MINI: This study examined the association between physical performance and patient-reported outcomes at 12-months after lumbar spine surgery. Physical performance tests provided distinct information in both predicting and assessing outcomes in patients undergoing lumbar spine surgery. The 5-Chair Stand test may be a valuable addition to a comprehensive preoperative risk assessment.

Study design:

Secondary analysis of randomized controlled trial data.

Objective:

To examine whether preoperative physical performance is an independent predictor of patient-reported disability and pain at 12-months after lumbar spine surgery.

Summary of background data:

Patient-reported outcome measures (PROMs) are commonly used to assess clinical improvement after lumbar spine surgery. However, there is evidence in the orthopedic literature to suggest that PROMs should be supplemented with physical performance tests to accurately evaluate long-term outcomes.

Methods:

248 patients undergoing surgery for degenerative lumbar spine conditions were recruited from two institutions. Physical performance tests (5-Chair Stand and Timed Up and Go) and PROMs of disability (Oswestry Disability Index: ODI) and back and leg pain (Brief Pain Inventory) were assessed preoperatively and at 12-months after surgery.

Results:

Physical performance tests and PROMs significantly improved over 12-months following lumbar spine surgery (p < 0.01). Weak correlations were found between physical performance tests and disability and pain (ρ=0.15 to 0.32, p < 0.05). Multivariable regression analyses controlling for age, education, preoperative outcome score, fusion, prior spine surgery, depressive symptoms and randomization group found that preoperative 5-Chair Stand test was significantly associated with disability and back pain at 12-month follow-up. Each additional 10 seconds needed to complete the 5-Chair Stand test was associated with 6-point increase in ODI (p = 0.047) and 1-point increase in back pain (p = 0.028) scores. The physical performance tests identified an additional 14% to 19% of patients as achieving clinical improvement that were not captured by disability or pain questionnaires.

Conclusions:

Results indicate that physical performance tests may provide distinct information in both predicting and assessing clinical outcomes in patients undergoing lumbar spine surgery. Our findings suggest that the 5-Chair Stand test may be a useful test to include within a comprehensive risk assessment before surgery and as an outcome measure at long-term follow-up.

Level of evidence:

3.