Validation of a Model Predicting That Physical Activities Improve Health-Related Quality of Life in Older Japanese Adults with Pain, Dysesthesia, and Kinesiophobia after Lumbar Surgery: Structural Equation Modeling

Abstract

Objectives. This study assessed the validity of a hypothesized model predicting that physical activity improves health-related quality of life (HRQOL) in older Japanese adults with pain, dysesthesia, and kinesiophobia following lumbar surgery. Methods. We included 431 elderly patients who underwent surgery for lumbar spinal stenosis at two hospitals. The frequency of physical activity, pain, dysesthesia, kinesiophobia (somatic focus and activity avoidance), and HRQOL were investigated using a questionnaire. Missing values were complemented by the stochastic regression imputation. We constructed the following model. (i) physical activity affects pain, dysesthesia, and kinesiophobia. (ii) pain, dysesthesia, and kinesiophobia separately affect HRQOL. This hypothetical model was tested by structural equation modeling. The model was improved based on a modified index. Results. Of the 431 respondents, 297 (median age 72 years, range 65–91 years; 158 men and 139 women) were analyzed (68.9%). The fit of the model improved based on the modification index and was acceptable comparative fit index, 0.948; Tucker–Lewis index, 0.919; root mean square error of approximation, 0.048 (90% confidence interval, 0.026–0.069), and standardized root mean square residual (0.046). The paths by which physical activities reduced pain or dysesthesia (standardized pass coefficients, −0.406) and somatic focus (−0.301) and consequently improved HRQOL were significant (pain/dysesthesia, −0.684; somatic focus, −0.218). Discussion. Our hypothesized model predicting that physical activity improves HRQOL in terms of pain, dysesthesia, and kinesiophobia in older Japanese adults after lumbar surgery was validated using cross-sectional data. Interventional studies on physical activity based on this model are required to establish the model.

Health-Related Quality of Life is Associated With Pain, Kinesiophobia, and Physical Activity in Individuals Who Underwent Cervical Spine Surgery

“…Respondents were asked how frequently they performed each of the five modalities of physical activity (paid work, light exercise, walking, strength training, and gardening) investigated by Higuchi et al [ 22 ] in developing their model of HRQOL and physical activity in patients after lumbar spine surgery during the past month. We used a 5-point scale as follows: one point, “not at all;” two points, “irregularly;” three points, “once or twice a week;” four points, “three or four times a week;” and five points, “five or more times a week.”…”

Impact of Postoperative Bracing Following Spinal Fusion for Degenerative Lumbar Conditions: An Updated Meta-Analysis of Randomized Controlled Trials

“…Emerging evidence underscores the importance of avoiding excessive activity restriction after lumbar spine surgery, as it has been associated with adverse outcomes such as a diminished quality of life, prolonged hospitalization, and heightened rates of rehospitalization. 18,19 Hence, it is imperative to consider patient education and early mobilization as pivotal components of postoperative rehabilitation following lumbar fusion procedures to avert the aggravation of distressing pain. 20 These findings suggest that postoperative bracing may offer certain advantages in terms of early pain management and functional recovery, which is consistent with conventional wisdom suggesting that bracing may help stabilize the surgical area and provide comfort to patients during the early postoperative phase.…”