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.

中文翻译：

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对患者的观点和腰椎手术后改善健康生活方式的积极性的定性评估。

目的

许多患者在腰部手术后仍保持久坐的生活方式，并增加了不利健康后果的风险。这项研究的目的是评估患者对术后身体活动的看法。

方法

在三级护理中心进行例行腰椎手术后的常规访问期间，向260名患者询问了有关其脊椎和身体活动的开放性问题。三名调查员审查了答复并确定了主题类别。患者还完成了测量，以测量残疾，抑郁症状，焦虑和避免运动的恐惧感。根据手术特点分配手术复杂性。

结果

平均年龄为63岁，男性为53％。39％的人认为步行对脊椎有好处，特别是在那些避免恐惧，残疾和手术复杂程度较低的人中。短期（“更快恢复”）和长期（“减少再次手术的机会”），尤其是年轻患者的脊柱获益（42％）。为了增加活动量，患者建议使用脊柱特有的技术（35％，“使用栏杆”）并建议谨慎（24％，“使自己步调”）。主要的威慑因素是持续的背痛（36％），特别是对于那些残疾程度更高，抑郁症状，焦虑症，复杂的手术和避免恐惧的人。我们的发现与健康行为的社会认知理论一致，该理论提出了个人因素，环境影响和行为的动态三向相互作用。

结论

患者承认体育锻炼对脊柱和整体健康的短期和长期益处；但是，由于脊柱相关的担忧，许多人无法增加活动量。改善体育锻炼的干预措施应能提高自我效能感和自我指导能力，并应由精通脊椎护理团队的成员加强，他们对审慎的活动有所了解。