Behavioural intervention increases physical activity in lumbar surgery patients

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Carol Mancuso at EUROSPINE

A psychosocial behavioural intervention administered in the spine care setting was successful in increasing physical activity after recuperation from lumbar surgery, a trial has found. Carol A Mancuso (Hospital for Special Surgery, New York, USA) presented the findings of the study at the recent EUROSPINE annual meeting (15-18 October, Helsinki, Finland).

Patients are instructed to restrict physical activity for several months after complex lumbar surgery in order to safely recuperate. However, many patients make a sedentary lifestyle permanent because of fear of spine injury, persistent pain, deconditioning and habit, Mancuso said, leading to poor long-term general health, known as sedentary death syndrome.

The objective of the randomised clinical trial was to determine if a psychosocial behavioural intervention would be effective in increasing physical activity, particularly walking, four months after lumbar surgery. 260 patients were enrolled in the trial, with 225 participating to the conclusion.

Because preoperative mobility is markedly limited by the spine disability, Mancuso told the Eurospine meeting, patients were first approached and enroled into the trial during routine three-month post-operative visits. They were randomised to the intervention or the control group and the primary outcome was assessed four months later. 114 patients were randomised to the control group and received information about safe physical activity and monthly phone calls to ensure safety. 111 patients were randomised to the intervention group and received a booklet on the benefits of physical activity and instructions on how to safely increase activity, primarily walking. They were given a pedometer and they made a self-contract to increase walking. They received weekly and then monthly phone calls, to ensure safety and encourage the contract.

The primary outcome was assessed against the Paffenbarger Physical Activity and Exercise Index (PAEI), taking into account daily distance walked, stairs climbed or any exercise completed, converted into Kcal per-week. Kcal per-week were calculated for each domain and for an overall total. Operative records were reviewed to ascertain complexity of surgery according to the Surgical Invasiveness Index (SII) which assigns points based on decompression, fusion and other surgical features

At four months after surgery, all patients then repeated the PAEI. Mancuso said that at follow-up, the results showed that the intervention patients had recorded more walking, and their change from enrolment 1,132 Kcal, was greater than the change from the controls, 582Kcals. Similarly the overall Kcals per week, 1,713 for the intervention patients, was greater than the control group’s 1,067.

The study also assessed the outcomes in terms of meeting the US recommended weekly target of ≥2,000 kCals. At enrolment there was no difference in either of the groups (37% vs. 30%), but Mancuso said that at the follow-up more of the intervention group met the target, (63% vs. 46%).

Questioned after the presentation as to whether the interventions could be introduced at an earlier stage in the treatment, potentially preoperatively, Mancuso said: “In our experience, preoperatively patients are most concerned with the risks of anasthaesia, what is going to happen to them when they leave the hospital, will there be complications from surgery. So we think three-months post operatively, when the surgery is in the rear view mirror, and when they have healed and recuperated, their surgeon thinks they are doing well, that is the teachable moment. Not preoperatively, but post-operatively when they can clearly see that the surgery is behind them and they are ready to move forward.” Maintenance of increased physical activity up to 12 months will be the next outcome to consider, Mancuso said.


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