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Qualitative assessment of patients’ perspectives and willingness to improve healthy lifestyle physical activity after lumbar surgery

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Abstract

Purpose

Many patients retain sedentary lifestyles after lumbar surgery and incur increased risks of adverse health outcomes. The goal of this study was to assess patients’ perspectives about postoperative physical activity.

Methods

During routine post-lumbar surgery visits in a tertiary care center, 260 patients were asked open-ended questions about their spine and physical activity. Three investigators reviewed responses and determined themed categories. Patients also completed surveys measuring disability, depressive symptoms, anxiety, and fear-avoidance of physical activity. Surgical complexity was assigned based on operative features.

Results

Mean age was 63, and 53% were men. Thirty-nine percent thought walking was good for the spine, particularly among those with less fear-avoidance, less disability, and less complex surgery. Spine benefits were cited (42%) for the short-term (“faster recovery”) and long-term (“decreases chances of another surgery”), particularly by younger patients. To increase activity, patients suggested spine-specific techniques (35%, “use railings”) and advised caution (24%, “pace yourself”). The major deterrent was persistent back pain (36%) particularly for those with worse disability, and more depressive symptoms, anxiety, complex surgery, and fear-avoidance. Our findings consistently fit with the Social Cognitive Theory of health behavior which posits a dynamic three-way interaction of personal factors, environmental influences, and behavior.

Conclusions

Patients acknowledge short- and long-term benefits of physical activity for their spine and overall health; however, many are deterred from increasing activity by spine-related concerns. Interventions to improve physical activity should foster self-efficacy and self-direction and should be reinforced by members of the spine care team who are knowledgeable about prudent activities.

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Funding

This research was not supported by external sources.

Author information

Authors and Affiliations

  1. Research Division, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA

    Carol A. Mancuso

  2. Department of Medicine, Weill Cornell Medical College, New York, NY, USA

    Carol A. Mancuso

  3. Rory Meyers College of Nursing, New York University, New York, NY, USA

    Manuela C. Rigaud

  4. Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA

    Bay Wellington, Roland Duculan, Frank P. Cammisa, Andrew A. Sama, Alexander P. Hughes & Federico P. Girardi

Authors
  1. Carol A. Mancuso
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  2. Manuela C. Rigaud
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  3. Bay Wellington
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  4. Roland Duculan
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  5. Frank P. Cammisa
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  6. Andrew A. Sama
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  7. Alexander P. Hughes
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  8. Federico P. Girardi
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Corresponding author

Correspondence to Carol A. Mancuso.

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Conflict of interest

None of the authors has a conflict related to this work.

Ethical approval

The study was approved by the Institutional Review Board at Hospital for Special Surgery.

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All patients provided written informed consent.

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Mancuso, C.A., Rigaud, M.C., Wellington, B. et al. Qualitative assessment of patients’ perspectives and willingness to improve healthy lifestyle physical activity after lumbar surgery. Eur Spine J 30, 200–207 (2021). https://doi.org/10.1007/s00586-020-06508-2

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  • DOI: https://doi.org/10.1007/s00586-020-06508-2

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