LAUSR

OBJECTIVE To investigate whether early postoperative walking is associated with "best outcome" and no opioid use at 1-year after lumbar spine surgery and establish a threshold for steps/day to inform clinical practice. DESIGN Secondary analysis from randomized controlled trial. SETTING Two academic medical centers in the United States. PARTICIPANTS We enrolled 248 participants undergoing surgery for a degenerative lumbar spine condition. INTERVENTION N/A MAIN OUTCOME MEASURES: Disability (Oswestry Disability Index: ODI), back and leg pain (Brief Pain Inventory) and opioid use (yes vs. no) were assessed at baseline and 1-year after surgery. "Best outcome" was defined as ODI ≤ 20, back pain ≤ 2 and leg pain ≤ 2. Steps/day (walking) was assessed with an accelerometer (Actigraph GT3X) worn for at least 3 days and 10 hours/day at 6 weeks after spine surgery, which was considered as study baseline. Separate multivariable logistic regression analyses were conducted to determine the association between steps/day at 6 weeks and "best outcome" and no opioid use at 1-year. Receiver operating characteristic curves identified a steps/day threshold for achieving outcomes. RESULTS Two-hundred and twelve participants (mean ± SD; age= 62.8 ± 11.4 years, 53.3% female) had valid walking data at baseline. Each additional 1000 steps/day at 6-week after spine surgery was associated with 41% higher odds of achieving "best outcome" (95% CI=1.15, 1.74) and 38% higher odds of no opioid use (95% CI=1.09, 1.76) at 1-year. Walking ≥3500 steps/day was associated with 3.75 times the odds (95% CI=1.56, 9.02) of achieving "best outcome" and 2.37 times the odds (95% CI=1.07, 5.24) of not using opioids. CONCLUSIONS Walking early after surgery may optimize patient-reported outcomes after lumbar spine surgery. A 3500 steps/day threshold may serve as an initial recommendation during early postoperative counseling.