Prediction of objective and subjective outcome measures two years after lumbar fusion surgery — The International Society for the Study of the Lumbar Spine
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Prediction of objective and subjective outcome measures two years after lumbar fusion surgery (#1088)

Christian Ernest 1 , Max Jakobsson 2 3 , Hanna Lotzke 4 , Mari Lundberg 5 6
  1. Physiotherapy Department, GHP Spine Center i Göteborg, Västra Frölunda, Sweden
  2. Division of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
  3. Department of Physical Therapy and Occupational Therapy, Sahlgrenska University Hospital, Gothenburg, Seden
  4. Department of Rehabilitation, Ängelholm Hospital, Ängelholm, Sweden
  5. Department of Health Promoting Science, Sophiahemmet University, Stockholm, Sweden
  6. University of Gothenburg Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden

Introduction

The outcome of lumbar fusion surgery is traditionally measured with patient-reported outcome measures (PROMs) However, recent research indicates that PROMs are not sufficient to cover the outcome, and physical capacity tasks, e.g. timed up-and-go (TUG), have therefore been recommended. The aim was to investigate which factors that can predict the postoperative change of ODI and four physical capacity tasks in patients with chronic low back pain (LBP) and degenerative disc disease (DDD) two years after lumbar fusion surgery.

 

Method

A cohort of 118 patients with chronic LBP and DDD scheduled for lumbar fusion surgery were included. Dependent variables were the change from baseline to two years postoperatively of Oswestry Disability Index (ODI) and the physical capacity tasks TUG, five-minute walk, 15-meter fast walk, and one-minute stair climbing. Preoperative predictors were age, sex, income, body mass index, sick leave before surgery, smoking, duration of LBP, pain intensity in back and leg/legs (Visual Analog Scale), pain-related catastrophizing thoughts (Pain Catastrophizing Scale), fear of movement (Tampa Scale of Kinesiophobia), beliefs of self-efficacy (Self-Efficacy for Exercise Scale, SEESV), depressive symptoms (Hospital Anxiety and Depression Scale) and the preoperative results of ODI and the four physical capacity tasks. Stepwise multiple linear regression analysis was performed in separate models for each dependent variable.

 

Results

Baseline ODI and baseline TUG significantly predicted the change of ODI (R2 = 0.333), meaning that a preoperatively higher score on ODI and longer time on TUG predicted a larger improvement two years postoperatively. In all four physical capacity tasks, the postoperative change from baseline was predicted by the baseline measure of the same physical capacity task (R2 = 0.368–0.870), meaning that a worse performance preoperatively predicted a larger improvement postoperatively. A larger improvement in TUG and 15-meter fast walk was also predicted by a higher degree of self-efficacy. Finally, a larger improvement in 5-minute walk was predicted by more intense back pain at baseline.

 

Discussion

To our knowledge, this is the first time a physical capacity task has been shown to predict postoperative change in disability measured with ODI. The findings suggest that patients with worse preoperative results of ODI and physical capacity tasks have more to gain from lumbar fusion surgery than patients with a lower degree of disability and greater physical capacity. This could be an important aspect to consider in the patient selection for lumbar fusion surgery. Moreover, a low self-efficacy predicted smaller improvements in TUG and 15-meter fast walk, but if increasing patients´ self-efficacy before surgery leads to a better postoperative outcome is beyond the scope of this study. The fact that ODI and the physical capacity tasks were predicted by different variables could indicate that the measurements represent somewhat different constructs. Thus, using both objective and subjective outcome measures might be important when evaluating the outcome of lumbar fusion surgery to get a broader perspective of the patient’s status.

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