Behavioral Intervention to Foster Healthy Lifestyle Physical Activity After Complex Lumbar Surgery: A Randomized Controlled Trial.

Abstract

BACKGROUND Persistent sedentary lifestyles are prevalent after complex lumbar surgery. Inactivity often is due to habit, is not necessary, and results in both adverse general health and adverse spine health. We tested a multicomponent behavioral intervention administered in surgical practices to increase lifestyle walking after recuperation from surgery involving ≥3 lumbar levels or fusion. This analysis reports the main objective of measuring change in physical activity; subsequent analysis will address the additional objective of measuring change in disability due to lumbar pain. METHODS At 3 months postoperatively, patients were interviewed in person, completed the self-reported Paffenbarger Physical Activity and Exercise Index measuring energy expenditure in kcal/week from walking and total activity, and were randomized to the control or a behavioral intervention. Patients in the intervention group made a contract to increase walking and received a pedometer and information about activity benefits, followed by telephone contacts over 1 year to reinforce the intervention and assess activity change. Controls received only information about activity benefits and fewer telephone contacts to assess activity change. The primary outcome was the difference in within-patient change in kcal/week from walking (as measured by the Paffenbarger Index) from enrollment to 4 months later. Additional assessments and outcomes included changes in the total Paffenbarger Index from enrollment to 4 and 12 months and changes in the walking domain to 12 months. RESULTS Among 250 patients (mean age, 63 years; 53% men; 96% White patients and 6% Latino patients), 123 received the intervention and 127 were controls. The mean energy expenditure from walking increased from enrollment to 4 months for patients in the intervention group (1,437 to 2,582 kcal/week; p < 0.0001) and for controls (1,320 to 1,870 kcal/week; p < 0.0001), with a greater difference for the intervention group (1,165 compared with 600 kcal/week; p = 0.03). At 12 months, the effectiveness of the intervention was sustained (estimated effect, 588 kcal/week [95% confidence interval (CI), 119 to 1,056 kcal/week]; p = 0.01) when accounting for new events that potentially affect activity, such as another lumbar surgery (estimate, -1,396 kcal/week [95% CI, -2,116 to -676 kcal/week]; p = 0.0002) and new arthroplasty or foot or ankle surgery (estimate, -701 kcal/week [95% CI, -1,212 to -189 kcal/week]; p = 0.007). Similar results were obtained for changes in total activity. Retention in this study was 92%; 72% of all patients reported that being in the study did not affect spine symptoms, and 28% reported that being in the study made symptoms better. No adverse events were associated with the trial. CONCLUSIONS A behavioral intervention was effective in increasing lifestyle walking after recuperation from complex lumbar surgery. These findings support integrating counseling about physical activity into routine postoperative care in surgical practices. LEVEL OF EVIDENCE Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.