Limaprost or Pregabalin: Preoperative and Postoperative Medication for Pain due to Lumbar Spinal Stenosis

Sex Differences in the Mediating Effect of Kinesiophobia on Chronic Pain, Dysesthesia, and Health-Related Quality of Life in Japanese Individuals Aged 65 Years Old and Older Treated with Surgery for Lumbar Spinal Stenosis

Purpose

This study aimed to determine whether kinesiophobia mediates the relationship between low back pain (LBP), leg pain (LP), and leg dysesthesia (LD) and health-related quality of life (HRQOL) among Japanese individuals aged 65 years old and older treated with surgery for lumbar spinal stenosis (LSS).

Patients and Methods

Data collection for this study took place between October 2019 and August 2020 at two Japanese medical facilities. Eligibility criteria for participants in this study were individuals aged 65 years or older and those who had undergone surgery for LSS at least more than one year ago. A self-administered questionnaire assessed the intensity of LBP, LP, and LD (numerical rating scale: NRS), HRQOL (EuroQol-5 Dimension-5 Levels: EQ-5D-5L), and kinesiophobia (Tampa Scale for Kinesiophobia-17 items: TSK-17). Mediation analysis using sex as a control variable was conducted.

Results

Complete responses were obtained from 238 of 431 individuals (73.1 ± 5.1 years; 135 males and 103 females). The mediating effect of NRS scores for LBP, LP, and LD to EQ-5D-5L index on TSK-17 score was significant, respectively (LBP: -0.007 [95% confidence interval -0.012, -0.004], p = 0.000; LP and LD: -0.007 [-0.011, -0.004], p = 0.000). The strength of the association between NRS scores and EQ-5D-5L index decreased when the mediating effect of TSK-17 score (LBP: β = -0.698 [-0.792, -0.603], p = 0.000 to β = -0.616 [-0.707, -0.524], p = 0.000; LP: β = -0.629 [-0.729, -0.529], p = 0.000 to β = -0.539 [-0.638, -0.440], p = 0.000; LD: β = -0.568 [-0.675, -0.460], p = 0.000 to β = -0.482 [-0.586, -0.378], p = 0.000). The mediating effect of TSK score was greater in females than males.

Conclusion

Kinophobia partially mediated the relationship between LBP, LP and LD, and HRQOL in Japanese aged 65 years and older after lumbar surgery. The mediating effect differed by sex.

New Factor Structure of the Tampa Scale for Kinesiophobia in Older Japanese Adults After Lumbar Surgery

Purpose

The Tampa Scale for Kinesiophobia (TSK) has been used worldwide as a measure of kinesiophobia, but its factor structure in older Japanese adults after lumbar surgery is unknown. The purpose of this study was to fill this research gap by identifying the factors that comprise TSK in older Japanese adults after lumbar surgery.

Patients and Methods

Participants were older Japanese adults who had undergone surgery for lumbar spinal stenosis. Clinicodemographic data, TSK, intensity of low back pain and leg pain, dysesthesia (using an 11-point numerical rating scale), and HRQOL (using the EQ-5D-5L) were collected. After supplementing the missing values by the multiple assignment method, the hypothetical model of TSK was developed by categorical exploratory factor analysis (weighted least squares method, promax rotation). Confirmatory factor analysis (WLSMV method, promax rotation) was used to compare the hypothetical model and the traditional one-factor and two-factor models. Furthermore, we confirmed the relationship between factors extracted from the hypothetical model and HRQOL, pain, and dysesthesia.

Results

Questionnaires were mailed to 302 individuals, and responses were obtained from 211 (72.4±4.2 years [range: 65–88]; 115 men and 96 women; 804±343.1 [380–1531] days after surgery; 137 who had undergone decompression and fixation surgery, 74 who had undergone decompression surgery) (response rate: 69.9%). The hypothesized model consisted of “somatic focus,” “activity avoidance,” and “efficacy of physical activities,” all of which were highly consistent. The fit of the hypothetical model was slightly inferior to that of the traditional two-factor model, but the hypothetical model met the criteria for fit. Somatic focus in the hypothetical model was significantly associated with HRQOL, pain, and dysesthesia.

Conclusion

In older Japanese adults after lumbar surgery, the goodness of fit of the TSK model was maintained by adding efficacy of physical activities as a third factor to the traditional two factors.

Patterns of physical activity and exercise after lumbar surgery among Japanese patients with lumbar spinal stenosis

[Purpose] The purpose of this study was to assess the feasibility of classifying the patterns of physical activity and exercise after surgery for lumbar spinal stenosis in Japanese patients and describe the characteristics of the patient groups. [Participants and Methods] We evaluated Japanese patients diagnosed as having lumbar spinal stenosis and underwent surgery. The frequencies of the 15 types of physical activity and exercise recommended in Kenko Nippon 21 (Japanese policy for health promotion) were investigated by mail. The study included 102 respondents (median age, 69 years [range, 34–88 years]; 55 males and 47 females). A hierarchical cluster analysis was used for grouping according to the physical activity and exercise patterns. The Holm method and residual analysis were used for comparisons of the frequencies of the physical activity and exercise patterns and basic demographics among the groups. [Results] Three clusters, namely clusters A (younger), B (frail older), and C (active older), were identified from the dendrogram. The participants in cluster A frequently performed paid work. In cluster B, the frequencies of all the physical activity and exercise patterns were low. The older people in cluster C regularly performed stretching/light-intensity exercises, walking, muscle-strengthening exercises, and house and garden maintenance tasks. [Conclusion] We found that the physical activity and exercise after lumbar surgery in Japanese patients could be divided into three patterns.