Muscle Specific Strengthening Exercise Following Lumbar Microdiscectomy MUSSEL Kornelia Kulig, PhD, PT John M. Popovich, Jr., DPT, ATC Carolyn Ervin, PhD Stan Azen, PhD
Muscle Specific Strengthening Exercise Following Lumbar Microdiscectomy (MUSSEL) • Physical Therapy Clinical Research Network (PTClinResNet – PIs: Drs. Winstein/Gordon) • Randomized Clinical Trial, Multi-site: 17 clinics in the Greater Los Angeles Area • PIs: Drs. Kulig and Powers • Project Coordinator: Kimiko Yamada, BS, ATC, soon to be DPT • Specific Aim:To determine the effectiveness of a strength and endurance training program on recovery after spinal surgery.
MUSSEL Quality of Life and Patient Perspectives
Superior Tissue to be Removed Ligamentum Flavum Intervertebral Disc Inferior Microdiscectomy --- Common Surgery for Low Back Pain with Radicular Pain
Purpose • Identify impact of post-surgical Low Back Pain on Activity, Disability and Participation • Identify contributors to Subjective Quality of Life
ICF Conceptual Framework: MUSSEL outcome measures Health Condition (Low Back Dysfunction) Body functions & structures (impairments) Activity Participation Pain after 10-min of sitting Pain after 5-min of walking Sorensen Endurance Test 24-hour activity 5-min walk 50-ft walk Repeated Sit-to-Stand SF-36 physical SF-36 mental Oswestry Disability Index Roland-Morris Disability FABQ Activity Subscale FABQ Work Subscale Overall well-being Subjective Quality of Life
Body functions & structures(impairments) • Pain (mm), assessed immediately after • sitting for 10 minutes • walking for 5 minutes NO PAIN WORST PAIN POSSIBLE Back Extensors’ Endurance Test, (Nms)
Body functions & structures(impairments) • Back Extensors’ Endurance Test, (Nms) • recommended as an rehabilitation outcome measure (Ropponen et al., Physical Therapy, 2004) • Hypothesized to be “safer” for post-surgical cases • was a component of the chosen intervention in this study
x 8 0 0 A x 6 3 0 x C 0 0 0 I Activity • Level of Activity “How physically active are you on an average weekday?” Aadahl M, and Jorgensen T MSSE, 2003 Low Activity High Activity
Activity • Level of Activity during a 24-hour period (METs) • Aadahl M, and Jorgensen T MSSE, 2003 • 5-minute walk, self selected pace (feet) • 50-ft walk, as fast as tolerated (seconds) • RepeatedSit-To-Stand(x5),as fast as tolerated (seconds)
Participation • Quality of Life; SF-36 v. 2
Other … • Disability; Oswestry Disability Index and Roland-Morris • Fear Avoidance Beliefs Questionnaire
Purpose • Identify impact of post-surgical Low Back Pain on Activity and Participation 73 of 98 (74.5%) persons with a recent history of lumbar surgery (4-6 weeks) reported pain after walking for 5 minutes
Demographics of Participants who had Low Back Pain and who are included in this analysis (N = 73)
Univariate Correlations – Low Back Pain* and Activity Variables *after 5-minute Walk
Low Back Pain* Intensity vs. Physical Activity (5-Minute Walk) r = - 0.385, p < 0.001 *after 5-minute Walk
Low Back Pain* Intensity vs. Physical Activity (50-Foot Walk) r = 0.550, p < 0.001 *after 5-minute Walk
Univariate Correlations – Low Back Pain* and Participation Variables *after 5-minute Walk
Univariate Correlations – Low Back Pain* and Participation Variables *after 5-minute Walk
Low Back Pain* Intensity vs. Participation (SF-36 Physical) r = -0.465, p < 0.001 *after 5-minute Walk
Univariate Correlations – Low Back Pain* and Others *after 5-minute Walk
Low Back Pain* Intensity vs. Disability (Roland-Morris Disability) r = 0.663, p < 0.001 *after 5-minute Walk
Low Back Pain* Intensity vs. Disability (Oswestry Disability Index) r = 0.594, p < 0.001 *after 5-minute Walk
Low Back Pain* Intensity vs. Disability (FABQ Work) r = 0.486, p < 0.001 *after 5-minute Walk
Purpose • Identify impact of post-surgical Low Back Pain on Activity, Disability and Participation • Identify contributors to Subjective Quality of Life
Very Distressing So-So Great! 1 2 3 4 5 6 7 Subjective Quality of Life Taking everything in your life into account, please rate your current overall quality of life by placing X on this 7-point scale The instructions further state: 1 - “Means life is very distressing; it’s hard to imagine how it could get much worse. 4 - “Means life is neither good nor bad”. 7 - “Means life is great; it’s really hard to imagine how it could get much better.”
Predictors of Subjective Quality of Life VARIABLES IN STEPWISE REGRESSION: Pain after 10-min of sitting, Pain after 5-min of walking, Sorensen Endurance Test, 24-hour activity, 5-min walk, 50-ft walk, Repeated Sit-to-Stand, SF-36 physical, SF-36 mental, Roland-Morris Disability, FABQ Activity Subscale, FABQ Work Subscale SUMMARY of Stepwise Selection
ICF Conceptual Framework: Explanatory variables for SQOL R2 = 0.493 p < 0.001 Health Condition (Low Back Dysfunction) Body functions & structures (impairments) Activity Participation Pain after 10-min of sitting Pain after 5-min of walking Sorensen Endurance Test 24-hour activity 5-min walk 50-ft walk Repeated Sit-to-Stand SF-36 physical SF-36 mental Roland-Morris Disability FABQ Activity Subscale FABQ Work Subscale Subjective Quality of Life
SUMMARY Persons with a recent history of Lumbar Surgery who are still experiencing Low Back Pain Exhibit limitations in Activity and Participation
SUMMARY Common measures of Impairments, Activity and Participation partially explain the persons Quality of Life
