Carol A. Mancuso, Manuela C. Rigaud, Bay Wellington, Roland Duculan, Frank P. Cammisa, Andrew A. Sama, Alexander P. Hughes, Federico P. Girardi

January 2021, Volume 30, Issue 1, pp 200 - 207 Original Article Read Full Article 10.1007/s00586-020-06508-2

First Online: 19 June 2020

Qualitative assessment of patients' perspectives and willingness to improve healthy lifestyle physical activity after lumbar surgery


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.


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.


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.


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.

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