. CONCLUSIONS The impact of neurogenic claudication on walking ability in daily living seems possible to describe by continuous walking periods along with steps per day. The results support known-group validity of steps per day. This is the next step toward a clinically relevant and comprehensive assessment of walking in daily living in individuals with lumbar spinal stenosis.
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Affiliation(s)
- Malin Eleonora Av Kák Gustafsson
- Medical Research Unit, Spine Center of Southern Denmark, University Hospital of Southern Denmark, Østre Hougvej 55, 5500 Middelfart, Denmark; Department of Regional Health Research, University of Southern Denmark, Campusvej 55, 5230 Odense, Denmark.
| | - Berit Schiøttz-Christensen
- Research Unit of General Practice, University of Southern Denmark, J.B. Winsløws Vej 9A, 5000 Odense C, Denmark
| | - Therese Lockenwitz Petersen
- Centre for Epidemiological Research, Nykøbing Falster Hospital, Strandboulevarden 64, 4800 Nykøbing Falster, Denmark
| | - Randi Jepsen
- Centre for Epidemiological Research, Nykøbing Falster Hospital, Strandboulevarden 64, 4800 Nykøbing Falster, Denmark
| | - Niels Wedderkopp
- Department of Regional Health Research, University of Southern Denmark, Campusvej 55, 5230 Odense, Denmark; Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230 Odense, Denmark
| | - Jan Christian Brønd
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230 Odense, Denmark
| | - Søren Francis Dyhrberg O'Neill
- Medical Research Unit, Spine Center of Southern Denmark, University Hospital of Southern Denmark, Østre Hougvej 55, 5500 Middelfart, Denmark; Department of Regional Health Research, University of Southern Denmark, Campusvej 55, 5230 Odense, Denmark
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Kim JH, Chegal Y, Kim S, Park H, Kim YR, Kim S, Kim K, Lee CH, Kim CH, Chung CK. Healthcare burden changes by restricted physical activities in lumbar spinal stenosis and spondylolisthesis: a retrospective large cohort study during the COVID-19 pandemic. BMC Musculoskelet Disord 2024; 25:411. [PMID: 38783291 PMCID: PMC11118721 DOI: 10.1186/s12891-024-07332-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 03/04/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Lumbar spinal stenosis (LSS) and spondylolisthesis (SPL) are characterized as degenerative spinal pathologies and share considerable similarities. However, opinions vary on whether to recommend exercise or restrict it for these diseases. Few studies have objectively compared the effects of daily physical activity on LSS and SPL because it is impossible to restrict activities ethnically and practically. We investigated the effect of restricting physical activity due to social distancing (SoD) on LSS and SPL, focusing on the aspect of healthcare burden changes during the pandemic period. METHODS We included first-visit patients diagnosed exclusively with LSS and SPL in 2017 and followed them up for two years before and after the implementation of the SoD policy. As controls, patients who first visited in 2015 and were followed for four years without SoD were analyzed. The common data model was employed to analyze each patient's diagnostic codes and treatments. Hospital visits and medical costs were analyzed by regression discontinuity in time to control for temporal effects on dependent variables. RESULTS Among 33,484 patients, 2,615 with LSS and 446 with SPL were included. A significant decrease in hospital visits was observed in the LSS (difference, -3.94 times/month·100 patients; p = 0.023) and SPL (difference, -3.44 times/month·100 patients; p = 0.026) groups after SoD. This decrease was not observed in the data from the control group. Concerning medical costs, the LSS group showed a statistically significant reduction in median copayment (difference, -$45/month·patient; p < 0.001) after SoD, whereas a significant change was not observed in the SPL group (difference, -$19/month·patient; p = 0.160). CONCLUSION Restricted physical activity during the SoD period decreased the healthcare burden for patients with LSS or, conversely, it did not significantly affect patients with SPL. Under circumstances of physical inactivity, patients with LSS may underrate their symptoms, while maintaining an appropriate activity level may be beneficial for patients with SPL.
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Affiliation(s)
- Jun-Hoe Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul, South Korea
| | - Yebin Chegal
- Department of Statistics, Korea University, Seoul, South Korea
| | - Suhyun Kim
- Transdisciplinary Department of Medicine & Advanced Technology, Seoul National University Hospital, Seoul, South Korea
| | - Hangeul Park
- Department of Neurosurgery, Seoul National University Hospital, Seoul, South Korea
| | - Young Rak Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul, South Korea
| | - Sum Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul, South Korea
| | - Kwangsoo Kim
- Transdisciplinary Department of Medicine & Advanced Technology, Seoul National University Hospital, Seoul, South Korea.
| | - Chang-Hyun Lee
- Department of Neurosurgery, Seoul National University Hospital, Seoul, South Korea.
- Department of Neurosurgery, Seoul National University College of Medicine, 101 Daehak-ro, Jongro-gu, Seoul, 03080, South Korea.
| | - Chi Heon Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul, South Korea
- Department of Neurosurgery, Seoul National University College of Medicine, 101 Daehak-ro, Jongro-gu, Seoul, 03080, South Korea
| | - Chun Kee Chung
- Department of Neurosurgery, Seoul National University Hospital, Seoul, South Korea
- Department of Neurosurgery, Seoul National University College of Medicine, 101 Daehak-ro, Jongro-gu, Seoul, 03080, South Korea
- Department of Brain and Cognitive Sciences, Seoul National University, Seoul, 03080, Republic of Korea
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Comer C, Williamson E, McIlroy S, Srikesavan C, Dalton S, Melendez-Torres GJ, Lamb SE. Exercise treatments for lumbar spinal stenosis: A systematic review and intervention component analysis of randomised controlled trials. Clin Rehabil 2024; 38:361-374. [PMID: 37715644 PMCID: PMC10829420 DOI: 10.1177/02692155231201048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 08/27/2023] [Indexed: 09/18/2023]
Abstract
OBJECTIVE To analyse the components used in exercise interventions for people with symptoms of neurogenic claudication due to lumbar spinal stenosis and identify components associated with successful interventions. DATA SOURCES Eligible papers published up to April 2023 from MEDLINE, EMBASE, CINAHL, PEDro, CENTRAL, Web of Science, and trial registry websites. REVIEW METHODS Literature searches were performed by an Information Specialist. We searched for randomised trials evaluating exercise interventions for people with neurogenic claudication symptoms (the primary symptom of lumbar spinal stenosis). Two authors independently performed study selection, data extraction, and quality assessments using the Cochrane Risk of Bias tool Version 2 and the TIDieR checklist for intervention reporting. Details of intervention components were extracted, tabulated, and synthesised using an intervention component analysis approach. RESULTS We found thirteen trials reporting 23 exercise interventions delivered to 1440 participants. These featured 60 different components. Most exercise interventions included supervision and flexion-based exercises. Balance exercises were rarely included. Exercise components featured more frequently in successful interventions included stretches, strength or trunk muscle exercises, fitness exercises, especially cycling, and psychologically informed approaches. Interpretation is limited by low study numbers and heterogeneity. No conclusions could be drawn about exercise supervision or dose. DISCUSSION Exercise interventions for people with neurogenic claudication typically feature multiple components. Common features such as supervision, lumbar flexion, and aerobic fitness exercises and also less common features such as stretches, strengthening exercises, and psychologically informed approaches warrant consideration for inclusion when designing and optimising exercise interventions for people with lumbar spinal stenosis.
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Affiliation(s)
- Christine Comer
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, Faculty of Medicine, University of Leeds, UK
- Leeds Community Healthcare Musculoskeletal and Rehabilitation Services, Leeds Community Healthcare NHS Trust, UK
| | - Esther Williamson
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, UK
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Suzanne McIlroy
- Physiotherapy Department, King's College Hospital NHS Foundation Trust, UK
- Health Psychology Section, The Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, UK
| | - Cynthia Srikesavan
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, UK
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | | | | | - Sarah E Lamb
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
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Karlsson E, Hanafi R, Brisby H, Fors A, Kemani M, Hedman H, Nijs J, Lundberg M. Get Back, a person-centred digital programme targeting physical activity for patients undergoing spinal stenosis surgery-a study protocol of a randomized feasibility study. Pilot Feasibility Stud 2024; 10:16. [PMID: 38279131 PMCID: PMC10811854 DOI: 10.1186/s40814-023-01433-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 12/19/2023] [Indexed: 01/28/2024] Open
Abstract
BACKGROUND Spinal stenosis is the most common reason for elective spine surgery, and the cardinal symptom is leg pain and discomfort when walking. Patients with spinal stenosis have a decreased level of physical activity and thereby an increased risk of poor health. Get Back is a person-centred digital programme that strives to support patients being physically active after surgery. The aim is to explore if Get Back, in its present format (referred to as Get Backfeasibility), is feasible and contributes to detectable change in variables related to intervention content. METHODS Thirty patients planned for decompression surgery due to central lumbar spinal stenosis who present with low physical activity, pain catastrophizing or fear of movement, will be included in a randomized feasibility study. All patients will be randomly allocated to either Get Backfeasibility or usual physical therapy. Get Backfeasibility aims to increase the patient's physical activity level by combining a person-centred and cognitive behavioural approach. It comprises 10 video and telephone sessions led by a physical therapist over 12 weeks (pre/postoperatively). Outcomes are treatment fidelity (treatment dose, adherence, and content), process feasibility (recruitment, intervention use, and acceptability of measurements and intervention), and variables related to the intervention content (steps per day, physical activity level, pain catastrophizing, fear of movement, and general self-efficacy). Treatment fidelity and feasibility data will be assessed during the full study period (12 weeks). Physical activity, physical capacity, and patient-reported outcomes will be assessed digitally at baseline (2 weeks preoperatively) and 11-12 weeks postoperatively. Variables related to the intervention content will be monitored weekly through a digital application. Feasibility data will be analysed descriptively and inferentially using a nonparametric approach, data from repeated measures will be displayed graphically and data from telephone interviews will be analysed using content analysis with a descriptive manifest approach. DISCUSSION The results will provide information on whether Get Back in its present format is feasible and can be evaluated for effectiveness in a larger randomized controlled trial, for patients with a low physical activity level and a high fear of movement who are undergoing decompression surgery. TRIAL REGISTRATION Registered at ClinicalTrails.gov 04/08/2023, registration no. NCT05806593.
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Affiliation(s)
- Emelie Karlsson
- Back in Motion Research Group, Department of Health Promoting Science, Sophiahemmet University, Box 5605, 114 86, Stockholm, SE, Sweden.
| | - Rikard Hanafi
- Back in Motion Research Group, Department of Health Promoting Science, Sophiahemmet University, Box 5605, 114 86, Stockholm, SE, Sweden
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, 1050, Brussels, Belgium
- Karolinska University Hospital, Theme Women's Health and Allied Health Professionals, Medical Unit Medical Psychology, Solna, Sweden
| | - Helena Brisby
- Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Andreas Fors
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- University of Gothenburg Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Research, Education, Development and Innovation, Primary Health Care, Gothenburg, Sweden
| | - Mike Kemani
- Back in Motion Research Group, Department of Health Promoting Science, Sophiahemmet University, Box 5605, 114 86, Stockholm, SE, Sweden
- Karolinska University Hospital, Theme Women's Health and Allied Health Professionals, Medical Unit Medical Psychology, Solna, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Håkan Hedman
- University of Gothenburg Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Jo Nijs
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, 1050, Brussels, Belgium
- Chronic Pain Rehabilitation, Department of Physical Medicine and Physiotherapy, University Hospital Brussels, 1050, Brussels, Belgium
- Department of Health and Rehabilitation, Unit of Physiotherapy, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Mari Lundberg
- Back in Motion Research Group, Department of Health Promoting Science, Sophiahemmet University, Box 5605, 114 86, Stockholm, SE, Sweden
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, 1050, Brussels, Belgium
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- University of Gothenburg Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Jakobsson M, Hagströmer M, Lotzke H, von Rosen P, Lundberg M. Fear of movement was associated with sedentary behaviour 12 months after lumbar fusion surgery in patients with low back pain and degenerative disc disorder. BMC Musculoskelet Disord 2023; 24:874. [PMID: 37950235 PMCID: PMC10636920 DOI: 10.1186/s12891-023-06980-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 10/19/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Movement behaviours, such as sedentary behaviour (SB) and moderate to vigorous physical activity (MVPA), are linked with multiple aspects of health and can be influenced by various pain-related psychological factors, such as fear of movement, pain catastrophising and self-efficacy for exercise. However, the relationships between these factors and postoperative SB and MVPA remain unclear in patients undergoing surgery for lumbar degenerative conditions. This study aimed to investigate the association between preoperative pain-related psychological factors and postoperative SB and MVPA in patients with low back pain (LBP) and degenerative disc disorder at 6 and 12 months after lumbar fusion surgery. METHODS Secondary data were collected from 118 patients (63 women and 55 men; mean age 46 years) who underwent lumbar fusion surgery in a randomised controlled trial. SB and MVPA were measured using the triaxial accelerometer ActiGraph GT3X+. Fear of movement, pain catastrophising and self-efficacy for exercise served as predictors. The association between these factors and the relative time spent in SB and MVPA 6 and 12 months after surgery was analysed via linear regression models, adjusting for potential confounders. RESULTS Preoperative fear of movement was significantly associated with relative time spent in SB at 6 and 12 months after surgery (β = 0.013, 95% confidence interval = 0.004 to 0.022, p = 0.007). Neither pain catastrophising nor self-efficacy for exercise showed significant associations with relative time spent in SB and MVPA at these time points. CONCLUSIONS Our study demonstrated that preoperative fear of movement was significantly associated with postoperative SB in patients with LBP and degenerative disc disorder. This finding underscores the potential benefits of preoperative screening for pain-related psychological factors, including fear of movement, preoperatively. Such screenings could aid in identifying patients who might benefit from targeted interventions to promote healthier postoperative movement behaviour and improved health outcomes.
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Affiliation(s)
- Max Jakobsson
- Division of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Maria Hagströmer
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
- Academic Primary Health Care Centre, Region Stockholm, Stockholm, Sweden
- The Back in Motion Research group, Department of Health Promoting Science, Sophiahemmet University, Box 5605, Stockholm, SE, 11486, Sweden
| | - Hanna Lotzke
- Department of Rehabilitation, Ängelholm Hospital, Ängelholm, Sweden
| | - Philip von Rosen
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
| | - Mari Lundberg
- The Back in Motion Research group, Department of Health Promoting Science, Sophiahemmet University, Box 5605, Stockholm, SE, 11486, Sweden.
- Sahlgrenska Academy, University of Gothenburg Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden.
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Koch D, Nüesch C, Ignasiak D, Aghlmandi S, Caimi A, Perrot G, Prüfer F, Harder D, Santini F, Schären S, Ferguson S, Mündermann A, Netzer C. The role of muscle degeneration and spinal balance in the pathophysiology of lumbar spinal stenosis: Study protocol of a translational approach combining in vivo biomechanical experiments with clinical and radiological parameters. PLoS One 2023; 18:e0293435. [PMID: 37889898 PMCID: PMC10610482 DOI: 10.1371/journal.pone.0293435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 09/25/2023] [Indexed: 10/29/2023] Open
Abstract
OBJECTIVE To describe a study protocol for investigating the functional association between posture, spinal balance, ambulatory biomechanics, paraspinal muscle fatigue, paraspinal muscle quality and symptoms in patients with symptomatic lumbar spinal stenosis (sLSS) before and 1-year after elective surgical intervention. DESIGN Single-centre prospective, experimental, multimodal (clinical, biomechanical, radiological) study with three instances of data collection: baseline (study visit 1), 6-month follow-up (remote) and 1-year follow-up (study visit 2). Both study visits include an in vivo experiment aiming to elicit paraspinal muscle fatigue for postural assessment in a non-fatigued and fatigued state. EXPERIMENTAL PROTOCOL At baseline and 1-year follow-up, 122 patients with sLSS will be assessed clinically, perform the back-performance scale assessment and complete several patient-reported outcome measure (PROMs) questionnaires regarding overall health, disease-related symptoms and kinesiophobia. Posture and biomechanical parameters (joint kinematics, kinetics, surface electromyography, back curvature) will be recorded using an optoelectronic system and retroreflective markers during different tasks including overground walking and movement assessments before and after a modified Biering-Sørensen test, used to elicit paraspinal muscle fatigue. Measurements of muscle size and quality and the severity of spinal stenosis will be obtained using magnetic resonance imaging (MRI) and sagittal postural alignment data from EOS radiographies. After each study visit, physical activity level will be assessed during 9 days using a wrist-worn activity monitor. In addition, physical activity level and PROMs will be assessed remotely at 6-month follow-up. CONCLUSION The multimodal set of data obtained using the study protocol described in this paper will help to expand our current knowledge on the pathophysiology, biomechanics, and treatment outcome of degenerative sLSS. The results of this study may contribute to defining and/or altering patient treatment norms, surgery indication criteria and post-surgery rehabilitation schedules. TRIAL REGISTRATION The protocol was approved by the regional ethics committee and has been registered at clinicaltrials.gov (NCT05523388).
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Affiliation(s)
- David Koch
- Department of Spine Surgery, University Hospital Basel, Basel, Switzerland
- Department of Biomedical Engineering, University of Basel, Basel, Switzerland
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland
| | - Corina Nüesch
- Department of Spine Surgery, University Hospital Basel, Basel, Switzerland
- Department of Biomedical Engineering, University of Basel, Basel, Switzerland
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland
| | | | - Soheila Aghlmandi
- Division of Clinical Epidemiology, University of Basel and University Hospital Basel, Basel, Switzerland
| | - Alice Caimi
- Institute for Biomechanics, ETH Zurich, Zurich, Switzerland
| | - Guido Perrot
- Department of Physiotherapy, University Hospital Basel, Basel, Switzerland
| | - Friederike Prüfer
- Department of Pediatric Radiology, University Children’s Hospital Basel, Basel, Switzerland
| | - Dorothee Harder
- Department of Radiology, University Hospital Basel, Basel, Switzerland
| | - Francesco Santini
- Department of Biomedical Engineering, University of Basel, Basel, Switzerland
- Department of Radiology, University Hospital Basel, Basel, Switzerland
| | - Stefan Schären
- Department of Spine Surgery, University Hospital Basel, Basel, Switzerland
- Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | | | - Annegret Mündermann
- Department of Spine Surgery, University Hospital Basel, Basel, Switzerland
- Department of Biomedical Engineering, University of Basel, Basel, Switzerland
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland
| | - Cordula Netzer
- Department of Spine Surgery, University Hospital Basel, Basel, Switzerland
- Department of Biomedical Engineering, University of Basel, Basel, Switzerland
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Haddas R, Lawlor M, Moghadam E, Fields A, Wood A. Spine patient care with wearable medical technology: state-of-the-art, opportunities, and challenges: a systematic review. Spine J 2023; 23:929-944. [PMID: 36893918 DOI: 10.1016/j.spinee.2023.02.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 02/27/2023] [Accepted: 02/27/2023] [Indexed: 03/11/2023]
Abstract
BACKGROUND CONTEXT Healthcare reforms that demand quantitative outcomes and technical innovations have emphasized the use of Disability and Functional Outcome Measurements (DFOMs) to spinal conditions and interventions. Virtual healthcare has become increasingly important following the COVID-19 pandemic and wearable medical devices have proven to be a useful adjunct. Thus, given the advancement of wearable technology, broad adoption of commercial devices (ie, smartwatches, phone applications, and wearable monitors) by the general public, and the growing demand from consumers to take control of their health, the medical industry is now primed to formally incorporate evidence-based wearable device-mediated telehealth into standards of care. PURPOSE To (1) identify all wearable devices in the peer-reviewed literature that were used to assess DFOMs in Spine, (2) analyze clinical studies implementing such devices in spine care, and (3) provide clinical commentary on how such devices might be integrated into standards of care. STUDY DESIGN/SETTING A systematic review. METHODS A comprehensive systematic review was conducted in adherence to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Guidelines (PRISMA) across the following databases: PubMed; MEDLINE; EMBASE (Elsevier); and Scopus. Articles related to wearables systems in spine healthcare were selected. Extracted data was collected as per a predetermined checklist including wearable device type, study design, and clinical indices studied. RESULTS Of the 2,646 publications that were initially screened, 55 were extensively analyzed and selected for retrieval. Ultimately 39 publications were identified as being suitable for inclusion based on the relevance of their content to the core objectives of this systematic review. The most relevant studies were included, with a focus on wearables technologies that can be used in patients' home environments. CONCLUSIONS Wearable technologies mentioned in this paper have the potential to revolutionize spine healthcare through their ability to collect data continuously and in any environment. In this paper, the vast majority of wearable spine devices rely exclusively on accelerometers. Thus, these metrics provide information about general health rather than specific impairments caused by spinal conditions. As wearable technology becomes more prevalent in orthopedics, healthcare costs may be reduced and patient outcomes will improve. A combination of DFOMs gathered using a wearable device in conjunction with patient-reported outcomes and radiographic measurements will provide a comprehensive evaluation of a spine patient's health and assist the physician with patient-specific treatment decision-making. Establishing these ubiquitous diagnostic capabilities will allow improvement in patient monitoring and help us learn about postoperative recovery and the impact of our interventions.
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Affiliation(s)
- Ram Haddas
- University of Rochester Medical Center, Rochester, NY 14642, USA.
| | - Mark Lawlor
- University of Rochester Medical Center, Rochester, NY 14642, USA
| | - Ehsan Moghadam
- University of Rochester Medical Center, Rochester, NY 14642, USA
| | - Andrew Fields
- Medtronic Spine & Biologics, University of Rochester Medical Center, Rochester, NY 14642, USA
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Zheng X, Reneman MF, Preuper RHS, Otten E, Lamoth CJ. Relationship between physical activity and central sensitization in chronic low back pain: Insights from machine learning. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2023; 232:107432. [PMID: 36868164 DOI: 10.1016/j.cmpb.2023.107432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 02/09/2023] [Accepted: 02/16/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND AND OBJECTIVES Chronic low back pain (CLBP) is a leading cause of disability. The management guidelines for the management of CLBP often recommend optimizing physical activity (PA). Among a subsample of patients with CLBP, central sensitization (CS) is present. However, knowledge about the association between PA intensity patterns, CLBP, and CS is limited. The objective PA computed by conventional approaches (e.g. cut-points) may not be sensitive enough to explore this association. This study aimed to investigate PA intensity patterns in patients with CLBP and low or high CS (CLBP-, CLBP+, respectively) by using advanced unsupervised machine learning approach, Hidden semi-Markov model (HSMM). METHODS Forty-two patients were included (23 CLBP-, 19 CLBP+). CS-related symptoms (e.g. fatigue, sensitivity to light, psychological features) were assessed by a CS Inventory. Patients wore a standard 3D-accelerometer for one week and PA was recorded. The conventional cut-points approach was used to compute the time accumulation and distribution of PA intensity levels in a day. For the two groups, two HSMMs were developed to measure the temporal organization of and transition between hidden states (PA intensity levels), based on the accelerometer vector magnitude. RESULTS Based on the conventional cut-points approach, no significant differences were found between CLBP- and CLBP+ groups (p = 0.87). In contrast, HSMMs revealed significant differences between the two groups. For the 5 identified hidden states (rest, sedentary, light PA, light locomotion, and moderate-vigorous PA), the CLBP- group had a higher transition probability from rest, light PA, and moderate-vigorous PA states to the sedentary state (p < 0.001). In addition, the CBLP- group had a significantly shorter bout duration of the sedentary state (p < 0.001). The CLBP+ group exhibited longer durations of active (p < 0.001) and inactive states (p = 0.037) and had higher transition probabilities between active states (p < 0.001). CONCLUSIONS HSMM discloses the temporal organization and transitions of PA intensity levels based on accelerometer data, yielding valuable and detailed clinical information. The results imply that patients with CLBP- and CLBP+ have different PA intensity patterns. CLBP+ patients may adopt the distress-endurance response pattern with a prolonged bout duration of activity engagement.
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Affiliation(s)
- Xiaoping Zheng
- Department of Human Movement Sciences, University of Groningen,University Medical Center Groningen, Groningen 9713 AV, The Netherlands.
| | - Michiel F Reneman
- Department of Rehabilitation Medicine, University of Groningen,University Medical Center Groningen, Groningen 9751 ND, The Netherlands
| | - Rita Hr Schiphorst Preuper
- Department of Rehabilitation Medicine, University of Groningen,University Medical Center Groningen, Groningen 9751 ND, The Netherlands
| | - Egbert Otten
- Department of Human Movement Sciences, University of Groningen,University Medical Center Groningen, Groningen 9713 AV, The Netherlands
| | - Claudine Jc Lamoth
- Department of Human Movement Sciences, University of Groningen,University Medical Center Groningen, Groningen 9713 AV, The Netherlands
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9
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Urata R, Igawa T, Ito S, Suzuki A. Effectiveness of non-surgical treatment combined with supervised exercise for lumbar spinal stenosis: A systematic review and meta-analysis. J Back Musculoskelet Rehabil 2023:BMR220220. [PMID: 36911930 DOI: 10.3233/bmr-220220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
BACKGROUND The benefits of combining supervised exercise in the non-surgical treatment of lumbar spinal stenosis (LSS) is unclear. OBJECTIVE To compare the effectiveness of non-surgical treatments with and without supervised exercise for pain intensity, symptom severity, functional impairment/disability, walking distance, and quality of life (QOL) in LSS patients. METHODS Randomized controlled trials (RCTs) evaluating combinations of supervised exercises were searched using four electronic databases up to August 13, 2020. Meta-analysis was conducted for immediate and long-term results. RESULTS Three studies were identified, including 244 participants. Immediate-term results showed that leg pain intensity (mean distance [MD]: -0.94, 95% confidence intervals [95% CI]: -1.60 to -0.29, p< 0.01) and symptom severity (MD: -0.29, 95% CI: -0.50 to -0.08, p< 0.01) were lower in the study group than in the control group, and walking distance (MD: 415.83, 95% CI: 298.15-533.50, p< 0.001) and QOL were higher in the study group. Long-term results showed that functional disability/impairment (MD: 0.27, 95% CI: -0.49 to -0.04, p< 0.05) was lower in the study group than in the control group, and walking distance and QOL were higher in the study group. CONCLUSION The number of studies on this topic was small and limited. Combinations of non-surgical treatment and supervised exercise may not provide significant benefits.
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Affiliation(s)
- Ryunosuke Urata
- Department of Rehabilitation, International University of Health and Welfare Mita Hospital, Tokyo, Japan.,Department of Rehabilitation, International University of Health and Welfare Mita Hospital, Tokyo, Japan
| | - Tatsuya Igawa
- Department of Rehabilitation, International University of Health and Welfare Mita Hospital, Tokyo, Japan.,Department of Physical Therapy, School of Health Science, International University of Health and Welfare, Tochigi, Japan.,Department of Rehabilitation, International University of Health and Welfare Hospital, Tochigi, Japan.,Department of Rehabilitation, International University of Health and Welfare Mita Hospital, Tokyo, Japan
| | - Shomaru Ito
- Department of Rehabilitation, International University of Health and Welfare Narita Hospital, Chiba, Japan
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10
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Ray BM, Kelleran KJ, Eubanks JE, Nan N, Ma C, Miles D. Relationship between Physical Activity and Pain in U.S. Adults. Med Sci Sports Exerc 2023; 55:497-506. [PMID: 36318739 DOI: 10.1249/mss.0000000000003078] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
PURPOSE We sought to assess the relationship between physical activity (PA) and pain within the available sample, with secondary aims to assess prevalence of pain, PA levels, health care seeking behaviors, and impact of pain on daily activities and work. METHODS We conducted an epidemiological cross-sectional observational study utilizing National Health Interview Survey data from 2020. We examined the self-reported adherence to current PA guidelines and the prevalence of pain. We hypothesized those dealing with pain were less likely to meet PA guidelines. The PA levels, pain prevalence, frequency, and intensity were assessed via the survey and relationships explored via modeling. RESULTS Of 31,568, 46% were men and 53.99% women with mean age of 52.27 yr (±17.31 yr). There were 12,429 (39.37%) participants that reported pain on some days, 2761 (8.75%) on most days, and 4661 (14.76%) every day. The odds of engaging in PA decreased in a stepwise fashion based on frequency and intensity of pain reporting when compared with no pain. Importantly, PA is a significant correlate affecting pain reporting, with individuals engaging in PA (strength and aerobic) demonstrating two times lower odds of reporting pain when compared with those not meeting the PA guidelines. CONCLUSIONS There is a significant correlation between meeting PA guidelines and pain. Meeting both criteria of PA guidelines resulted in lower odds of reporting pain. In addition, the odds of participating in PA decreased based on pain frequency reporting. These are important findings for clinicians, highlighting the need for assessing PA not only for those dealing with pain but also as a potential risk factor for minimizing development of chronic pain.
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Affiliation(s)
- Billy Michael Ray
- Department of Health and Human Sciences, Bridgewater College, Bridgewater, VA
| | - Kyle J Kelleran
- Department of Emergency Medicine, University at Buffalo, Buffalo, NY
| | - James E Eubanks
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Nan Nan
- Department of Biostatistics, University at Buffalo, Buffalo, NY
| | - Changxing Ma
- Department of Biostatistics, University at Buffalo, Buffalo, NY
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11
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Houle M, Tétreau C, Châtillon CÉ, Marchand AA, Descarreaux M. Effectiveness of a 6-week specific rehabilitation program combining education and exercises on walking capacity in patients with lumbar spinal stenosis with neurogenic claudication: a randomized controlled clinical trial protocol. Trials 2022; 23:1046. [PMID: 36572884 PMCID: PMC9793648 DOI: 10.1186/s13063-022-07011-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 12/14/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Lumbar spinal stenosis (LSS) causing neurogenic claudication (NC) is a leading cause of disability which is intimately related to a decrease in walking capacity. Walking limitation has negative physical and mental impacts on patients. Recent guidelines recommend the use of conservative treatment options such as exercises before considering surgery. Unfortunately, dedicated healthcare resources for the conservative management of patients with LSS causing NC are uncommon. Thus, it is important to develop accessible and specific rehabilitation programs aimed at improving patients' self-management, especially with regard to walking capacity. The aim of this study is to evaluate the effectiveness of a 6-week specific rehabilitation program combining education and exercises on walking capacity in patients with LSS causing NC. METHODS/DESIGN This is a prospective randomized controlled parallel-group clinical trial. Sixty-six patients with LSS causing NC will be recruited from identified clinics and local advertisements. The intervention group will receive standardized education and specific exercises while the control group will only receive a standardized education. The program in both groups will last for 6 weeks with 5 evaluation time points (baseline, week 2, week 4, week 6, and week 12). The primary outcome will be walking capacity measured with the Self-Paced Walking Test, and the secondary outcomes will be back and leg pain intensity, LSS-related disability, self-efficacy, level of physical activity, anxiety, depression, gait pattern characteristics, balance, and global perceived change. DISCUSSION This study will assess the effectiveness of a 6-week specific rehabilitation program combining education and exercises on walking capacity in patients with LSS causing NC. By measuring objective gait pattern characteristics, the study will also provide new information about the impact of NC on gait pattern that could eventually improve the evaluation and the management of LSS. TRIAL REGISTRATION ClinicalTrials.gov NCT05513326 . Registered on August 22, 2022.
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Affiliation(s)
- Mariève Houle
- grid.265703.50000 0001 2197 8284Department of Anatomy, Université du Québec à Trois-Rivières, 3351, boul. des Forges, Trois-Rivières, QC G8Z 4M3 Canada
| | - Charles Tétreau
- grid.265703.50000 0001 2197 8284Department of Human Kinetics, Université du Québec à Trois-Rivières, Trois-Rivières, Canada
| | - Claude-Édouard Châtillon
- Centre intégré universitaire de santé et de services sociaux de la Mauricie et du Centre-du-Québec (CIUSSS MCQ), Trois-Rivières, Canada ,grid.14848.310000 0001 2292 3357Division of Neurosurgery, Faculty of Medicine, University of Montreal, Montréal, Canada
| | - Andrée-Anne Marchand
- grid.265703.50000 0001 2197 8284Department of Chiropractic, Université du Québec à Trois-Rivières, Trois-Rivières, Canada
| | - Martin Descarreaux
- grid.265703.50000 0001 2197 8284Department of Human Kinetics, Université du Québec à Trois-Rivières, Trois-Rivières, Canada
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12
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Impact of lumbar spinal stenosis on metabolic syndrome incidence in community-dwelling adults in Aizu cohort study (LOHAS). Sci Rep 2022; 12:11246. [PMID: 35789178 PMCID: PMC9253139 DOI: 10.1038/s41598-022-15173-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 06/20/2022] [Indexed: 12/14/2022] Open
Abstract
Metabolic syndrome and lumbar spinal stenosis (LSS) are common age-related diseases. However, the causal relationship between them remains unclear. This study aimed to identify the effects of LSS on metabolic syndrome incidence in community-dwelling adults. This prospective cohort study included participants of the Aizu cohort study (LOHAS) aged < 75 years as of 2008. Participants with metabolic syndrome at baseline were excluded. The primary outcome measure was metabolic syndrome incidence, and the main explanatory variable was the presence of LSS, as assessed by a self-reported questionnaire. A multivariate Cox proportional hazard regression model was used to estimate hazard ratios (HRs) for metabolic syndrome incidence during the 6-year follow-up period. Complete-case analyses were compared with the multiple imputation results. Among 1599 participants, 1390 complete cases were analyzed (mean [SD] age 62.3 [9.0] years; females, 734 [52.8%]). Among those participants, 525 (37.8%) developed metabolic syndrome during the follow-up of 3.89 [1.96] years. The presence of LSS was associated with developing metabolic syndrome (HR, 1.41; 95% confidence interval [CI] 1.02–1.95). Multiple imputation results showed similar trends of those having complete-case data (HR, 1.47; 95% CI 1.08–2.00). This finding suggests the importance of prevention and management of LSS in community settings.
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13
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Objective features of sedentary time and light activity differentiate people with low back pain from healthy controls: a pilot study. Spine J 2022; 22:629-634. [PMID: 34798245 DOI: 10.1016/j.spinee.2021.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 11/03/2021] [Accepted: 11/04/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Physical inactivity has been described as both a cause and a consequence of low back pain (LBP) largely based on self-reported measures of daily activity. A better understanding of the connections between routine physical activity and LBP may improve LBP interventions. PURPOSE In this study, we aim to objectively characterize the free-living physical activity of people with low back pain in comparison to healthy controls using accelerometers, and we aim to derive a set of LBP-specific physical activity minutes thresholds that may be used as targets for future physical activity interventions. STUDY DESIGN Cross-sectional. PATIENT SAMPLE A total of 22 low back pain patients and 155 controls. OUTCOME MEASURES Accelerometry derived physical activity measures. METHODS Twenty-two people with LBP were compared to 155 age and gender-matched healthy controls. All subjects wore an ActiGraph accelerometer on the right hip for 7 consecutive days. Accelerometry-based physical activity features (count-per-minute CPM) were derived using Freedson's intervals and physical performance intervals. A random forest machine learning classifier was trained to classify LBP status using a leave-one-out cross-validation procedure. An interpretation algorithm, the SHapley Additive exPlanations (SHAP) algorithm was subsequently applied to assess the feature importance and to establish LBP-specific physical activity thresholds. RESULTS The LBP group reported mild to moderate disability (average ODI=18.5). The random forest classifier identified a set of 8 features (digital biomarkers) that achieved 88.1% accuracy for distinguishing LBP from controls. All of the top distinguishing features were related to differences in the sedentary and light activity ranges (<800 CPM), whereas moderate to vigorous physical activity was not discriminative. In addition, we identified and ranked physical activity thresholds that are associated with LBP prediction that can be used in future studies of physical activity interventions for LBP. CONCLUSIONS We describe a set of physical activity features from accelerometry data associated with LBP. All of the discriminating features were derived from the sedentary and light activity range. We also identified specific activity intensity minutes thresholds that distinguished LBP subjects from healthy controls. Future examination on the digital markers and thresholds identified through this work can be used to improve physical activity interventions for LBP treatment and prevention by allowing the development of LBP-specific physical activity guidelines.
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14
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Decreased physical activity in patients with ankle osteoarthritis. A case-control study comparing daily step counts. Foot Ankle Surg 2022; 28:66-71. [PMID: 33551322 DOI: 10.1016/j.fas.2021.01.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 12/03/2020] [Accepted: 01/25/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND The purpose of this study was to compare physical activity levels and the proportion of patients who met physical activity recommendations in patients with ankle osteoarthritis and controls. METHODS Ankle osteoarthritis patients (n = 50) and controls (n = 50) were recruited. physical activity was measured using an accelerometer-based monitor. Physical activity parameters, including the step count/day, the proportion of patients who met physical activity recommendations of ≥7000 steps/day, and moderate to vigorous physical activity minutes/day, were compared between the patient groups. RESULTS The patients with ankle osteoarthritis walked 3998 steps/day, while the controls walked 6531 steps/day (P < .001). Only 7 (14%) ankle osteoarthritis patients and 17 (34%) controls met the physical activity recommendations of ≥7000 steps/day (P = .01). Time spent performing moderate to vigorous physical activity was 58 and 78 min/day in the ankle osteoarthritis and controls, respectively. CONCLUSIONS The physical activity level of ankle osteoarthritis patients was lower than that of controls. Only a limited proportion of ankle osteoarthritis patients met the physical activity recommendation.
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15
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Bienstock DM, Shankar D, Kim J, Gao M, Srivastava K, Bronson WH, Chaudhary SB, Poeran J, Iatridis JC, Hecht AC. Accelerometry Data Delineates Phases of Recovery and Supplements Patient-Reported Outcome Measures Following Lumbar Laminectomy. World Neurosurg 2022; 160:e608-e615. [PMID: 35104658 PMCID: PMC8977241 DOI: 10.1016/j.wneu.2022.01.097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/23/2022] [Accepted: 01/23/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Patient-reported outcome measures (PROMs) are traditionally used to track recovery of patients after spine surgery. Wearable accelerometers have adjunctive value because of the continuous, granular, and objective data they provide. We conducted a prospective study of lumbar laminectomy patients to determine if time-series data from wearable accelerometers could delineate phases of recovery and compare accelerometry data to PROMs during recovery tracking. METHODS Patients with lumbar stenosis for whom lumbar laminectomy was indicated were prospectively recruited. Subjects wore accelerometers that recorded their daily step counts from at least 1 week preoperatively to 6 months postoperatively. Subjects completed the Oswestry Disability Index and the 12-Item Short Form Health Survey preoperatively and at 2 weeks, 1 month, 3 months, and 6 months postoperatively. Daily aggregate median steps and individual visit-specific median steps were calculated. The Pruned Linear Exact Time method was used to segment aggregate median steps into distinct phases. Associations between visit-specific median steps and PROMs were identified using Spearman rank correlation. RESULTS Segmentation analysis revealed 3 distinct postoperative phases: step counts rapidly increased for the first 40 days postoperatively (acute healing), then gained more slowly for the next 90 days (recovery), and finally plateaued at preoperative levels (stabilization). Visit-specific median steps were significantly correlated with PROMs throughout the postoperative period. PROMs significantly exceeded baseline at 6 months postoperatively, while step counts did not (all P < 0.05). CONCLUSIONS Continuous data from accelerometers allowed for identification of 3 distinct stages of postoperative recovery after lumbar laminectomy. PROMs remain necessary to capture subjective elements of recovery.
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16
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Aubry C, Nüesch C, Fiebig O, Stoll TM, Köhler M, Barth A, Mündermann A. Accelerometry-based physical activity, disability and quality of life before and after lumbar decompression surgery from a physiotherapeutic perspective: An observational cohort study. NORTH AMERICAN SPINE SOCIETY JOURNAL 2021; 8:100087. [PMID: 35141652 PMCID: PMC8819940 DOI: 10.1016/j.xnsj.2021.100087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 10/18/2021] [Accepted: 10/18/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND The effect of lumbar decompression on physical activity (PA) measures (measured as number of steps/day and as moderate to vigorous PA (MVPA)) is poorly understood. The aim of the current study was to compare PA in patients before and after lumbar decompression and to determine the association between change in steps/day and MVPA with change in disability, health-related quality of life (HRQOL) and pain. METHODS Patients undergoing lumbar decompression surgery were recruited. Steps/day and MVPA MVPA were recorded with an accelerometer. Oswestry Disability Index (ODI), HRQOL (Short Form 36 questionnaire (SF-36)) and pain levels (visual analogue scale (VAS)) were collected prior to surgery and six and twelve weeks postoperatively. Steps/day were compared to the lower bound of steps/day in healthy persons (7,000 steps per day), and the relationship between changes in steps/day, MVPA, ODI, SF-36, and VAS were calculated. RESULTS Twenty-six patients aged 37 to 75 years met inclusion criteria and were included in the study. Lumbar decompressions were performed for stenosis and/or disc herniation. Preoperatively, patients took an average 5,073±2,621 (mean±standard deviation) steps/day. At 6 weeks postoperatively, patients took 6,131±2,343 steps/day. At 12 weeks postoperatively, patients took 5,683±2,128 steps/day. Postoperative MVPA minutes per week increased compared to preoperative MVPA (preoperative: 94.6±122.9; 6 weeks: 173.9±181.9; 12 weeks: 145.7±132.8). From preoperative to 12 weeks postoperative, change in steps correlated with MVPA (R=0.775; P<0.001), but not with ODI (R=0.069; P=0.739), SF-36 (R=0.138; P=0.371), VAS in the back (R=0.230; P=0.259) or VAS in the leg (R=-0.123; P=0.550). CONCLUSIONS During the first 12 postoperative weeks, daily steps did not reach the lower bound of normal step activity of 7,000 steps/day, however postoperative steps/day were higher than before surgery. Steps/day and MVPA appear to be independent of ODI and SF-36 and represent additional outcome parameters in patients undergoing lumbar decompression surgery and should be considered e.g., by physiotherapists especially from 6 to 12 weeks postoperatively. LEVEL OF EVIDENCE 2, prospective cohort study.
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Affiliation(s)
- Caroline Aubry
- Department of Physiotherapy, Bethesda Hospital AG, Basel, Switzerland
- Zurich University of Applied Sciences, School of Health Professions, Institute of Physiotherapy, Winterthur, Switzerland
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland
| | - Corina Nüesch
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland
- Department of Spine Surgery, University Hospital Basel, Basel, Switzerland
- Department of Biomedical Engineering, University of Basel, Allschwil, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Oliver Fiebig
- Department of Spine Surgery, University Hospital Basel, Basel, Switzerland
- Department of Neurosurgical and Orthopaedic Spine Surgery, Bethesda Hospital AG, 4052 Basel, Switzerland
| | - Thomas M. Stoll
- Department of Neurosurgical and Orthopaedic Spine Surgery, Bethesda Hospital AG, 4052 Basel, Switzerland
| | - Markus Köhler
- Department of Neurosurgical and Orthopaedic Spine Surgery, Bethesda Hospital AG, 4052 Basel, Switzerland
| | - Alain Barth
- Department of Neurosurgical and Orthopaedic Spine Surgery, Bethesda Hospital AG, 4052 Basel, Switzerland
| | - Annegret Mündermann
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland
- Department of Spine Surgery, University Hospital Basel, Basel, Switzerland
- Department of Biomedical Engineering, University of Basel, Allschwil, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
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17
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Odonkor CA, Taraben S, Tomkins-Lane C, Zhang W, Muaremi A, Leutheuser H, Sun R, Smuck M. Examining the Association Between Self-Reported Estimates of Function and Objective Measures of Gait and Physical Capacity in Lumbar Stenosis. Arch Rehabil Res Clin Transl 2021; 3:100147. [PMID: 34589697 PMCID: PMC8463455 DOI: 10.1016/j.arrct.2021.100147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Objective: To evaluate the association of self-reported physical function with subjective and objective measures as well as temporospatial gait features in lumbar spinal stenosis (LSS). Design: Cross-sectional pilot study. Setting: Outpatient multispecialty clinic. Participants: Participants with LSS and matched controls without LSS (n=10 per group; N=20). Interventions: Not applicable. Main Outcome Measures: Self-reported physical function (36-Item Short Form Health Survey [SF-36] physical functioning domain), Oswestry Disability Index, Swiss Spinal Stenosis Questionnaire, the Neurogenic Claudication Outcome Score, and inertia measurement unit (IMU)-derived temporospatial gait features Results: Higher self-reported physical function scores (SF-36 physical functioning) correlated with lower disability ratings, neurogenic claudication, and symptom severity ratings in patients with LSS (P<.05). Compared with controls without LSS, patients with LSS have lower scores on physical capacity measures (median total distance traveled on 6-minute walk test: controls 505 m vs LSS 316 m; median total distance traveled on self-paced walking test: controls 718 m vs LSS 174 m). Observed differences in IMU-derived gait features, physical capacity measures, disability ratings, and neurogenic claudication scores between populations with and without LSS were statistically significant. Conclusions: Further evaluation of the association of IMU-derived temporospatial gait with self-reported physical function, pain related-disability, neurogenic claudication, and spinal stenosis symptom severity score in LSS would help clarify their role in tracking LSS outcomes.
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Affiliation(s)
- Charles A Odonkor
- Department of Orthopedics and Rehabilitation, Division of Physiatry, Yale School of Medicine, New Haven, CT.,Orthopedics and Rehabilitation, Interventional Pain Medicine and Physiatry, Yale New Haven Hospital, New Haven, CT
| | - Salam Taraben
- Frank H. Netter School of Medicine, Quinnipiac University, Hamden, CT
| | - Christy Tomkins-Lane
- Department of Health and Physical Education, Mount Royal University, Calgary, Canada
| | - Wei Zhang
- Department of Essential Medicine and Health Product, World Health Organization, Geneva, Switzerland
| | - Amir Muaremi
- Novartis Institutes for BioMedical Research, Basel, Switzerland
| | - Heike Leutheuser
- Central Institute for Medical Engineering, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Ruopeng Sun
- Division of Physical Medicine and Rehabilitation, Stanford University, Stanford, CA
| | - Matthew Smuck
- Division of Physical Medicine and Rehabilitation, Stanford University, Stanford, CA
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Bussières A, Cancelliere C, Ammendolia C, Comer CM, Zoubi FA, Châtillon CE, Chernish G, Cox JM, Gliedt JA, Haskett D, Jensen RK, Marchand AA, Tomkins-Lane C, O'Shaughnessy J, Passmore S, Schneider MJ, Shipka P, Stewart G, Stuber K, Yee A, Ornelas J. Non-Surgical Interventions for Lumbar Spinal Stenosis Leading To Neurogenic Claudication: A Clinical Practice Guideline. THE JOURNAL OF PAIN 2021; 22:1015-1039. [PMID: 33857615 DOI: 10.1016/j.jpain.2021.03.147] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 03/14/2021] [Accepted: 03/16/2021] [Indexed: 12/14/2022]
Abstract
Lumbar spinal stenosis (LSS) causing neurogenic claudication (NC) is increasingly common with an aging population and can be associated with significant symptoms and functional limitations. We developed this guideline to present the evidence and provide clinical recommendations on nonsurgical management of patients with LSS causing NC. Using the GRADE approach, a multidisciplinary guidelines panel based recommendations on evidence from a systematic review of randomized controlled trials and systematic reviews published through June 2019, or expert consensus. The literature monitored up to October 2020. Clinical outcomes evaluated included pain, disability, quality of life, and walking capacity. The target audience for this guideline includes all clinicians, and the target patient population includes adults with LSS (congenital and/or acquired, lateral recess or central canal, with or without low back pain, with or without spondylolisthesis) causing NC. The guidelines panel developed 6 recommendations based on randomized controlled trials and 5 others based on professional consensus, summarized in 3 overarching recommendations: (Grade: statements are all conditional/weak recommendations) Recommendation 1. For patients with LSS causing NC, clinicians and patients may initially select multimodal care nonpharmacological therapies with education, advice and lifestyle changes, behavioral change techniques in conjunction with home exercise, manual therapy, and/or rehabilitation (moderate-quality evidence), traditional acupuncture on a trial basis (very low-quality evidence), and postoperative rehabilitation (supervised program of exercises and/or educational materials encouraging activity) with cognitive-behavioral therapy 12 weeks postsurgery (low-quality evidence). Recommendation 2. In patients LSS causing NC, clinicians and patients may consider a trial of serotonin-norepinephrine reuptake inhibitors or tricyclic antidepressants. (very low-quality evidence). Recommendation 3. For patients LSS causing NC, we recommend against the use of the following pharmacological therapies: nonsteroidal anti-inflammatory drugs, methylcobalamin, calcitonin, paracetamol, opioids, muscle relaxants, pregabalin (consensus-based), gabapentin (very low-quality), and epidural steroidal injections (high-quality evidence). PERSPECTIVE: This guideline, on the basis of a systematic review of the evidence on the nonsurgical management of lumbar spine stenosis, provides recommendations developed by a multidisciplinary expert panel. Safe and effective non-surgical management of lumbar spine stenosis should be on the basis of a plan of care tailored to the individual and the type of treatment involved, and multimodal care is recommended in most situations.
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Affiliation(s)
- André Bussières
- School of Physical Medicine & Occupational Therapy, McGill University, Montreal, Quebec, Canada; Département Chiropratique, Université du Québec à Trois-Rivières, Quebec, Canada.
| | - Carolina Cancelliere
- Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, Canada
| | - Carlo Ammendolia
- Faculty of Medicine, University of Toronto and Mount Sinai Hospital, Ontario, Canada
| | - Christine M Comer
- Leeds Community Healthcare NHS Trust, Leeds, United Kingdom/ Faculty of Medicine, University of Leeds, United Kingdom
| | - Fadi Al Zoubi
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | | | - Greg Chernish
- Family Medicine at the University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Jordan A Gliedt
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | | | - Rikke Krüger Jensen
- NIKKB and Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Denmark
| | - Andrée-Anne Marchand
- Département Chiropratique, Université du Québec à Trois-Rivières, Quebec, Canada
| | - Christy Tomkins-Lane
- Department of Health and Physical Education, Mount Royal University, Calgary, Canada
| | - Julie O'Shaughnessy
- Département Chiropratique, Université du Québec à Trois-Rivières, Quebec, Canada
| | - Steven Passmore
- Faculty of Kinesiology & Recreation Management, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Michael J Schneider
- Department of Physical Therapy, University of Pittsburgh, Pennsylvania; Clinical and Translational Science Institute, University of Pittsburgh, Pennsylvania
| | | | | | - Kent Stuber
- Canadian Memorial Chiropractic College, Toronto, Ontario, Canada; Sunnybrook Health Sciences Centre, Toronto, Ontario
| | - Albert Yee
- Health Systems Management, Rush University, Chicago, Illinois
| | - Joseph Ornelas
- American Hip Institute, Des Plaines, Illinois; Clinical and Translational Science Institute, University of Pittsburgh, Pennsylvania
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19
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Coyle PC, O'Brien VA, Edwards DG, Pohlig RT, Hicks GE. Markers of Cardiovascular Health in Older Adults with and Without Chronic Low Back and Radicular Leg Pain: A Comparative Analysis. PAIN MEDICINE 2021; 22:1353-1359. [PMID: 33585935 DOI: 10.1093/pm/pnaa426] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVES There is considerable overlap in risk profiles between chronic low back pain with radiculopathy (CLBPR) and cardiovascular health among older adults; obesity and smoking are related to both conditions and may largely drive the potential relationship. We sought to explore the impact of CLBPR on cardiovascular health outcomes, independent of body mass index (BMI) and current smoking status. METHODS Age- and sex-matched older adults (60-85 years of age) with (n = 21) and without (n = 21) CLBPR were recruited. Current smokers were excluded. Blood samples were collected to measure cholesterol levels and pro-inflammatory markers (i.e., C-reactive protein and interleukin-6). Vascular endothelial function, a marker of cardiovascular health, was evaluated by measuring brachial artery flow-mediated dilation (FMD). General linear models with multifactorial designs were evaluated; group membership, BMI, education, and their respective two-way interaction terms were included as independent variables. RESULTS Older adults with CLBPR had significantly higher BMIs (P = 0.004) and lower educational levels (P = 0.013) than did those without pain. There was a significant group-by-education interaction effect (P = 0.049) for endothelial function. Older adults without pain who were highly educated had higher FMD values, indicating better endothelial function (9.2%), whereas the following combinations all had lower FMD values: no pain plus low education, CLBPR plus high education, and CLBPR plus low education (5.9%, 6.1%, and 6.6%, respectively). CONCLUSIONS Among older adults, CLBPR is linked with worse endothelial function, regardless of educational level and independent of BMI and smoking. These findings suggest that older adults with CLBPR may be at a higher risk of cardiovascular disease.
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Affiliation(s)
- Peter C Coyle
- Department of Physical Therapy, Newark, Delaware, USA
| | - Victoria A O'Brien
- Department of Physical Therapy, Newark, Delaware, USA.,Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania, USA
| | - David G Edwards
- Department of Kinesiology and Applied Physiology, Newark, Delaware, USA
| | - Ryan T Pohlig
- Department of Epidemiology, Newark, Delaware, USA.,Biostatistics Core, University of Delaware, Newark, Delaware, USA
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20
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Marchand AA, Houle M, O'Shaughnessy J, Châtillon CÉ, Cantin V, Descarreaux M. Effectiveness of an exercise-based prehabilitation program for patients awaiting surgery for lumbar spinal stenosis: a randomized clinical trial. Sci Rep 2021; 11:11080. [PMID: 34040109 PMCID: PMC8155114 DOI: 10.1038/s41598-021-90537-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 05/12/2021] [Indexed: 02/08/2023] Open
Abstract
Lumbar spinal stenosis is the most common reason for spine surgery in older adults, but the effects of prehabilitation on perioperative outcomes among these patients have not been investigated. This study aims to evaluate the effectiveness of a preoperative exercise-based intervention program compared with usual care on the improvement of clinical status, physical capacities and postoperative recovery of patients awaiting surgery for lumbar spinal stenosis. Sixty-eight participants were randomised to receive either a 6-week supervised exercise-based prehabilitation program or hospital usual care. The outcomes included both clinical and physical measures. Data collection occurred at post-intervention, and 6 weeks, 3- and 6-months post-surgery. Significant but small improvements were found in favour of the experimental group at the post-intervention assessment for pain intensity, lumbar spinal stenosis-related disability, lumbar strength in flexion, low back extensor muscles endurance, total ambulation time, and sit to stand performance. A significant difference in favor of the intervention group was found starting at the 3-month postoperative follow-up for low back-related disability. No adverse events were reported. Exercise-based prehabilitation did not improve short-term postoperative recovery in patients with lumbar spinal stenosis.
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Affiliation(s)
- Andrée-Anne Marchand
- Department of Chiropractic, Université du Québec à Trois-Rivières, 3351 Boul. des Forges, Trois-Rivières, QC, G9A 5H7, Canada.
| | - Mariève Houle
- Department of Anatomy, Université du Québec à Trois-Rivières, Trois-Rivières, Canada
| | - Julie O'Shaughnessy
- Department of Chiropractic, Université du Québec à Trois-Rivières, 3351 Boul. des Forges, Trois-Rivières, QC, G9A 5H7, Canada
| | - Claude-Édouard Châtillon
- Centre Intégré Universitaire de Santé et de Services Sociaux de la Mauricie-et-du-Centre-du-Québec, Trois-Rivières, Canada.,Division of Neurosurgery, Faculty of Medicine, University of Montreal, Montréal, Canada
| | - Vincent Cantin
- Department of Human Kinetics, Université du Québec à Trois-Rivières, Trois-Rivières, Canada
| | - Martin Descarreaux
- Department of Human Kinetics, Université du Québec à Trois-Rivières, Trois-Rivières, Canada
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21
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Effectiveness of Conservative Nonpharmacologic Therapies for Pain, Disability, Physical Capacity, and Physical Activity Behavior in Patients With Degenerative Lumbar Spinal Stenosis: A Systematic Review and Meta-Analysis. Arch Phys Med Rehabil 2021; 102:2247-2260.e7. [PMID: 33933439 DOI: 10.1016/j.apmr.2021.03.033] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 02/12/2021] [Accepted: 03/27/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To investigate the effectiveness of conservative nonpharmacologic therapies on pain, disability, physical capacity, and physical activity outcomes in patients with degenerative lumbar spinal stenosis (LSS). DATA SOURCES Systematic search of MEDLINE, EMBASE, CENTRAL, and PsycINFO from inception to November 4, 2019, without language restrictions. STUDY SELECTION Pairs of review authors independently identified randomized controlled trials published in peer-reviewed scientific journals reporting on the effects of rehabilitation interventions on pain intensity (back or leg), disability, symptom severity, physical capacity, physical activity behavior, or adverse events (secondary outcome) in adults with LSS. The search identified 1718 records; data from 21 reports of 19 trials (1432 patients) were included. DATA EXTRACTION Review author pairs independently extracted data and assessed included studies. We assessed risk of bias with the Cochrane tool, and overall study quality with the Grading of Recommendations Assessment, Development and Evaluation classification. DATA SYNTHESIS We pooled data using random-effects meta-analyses; treatment effects were reported as mean differences (MD) and 95% confidence intervals (CI). Directed exercise and manual therapy was superior to self-directed or group exercise for improving short-term walking capacity (MD, 293.3 m; 95% CI, 61.7-524.9 m; low-quality evidence), back pain (MD, -1.1; 95% CI, -1.8 to -0.4; moderate quality evidence), leg pain (MD, -.9; 95% CI, -0.2 to -1.5; moderate-quality evidence), and symptom severity (MD, -0.3; 95% CI, -0.4 to -0.2; low quality evidence). There is very low quality evidence that rehabilitation is no better than surgery at improving intermediate- or long-term disability. Single trials provided conflicting evidence of effectiveness for a variety of therapies. CONCLUSIONS For patients with LSS, there is low- to moderate-quality evidence that manual therapy with supervised exercises improves short-term walking capacity and results in small improvements in pain and symptom severity compared with self-directed or group exercise. The choice between rehabilitation and surgery for LSS is very uncertain owing to the very low quality of available evidence.
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22
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Minetama M, Kawakami M, Teraguchi M, Kagotani R, Mera Y, Sumiya T, Nakagawa M, Yamamoto Y, Matsuo S, Sakon N, Nakatani T, Kitano T, Nakagawa Y. Associations between psychological factors and daily step count in patients with lumbar spinal stenosis. Physiother Theory Pract 2020; 38:1519-1527. [PMID: 33267720 DOI: 10.1080/09593985.2020.1855685] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Background: Body mass index, pain, female sex, and age have been reported as predictors of physical activity in patients with lumbar spinal stenosis (LSS). However, no reports have examined the psychological factors associated with physical activity in people with LSS.Purpose: To use psychological assessments to identify the factors associated with physical activity measured as daily step count in people with LSS.Methods: Seventy-one patients who received outpatient physical therapy were included. All patients completed the following scales at baseline: Zurich Claudication Questionnaire; self-paced walking test (SPWT); numerical rating scale of low back pain, leg pain, and leg numbness; Hospital Anxiety and Depression Scale (HADS); Pain Catastrophizing Scale; Pain Anxiety Symptoms Scale (PASS-20); and Tampa Scale for Kinesiophobia. Physical activity was measured using a pedometer as the average number of daily steps.Results: Daily step count was significantly associated with age, number of stenoses, severity of stenosis at L3-L4, walking distance on the SPWT, PASS-20 total score, cognitive anxiety, escape/avoidance, fear, and HADS depression score (p < .05). Multiple regression analysis showed that age, severity of stenosis at L3-L4, walking distance on the SPWT, and PASS-20 fear predicted daily step count (r2 = 0.414).Conclusion: Older age, fewer stenoses, less severe stenosis at L3-L4, lower walking capacity, higher anxiety, and fear-avoidance beliefs about pain and depression are more closely associated with lower daily step count than are back and leg pain. Assessment and treatment of psychological factors might help to increase physical activity in patients with LSS.
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Affiliation(s)
- Masakazu Minetama
- Spine Care Center, Wakayama Medical University Kihoku Hospital, Wakayama, Japan
| | - Mamoru Kawakami
- Spine Care Center, Wakayama Medical University Kihoku Hospital, Wakayama, Japan.,Department of Orthopaedic Surgery, Saiseikai Wakayama Hospital, Wakayama, Japan
| | - Masatoshi Teraguchi
- Spine Care Center, Wakayama Medical University Kihoku Hospital, Wakayama, Japan
| | - Ryohei Kagotani
- Spine Care Center, Wakayama Medical University Kihoku Hospital, Wakayama, Japan
| | - Yoshimasa Mera
- Spine Care Center, Wakayama Medical University Kihoku Hospital, Wakayama, Japan
| | - Tadashi Sumiya
- Spine Care Center, Wakayama Medical University Kihoku Hospital, Wakayama, Japan
| | - Masafumi Nakagawa
- Spine Care Center, Wakayama Medical University Kihoku Hospital, Wakayama, Japan
| | - Yoshio Yamamoto
- Spine Care Center, Wakayama Medical University Kihoku Hospital, Wakayama, Japan
| | - Sachika Matsuo
- Spine Care Center, Wakayama Medical University Kihoku Hospital, Wakayama, Japan
| | - Nana Sakon
- Spine Care Center, Wakayama Medical University Kihoku Hospital, Wakayama, Japan
| | - Tomohiro Nakatani
- Spine Care Center, Wakayama Medical University Kihoku Hospital, Wakayama, Japan
| | - Tomoko Kitano
- Spine Care Center, Wakayama Medical University Kihoku Hospital, Wakayama, Japan
| | - Yukihiro Nakagawa
- Spine Care Center, Wakayama Medical University Kihoku Hospital, Wakayama, Japan
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23
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Abstract
STUDY DESIGN Cross-sectional design. OBJECTIVE To investigate the prevalence of sarcopenia and identify factors associated with sarcopenia in patients with lumbar spinal stenosis (LSS). SUMMARY OF BACKGROUND DATA Patients with LSS have a higher prevalence of sarcopenia compared with healthy older adults. However, the clinical features of sarcopenia in patients with LSS are poorly understood and the factors affecting sarcopenia in patients with LSS remain unclear. METHODS Patients diagnosed with LSS based on clinical examination and magnetic resonance imaging findings, and referred to physical therapy, were enrolled. Muscle mass was measured using bioelectrical impedance using InBody S10. We collected a numerical rating scale (NRS) for back pain, the 36-Item Short-Form Survey (SF-36), the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ), bone mineral density (BMD), and radiographic measurements of spinal alignment. Sarcopenia was defined according to the Asian Working Group for Sarcopenia guidelines and patients were classified into sarcopenia or nonsarcopenia groups. RESULTS A total of 178 patients were enrolled: 35 in the sarcopenia group and 143 in the nonsarcopenia group. The prevalence of sarcopenia was 19.7%. The average percent of slip (% slip) among patients in the sarcopenia group was significantly higher compared with those in the nonsarcopenia group (P < 0.05). Body mass index (BMI), BMD, physical function as assessed by the SF-36, and gait disturbance as assessed by the JOABPEQ were significantly lower in the sarcopenia group compared with those in the nonsarcopenia group (P < 0.05). A trend was observed toward between-group differences in back pain on the NRS (P < 0.1). In the logistic regression analysis, significant associations were seen between sarcopenia and % slip (odds ratio 1.15, 95% CI 1.01-1.30). CONCLUSION Patients with LSS and sarcopenia have a higher degree of slippage and lower BMI, BMD, and physical function, and reported more severe low back pain, compared with those without sarcopenia. LEVEL OF EVIDENCE 4.
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24
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Stienen MN, Rezaii PG, Ho AL, Veeravagu A, Zygourakis CC, Tomkins-Lane C, Park J, Ratliff JK, Desai AM. Objective activity tracking in spine surgery: a prospective feasibility study with a low-cost consumer grade wearable accelerometer. Sci Rep 2020; 10:4939. [PMID: 32188895 PMCID: PMC7080733 DOI: 10.1038/s41598-020-61893-4] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 03/04/2020] [Indexed: 01/29/2023] Open
Abstract
Patient-reported outcome measures (PROMs) are commonly used to estimate disability of patients with spinal degenerative disease. Emerging technological advances present an opportunity to provide objective measurements of activity. In a prospective, observational study we utilized a low-cost consumer grade wearable accelerometer (LCA) to determine patient activity (steps per day) preoperatively (baseline) and up to one year (Y1) after cervical and lumbar spine surgery. We studied 30 patients (46.7% male; mean age 57 years; 70% Caucasian) with a baseline activity level of 5624 steps per day. The activity level decreased by 71% in the 1st postoperative week (p < 0.001) and remained 37% lower in the 2nd (p < 0.001) and 23% lower in the 4th week (p = 0.015). At no time point until Y1 did patients increase their activity level, compared to baseline. Activity was greater in patients with cervical, as compared to patients with lumbar spine disease. Age, sex, ethnic group, anesthesia risk score and fusion were variables associated with activity. There was no correlation between activity and PROMs, but a strong correlation with depression. Determining activity using LCAs provides real-time and longitudinal information about patient mobility and return of function. Recovery took place over the first eight postoperative weeks, with subtle improvement afterwards.
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Affiliation(s)
- Martin N Stienen
- Department of Neurosurgery, Stanford University Hospitals and Clinics, Stanford, California, USA. .,Department of Neurosurgery, University Hospital Zurich, Zurich, Switzerland. .,Clinical Neuroscience Center, University of Zurich, Zurich, Switzerland.
| | - Paymon G Rezaii
- Department of Neurosurgery, Stanford University Hospitals and Clinics, Stanford, California, USA
| | - Allen L Ho
- Department of Neurosurgery, Stanford University Hospitals and Clinics, Stanford, California, USA
| | - Anand Veeravagu
- Department of Neurosurgery, Stanford University Hospitals and Clinics, Stanford, California, USA
| | - Corinna C Zygourakis
- Department of Neurosurgery, Stanford University Hospitals and Clinics, Stanford, California, USA
| | - Christy Tomkins-Lane
- Wearable Health Lab, Department of Physical Medicine and Rehabilitation, Stanford University Hospitals and Clinics, Stanford, California, USA.,Department of Health and Physical Education, Mount Royal University, Calgary, Alberta, Canada
| | - Jon Park
- Department of Neurosurgery, Stanford University Hospitals and Clinics, Stanford, California, USA
| | - John K Ratliff
- Department of Neurosurgery, Stanford University Hospitals and Clinics, Stanford, California, USA
| | - Atman M Desai
- Department of Neurosurgery, Stanford University Hospitals and Clinics, Stanford, California, USA
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25
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Fors M, Enthoven P, Abbott A, Öberg B. Effects of pre-surgery physiotherapy on walking ability and lower extremity strength in patients with degenerative lumbar spine disorder: Secondary outcomes of the PREPARE randomised controlled trial. BMC Musculoskelet Disord 2019; 20:468. [PMID: 31651299 PMCID: PMC6813060 DOI: 10.1186/s12891-019-2850-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 09/23/2019] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Degenerative lumbar spine disorders are common among musculoskeletal disorders. When disabling pain and radiculopathy persists after adequate course of rehabilitation and imaging confirms compressive pathology, surgical decompression is indicated. Prehabilitation aiming to augment functional capacity pre-surgery may improve physical function and activity levels pre and post-surgery. This study aims to evaluate the effect and dose-response of pre-surgery physiotherapy on quadriceps femoris strength and walking ability in patients with degenerative lumbar spine disorders compared to waiting-list controls and their association with postoperative physical activity level. METHOD In this single blinded, 2-arm randomised controlled trial, 197 patients were consecutively recruited. Inclusion criteria were: MRI confirmed diagnosis and scheduled for surgery due to disc herniation, lumbar spinal stenosis, degenerative disc disease or spondylolisthesis, ages 25-80 years. Patients were randomised to 9 weeks of pre-surgery physiotherapy or to waiting-list. Patient reported physical activity level, walking ability according to Oswestry Disability Index item 4, walking distance according to the SWESPINE national register and physical outcome measures including the timed ten-meter walk test, maximum voluntary isometric quadriceps femoris muscle strength, patient-rated were collected at baseline and follow-up. Parametric or non-parametric within and between group comparisons as well as multivariate regression was performed. RESULTS Patients who received pre-surgery physiotherapy significantly improved in all variables from baseline to follow-up (p < 0.001 - p < 0.05) and in comparison to waiting-list controls (p < 0.001 - p < 0.028). Patients adhering to ≥12 treatment sessions significantly improved in all variables (p < 0.001 - p < 0.032) and those receiving 0-11 treatment session in only normal walking speed (p0.035) but there were no significant differences when comparing dosages. Physical outcome measures after pre-surgery physiotherapy together significantly explain 27.5% of the variation in physical activity level 1 year after surgery with pre-surgery physical activity level having a significant multivariate association. CONCLUSION Pre-surgery physiotherapy increased walking ability and lower extremity strength in patients with degenerative lumbar spine disorders compared to waiting-list controls. A clear treatment dose-response response relationship was not found. These results implicate that pre-surgery physiotherapy can influence functional capacity before surgical treatment and has moderate associations with maintained postoperative physical activity levels mostly explained by physical activity level pre-surgery. TRIAL REGISTRATION NCT02454400 . Trial registration date: August 31st 2015, retrospectively registered.
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Affiliation(s)
- Maria Fors
- Department of Medical and Health Sciences, Division of Physiotherapy, Faculty of Medicine and Health Sciences, Linköping University, SE-581 83, Linköping, Sweden. .,Department of Activity and Health, and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
| | - Paul Enthoven
- Department of Medical and Health Sciences, Division of Physiotherapy, Faculty of Medicine and Health Sciences, Linköping University, SE-581 83, Linköping, Sweden
| | - Allan Abbott
- Department of Medical and Health Sciences, Division of Physiotherapy, Faculty of Medicine and Health Sciences, Linköping University, SE-581 83, Linköping, Sweden
| | - Birgitta Öberg
- Department of Medical and Health Sciences, Division of Physiotherapy, Faculty of Medicine and Health Sciences, Linköping University, SE-581 83, Linköping, Sweden
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Objective measures of functional impairment for degenerative diseases of the lumbar spine: a systematic review of the literature. Spine J 2019; 19:1276-1293. [PMID: 30831316 DOI: 10.1016/j.spinee.2019.02.014] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Revised: 02/24/2019] [Accepted: 02/24/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND CONTEXT The accurate determination of a patient's functional status is necessary for therapeutic decision-making and to critically appraise treatment efficacy. Current subjective patient-reported outcome measure (PROM)-based assessments have limitations and can be complimented by objective measures of function. PURPOSE To systematically review the literature and provide an overview on the available objective measures of function for patients with degenerative diseases of the lumbar spine. STUDY DESIGN/SETTING Systematic review of the literature. METHODS The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. Two reviewers independently searched the PubMed, Web of Science, EMBASE, and SCOPUS databases for permutations of the words "objective," "assessment," "function," "lumbar," and "spine" including articles on human subjects with degenerative diseases of the lumbar spine that reported on objective measures of function, published until September 2018. Risk of bias was not assessed. No funding was received. The authors report no conflicts of interest. RESULTS Of 2,389 identified articles, 82 were included in the final analysis. There was a significant increase of 0.12 per year in the number of publications dealing with objective measures of function since 1989 (95% CI 0.08-0.16, p<.001). Some publications studied multiple diagnoses and objective measures. The United States was the leading nation in terms of scientific output for objective outcome measures (n=21; 25.6%), followed by Switzerland (n=17; 20.7%), Canada, Germany, and the United Kingdom (each n=6; 7.3%). Our search revealed 21 different types of objective measures, predominantly applied to patients with lumbar spinal stenosis (n=67 publications; 81.7%), chronic/unspecific low back pain (n=28; 34.2%) and lumbar disc herniation (n=22; 26.8%). The Timed-Up-and-Go test was the most frequently applied measure (n=26 publications; 31.7%; cumulative number of reported subjects: 5,181), followed by the Motorized Treadmill Test (n=25 publications; 30.5%, 1,499 subjects) and with each n=9 publications (11.0%) the Five-Repetition Sit-To-Stand test (955 subjects), as well as accelerometry analyses (336 subjects). The reliability and validity of many of the less-applied objective measures was uncertain. There was profound heterogeneity in their application and interpretation of results. CONCLUSIONS Clinical studies on patients with lumbar degenerative diseases increasingly employ objective measures of function, which offer high potential for improving the quality of outcome measurement in patient-care and research. This review provides an overview on available options. Our findings call for an agreement and standardization in terms of test selection, conduction and analysis to facilitate comparison of results across cohorts. PROSPERO REGISTRATION NUMBER CRD42019122622.
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Tomkins-Lane C, Norden J, Sinha A, Hu R, Smuck M. Digital biomarkers of spine and musculoskeletal disease from accelerometers: Defining phenotypes of free-living physical activity in knee osteoarthritis and lumbar spinal stenosis. Spine J 2019; 19:15-23. [PMID: 30025995 DOI: 10.1016/j.spinee.2018.07.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 07/03/2018] [Accepted: 07/05/2018] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Lumbar spinal stenosis (LSS) and knee osteoarthritis (OA) are 2 of the leading causes of disability worldwide. In order to provide disease-specific prescriptions for physical activity, there is a clear need to better understand physical activity in daily life (performance) in these populations. PURPOSE To discover performance phenotypes for LSS and OA by applying novel analytical methods to accelerometry data. Specific objectives include the following: (1) to identify characteristic features (phenotypes) of free-living physical activity unique to individuals with LSS and OA, and (2) to determine which features can best differentiate between these conditions. STUDY DESIGN AND SETTING Leveraging data from 3 existing cross-sectional cohorts, accelerometry signal feature characterization and selection were performed in a computational laboratory. PATIENT SAMPLE Data from a total of 4,028 individuals were analyzed from the following 3 datasets: LSS Accelerometry Database (n=75); OA Initiative (n=1950); and the 2003 to 2004 National Health and Nutrition Examination Survey (pain-free controls, n=2003). METHODS In order to characterize the accelerometry signals, data were examined using (1) standard intervals for counts/minute from Freedson et al. and (2) the physical performance intervals for mobility-limited pain populations. From this, 42 novel accelerometry features were defined and evaluated for significance in discriminating between the groups (LSS, OA, and controls) in order to then determine which sparse set of features best differentiates between the groups. These sparse sets of features defined the performance phenotypes. OUTCOME MEASURES Accelerometry features and their ability to differentiate between individuals with LSS, OA, and controls. RESULTS Given age and gender, classification rates were at least 80% accurate (pairwise) between diseased and pain-free populations (LSS vs. controls and OA vs. controls). The most important features to distinguish between disease groups corresponded to measures in the light and sedentary activity intervals. The more subtle classification between diseased populations (LSS vs. OA) was 72% accurate, with light and moderate activity providing the prominent distinguishing features. CONCLUSIONS We describe the discovery of performance phenotypes of LSS and OA from accelerometry data, revealed through a novel set of features that characterize daily patterns of movement in people with LSS and OA. These performance phenotypes provide a new method for analyzing free-living physical activity (performance) in LSS and OA, and provide the groundwork for more personalized approaches to measuring and improving function.
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Affiliation(s)
- Christy Tomkins-Lane
- Department of Health and Physical Education, Mount Royal University, 4825 Mount Royal Gate SW, Calgary, AB T3E 6K6, Canada.
| | - Justin Norden
- Stanford University School of Medicine, 291 Campus Drive, Li Ka Shing Building, Stanford, CA 94305, USA
| | - Aman Sinha
- Department of Electrical Engineering, Stanford University, 350 Serra Mall, Stanford, CA 94305, USA
| | - Richard Hu
- Department of Surgery, University of Calgary, 1403 29 St NW, Calgary, AB T2N 2T9, Canada
| | - Matthew Smuck
- Department of Orthopaedic Surgery, Stanford University, 450 Broadway, Redwood City, CA 94063, USA
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Lotzke H, Jakobsson M, Gutke A, Hagströmer M, Brisby H, Hägg O, Smeets R, Lundberg M. Patients with severe low back pain exhibit a low level of physical activity before lumbar fusion surgery: a cross-sectional study. BMC Musculoskelet Disord 2018; 19:365. [PMID: 30305065 PMCID: PMC6180521 DOI: 10.1186/s12891-018-2274-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Accepted: 09/23/2018] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND People with severe low back pain are at higher risk of poor health. Patients scheduled for lumbar fusion surgery are assumed to have low levels of physical activity, but few data exist. The aim of the study was firstly to investigate preoperative levels of objectively measured physical activity in patients with severe low back pain waiting for lumbar fusion surgery, and secondly to investigate whether factors in the fear-avoidance model were associated with these levels. METHODS We included 118 patients waiting for lumbar fusion surgery (63 women and 55 men; mean age 46 years). Physical activity expressed as steps per day and total time spent in at least moderate-intensity physical activity was assessed with ActiGraph GT3X+ accelerometers. The data were compared to the WHO recommendations on physical activity for health. Whether factors in the fear-avoidance model were associated with physical activity was evaluated by two different multiple linear regression models. RESULTS Ninety-six patients (83%) did not reach the WHO recommendations on physical activity for health, and 19 (16%) patients took fewer than 5000 steps per day, which indicates a sedentary lifestyle. On a group level, higher scores for fear of movement and disability were associated with lower numbers of steps per day. CONCLUSION A high proportion of the patients did not reach the WHO recommendations on physical activity and are therefore at risk of poor health due to insufficient physical activity. We also found a negative association between both fear of movement and disability, and the number of steps per day. Action needs to be taken to motivate patients to be more physically active before surgery, to improve health postoperatively. There is a need for interventions aimed at increasing physical activity levels and reducing barriers to physical activity in the prehabilitation phase of this patient group. TRIAL REGISTRATION Current Controlled Trials ISCRTN 17115599 , retrospectively Registered 18 may 2015.
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Affiliation(s)
- Hanna Lotzke
- Institute of the Clinical Sciences, Department of Orthopaedics at Sahlgrenska Academy, University of Gothenburg, R-huset 7th Floor, SU/Mölndal, Göteborgsvägen 31, 431 80 Mölndal, Gothenburg, Sweden. .,Spine Center Göteborg, Gruvgatan 8, 421 30, Västra Frölunda, Sweden.
| | - Max Jakobsson
- Institute of the Clinical Sciences, Department of Orthopaedics at Sahlgrenska Academy, University of Gothenburg, R-huset 7th Floor, SU/Mölndal, Göteborgsvägen 31, 431 80 Mölndal, Gothenburg, Sweden.,Division of Home Medical Care, Department for Nursing and for the Care of the Elderly, Borås Stad, Borås, Sweden
| | - Annelie Gutke
- Division of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, University of Gothenburg, Box 455, 405 30, Gothenburg, Sweden
| | - Maria Hagströmer
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Alfred Nobels Alle 23, 141 83, Huddinge, Sweden.,Functional Area Occupational Therapy and Physiotherapy, Allied Health Professionals Function, Karolinska University Hospital, Stockholm, Sweden
| | - Helena Brisby
- Institute of the Clinical Sciences, Department of Orthopaedics at Sahlgrenska Academy, University of Gothenburg, R-huset 7th Floor, SU/Mölndal, Göteborgsvägen 31, 431 80 Mölndal, Gothenburg, Sweden.,Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Olle Hägg
- Institute of the Clinical Sciences, Department of Orthopaedics at Sahlgrenska Academy, University of Gothenburg, R-huset 7th Floor, SU/Mölndal, Göteborgsvägen 31, 431 80 Mölndal, Gothenburg, Sweden.,Spine Center Göteborg, Gruvgatan 8, 421 30, Västra Frölunda, Sweden
| | - Rob Smeets
- Department of Rehabilitation Medicine, Maastricht University, PO Box 616, 6200 MD, Maastricht, The Netherlands.,CIR Revalidatie, Eindhoven, The Netherlands
| | - Mari Lundberg
- Division of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, University of Gothenburg, Box 455, 405 30, Gothenburg, Sweden.,Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Alfred Nobels Alle 23, 141 83, Huddinge, Sweden.,Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden
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29
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Elsayed G, Erwood MS, Davis MC, Dupépé EC, McClugage SG, Szerlip P, Walters BC, Hadley MN. Association between preoperative activity level and functional outcome at 12 months following surgical decompression for lumbar spinal stenosis. J Neurosurg Spine 2018; 29:388-396. [PMID: 29979140 DOI: 10.3171/2018.2.spine171028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE This study defines the association of preoperative physical activity level with functional outcomes at 3 and 12 months following surgical decompression for lumbar spinal stenosis. METHODS Data were collected as a prospective observational registry at a single institution from 2012 through 2015, and then analyzed with a retrospective cohort design. Patients who were able to participate in activities outside the home preoperatively were compared to patients who did not participate in such activities, with respect to 3-month and 12-month functional outcomes postintervention, adjusted for relevant confounders. RESULTS Ninety-nine patients were included. At baseline, sedentary/inactive patients (n = 55) reported greater back pain, lower quality of life, and higher disability than similarly treated patients who were active preoperatively. Both cohorts experienced significant improvement from baseline in back pain, leg pain, disability, and quality of life at both 3 and 12 months after lumbar decompression surgery. At 3 months postintervention, sedentary/inactive patients reported more leg pain and worse disability than patients who performed activities outside the home preoperatively. However, at 12 months postintervention, there were no statistically significant differences between the two cohorts in back pain, leg pain, quality of life, or disability. Multivariate analysis revealed that sedentary/inactive patients had improved disability and higher quality of life after surgery compared to baseline. Active patients experienced greater overall improvement in disability compared to inactive patients. CONCLUSIONS Sedentary/inactive patients have a more protracted recovery after lumbar decompression surgery for spinal stenosis, but at 12 months postintervention can expect to reach similar long-term outcomes as patients who are active/perform activities outside the home preoperatively.
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Affiliation(s)
- Galal Elsayed
- 1Department of Neurosurgery, University of Alabama at Birmingham, Alabama; and
| | - Matthew S Erwood
- 1Department of Neurosurgery, University of Alabama at Birmingham, Alabama; and
| | - Matthew C Davis
- 1Department of Neurosurgery, University of Alabama at Birmingham, Alabama; and
| | - Esther C Dupépé
- 1Department of Neurosurgery, University of Alabama at Birmingham, Alabama; and
| | - Samuel G McClugage
- 1Department of Neurosurgery, University of Alabama at Birmingham, Alabama; and
| | - Paul Szerlip
- 2Department of Computer Science, University of Central Florida, Orlando, Florida
| | - Beverly C Walters
- 1Department of Neurosurgery, University of Alabama at Birmingham, Alabama; and
| | - Mark N Hadley
- 1Department of Neurosurgery, University of Alabama at Birmingham, Alabama; and
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30
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Czabanka M, Thomé C, Ringel F, Meyer B, Eicker SO, Rohde V, Stoffel M, Vajkoczy P. [Operative treatment of degenerative diseases of the lumbar spine]. DER NERVENARZT 2018; 89:639-647. [PMID: 29679129 DOI: 10.1007/s00115-018-0523-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Degenerative diseases of the lumbar spine and associated lower back pain represent a major epidemiological and health-related economic challenge. A distinction is made between specific and unspecific lower back pain. In specific lower back pain lumbar disc herniation and spinal canal stenosis with or without associated segment instability are among the most frequent pathologies. Diverse conservative and operative strategies for treatment of these diseases are available. OBJECTIVES The aim of this article is to present an overview of current data and an evidence-based assessment of the possible forms of treatment. MATERIAL AND METHODS An extensive literature search was carried out via Medline plus an additional evaluation of the authors' personal experiences. RESULTS Conservative and surgical treatment represent efficient treatment options for degenerative diseases of the lumbar spine. Surgical treatment of lumbar disc herniation shows slight advantages compared to conservative treatment consisting of faster recovery of neurological deficits and a faster restitution of pain control. Surgical decompression is superior to conservative measures for the treatment of spinal canal stenosis and degenerative spondylolisthesis. In this scenario conservative treatment represents an important supporting measure for surgical treatment in order to improve the mobility of patients and the outcome of surgical treatment. CONCLUSION The treatment of specific lower back pain due to degenerative lumbar pathologies represents an interdisciplinary challenge, requiring both conservative and surgical treatment strategies in a synergistic treatment concept in order to achieve the best results for patients.
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Affiliation(s)
- M Czabanka
- Klinik und Poliklinik für Neurochirurgie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - C Thomé
- Universitätsklinik für Neurochirurgie, Medizinische Universität Innsbruck, Innsbruck, Österreich
| | - F Ringel
- Neurochirurgische Klinik und Poliklinik, Universitätsmedizin Mainz, Mainz, Deutschland
| | - B Meyer
- Neurochirurgische Klinik und Poliklinik, Klinikum rechts der Isar der TU München, München, Deutschland
| | - S-O Eicker
- Klinik für Neurochirurgie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - V Rohde
- Klinik für Neurochirurgie, Universitätsmedizin Göttingen, Göttingen, Deutschland
| | - M Stoffel
- Klinik für Neurochirurgie, Helios Klinikum Krefeld, Lutherplatz 40, 47805, Krefeld, Deutschland.
| | - P Vajkoczy
- Klinik und Poliklinik für Neurochirurgie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
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31
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Objective measurement of function following lumbar spinal stenosis decompression reveals improved functional capacity with stagnant real-life physical activity. Spine J 2018; 18:15-21. [PMID: 28962914 PMCID: PMC5732871 DOI: 10.1016/j.spinee.2017.08.262] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 07/31/2017] [Accepted: 08/28/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Lumbar spinal stenosis (LSS) is a prevalent and costly condition associated with significant dysfunction. Alleviation of pain and improvement of function are the primary goals of surgical intervention. Although prior studies have measured subjective improvements in function after surgery, few have examined objective markers of functional improvement. PURPOSE We aimed to objectively measure and quantify changes in physical capacity and physical performance following surgical decompression of LSS. STUDY DESIGN/SETTING Prospective cohort study. PATIENT SAMPLE Thirty-eight patients with LSS determined by the treating surgeon's clinical and imaging evaluation, and who were scheduled for surgical treatment, were consecutively recruited at two academic medical facilities, with 28 providing valid data for analysis at baseline and 6 months after surgery. OUTCOME MEASURES Before surgery and at 6 months after surgery, participants provided 7 days of real-life physical activity (performance) using ActiGraph accelerometers; completed two objective functional capacity measures, the Short Physical Performance Battery and Self-Paced Walking Test; and completed three subjective functional outcome questionnaires, Oswestry Disability Index, Spinal Stenosis Symptom Questionnaire, and Short-Form 36. METHODS Physical activity, as measured by continuous activity monitoring, was analyzed as previously described according to the 2008 American Physical Activity Guidelines. Paired t tests were performed to assess for postsurgical changes in all questionnaire outcomes and all objective functional capacity measures. Chi-square analysis was used to categorically assess whether patients were more likely to meet these physical activity recommendations after surgery. RESULTS Participants were 70.1 years old (±8.9) with 17 females (60.7%) and an average body mass index of 28.4 (±6.2). All subjective measures (Oswestry Disability Index, Spinal Stenosis Symptom Questionnaire, and Short-Form 36) improved significantly at 6 months after surgery, as did objective functional measures of capacity including balance, gait speed, and ambulation distance (Short Physical Performance Battery, Self-Paced Walking Test). However, objectively measured performance (real-life physical activity) did not change following surgery. Although fewer participants qualified as inactive (54% vs. 71%), and more (11% vs. 4%) met the physical activity guideline recommendations at the 6-month follow-up, these differences were not statistically significant (p=.22) CONCLUSIONS: This is the first study, of which we are aware, to objectively evaluate changes in postsurgical performance (real-life physical activity) in people with LSS. We found that at 6 months after surgery for LSS, participants demonstrated significant improvements in self-reported function and objectively measured physical capacity, but not physical performance as measured by continuous activity monitoring. This lack of improvement in performance, despite improvements in self-reported function and objective capacity, suggests a role for postoperative rehabilitation focused specifically on increasing performance after surgery in the LSS population.
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