Physical Inactivity Before Surgery for Lumbar Spinal Stenosis Is Associated With Inferior Outcomes at 1- Year Follow- Up : A Cohort Study

Background: Lumbar spinal stenosis (LSS) is a common disorder in older people. Inactivity secondary to the disease state can further increase LSS symptoms. Initial care includes physiotherapy to relieve symptoms and optimize patient function and quality of life. It is currently unclear whether inactivity before surgery for LSS is associated with postoperative outcomes. Our aim was to investigate associations between self-reported exercise before LSS surgery and self-reported outcomes at 1 -year follow-up. Methods: Using a retrospective cohort study design, prospective data were collected from the National Swedish Register for Spine Surgery (Swespine) between September 2006 and December 2012: 11,956 patients diagnosed with LSS completed the 1 -year follow -up. The primary outcome measure was the Oswestry Disability Index (ODI). Secondary outcome measures were back and leg pain reported on a visual analog scale (VAS). The independent variable was dichotomized into no regular exercise (NRE) and regular exercise (RE). Adjusted analysis of covariance models were used to analyze differences in outcome improvement between the NRE and RE groups. Results: The mean improvement in the ODI was 15.9 (95% CI, 15.5-16.3) in the NRE group and 19.2 (95% CI, 18.5- 19.8) in the RE group (P < 0.001). Improvement in back pain (P < 0.001) and leg pain (P < 0.001) were also inferior in the NRE group compared to the RE group. The NRE group improved 21.8 (95% CI, 21.2-22.5) units in back pain and 28.8 (95% CI, 28.1-29.5) in leg pain on the VAS compared to 25.2 (95% CI, 24.2-26.3) units in back pain and 32.5 (95% CI, 31.3-33.6) in leg pain in the RE group. Conclusions: Inactivity defined as self-reported NRE before surgery for LSS is associated with worse outcomes 1 -year postsurgery compared to patients reporting RE. Clinical Relevance: This study is relevant to currently practicing spinal surgeons and spine physiotherapists. Level of Evidence: 3