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There is a critical need to target physical activity during postoperative management to optimize long-term recovery after lumbar spine surgery. The overall objective of this study is to conduct a two-group randomized control trial (RCT) to examine the feasibility and acceptability of a physical activity telehealth intervention delivered by a physical therapist for improving disability, physical function, pain, and physical activity compared to usual care after spine surgery for a degenerative lumbar condition. The physical activity intervention will include wearable technology and remote physical therapist support to counsel patients on a realistic progression of physical activity (steps per day). The central hypothesis is that this 8-week physical activity intervention performed at two weeks after surgery will be feasible and acceptable. The results of our randomized trial will be used to support a large multi-site clinical trial to test the effectiveness and implementation of this intervention
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Usual postoperative care | Other | Participants randomized to usual care group will receive postoperative care as determined by their treating surgeon. |
|
| Usual postoperative care + Physical activity intervention | Experimental | Participants randomized to the physical activity intervention group will receive usual postoperative care as determined by their treating surgeon and novel physical activity intervention. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Physical activity intervention | Behavioral | Participants will 1) receive Fitbit, 2) be enrolled in a secure electronic platform to access Fitbit data, 3) receive 8-week remote counseling by a physical therapist that will include motivational interviewing and creating SMART goals (1 session per week) through a web-based teleconference platform, and 4) receive usual postoperative care directed by their surgeon. The first session will be 45 minutes and sessions 2-8 will be 30 minutes each. During the sessions, participant's confidence in meeting daily step goals will be assessed using a 0-10 scale. If self-reported confidence to meet their goal is <8, the physical therapist will help participants modify their goal using techniques such as problem-solving, positive statements and affirmations. Progression will be made only if daily steps goals are met for at least 4 out of 7 days a week. If this weekly step goal is not met, a physical therapist will help the participant identify solutions for realistic progression. |
| Measure | Description | Time Frame |
|---|---|---|
| Recruitment rate | Proportion of potential eligible participants successfully contacted who agreed to participate and randomized. | At 2 weeks after spine surgery |
| Adherence rate to study protocol at 3 months after spine surgery | Proportion of participants who will complete the assessment at 2 weeks and 3 months after spine surgery. | From 2 weeks to 3-months after spine surgery |
| Adherence rate to study protocol at 6 months after spine surgery | Proportion of participants who will complete the assessment at 2 weeks and 6 months after spine surgery. | From 2 weeks to 6-months after spine surgery |
| Adherence to physical activity intervention | Number of weekly step goals completed by participant, which will be examined via Fitabase. In addition, number of weekly Zoom calls completed with the physical therapist will be recorded | From 2-weeks to 3-months after spine surgery |
| Number of adverse events | During the intervention phase, the study physical therapist will document adverse events related to walking to assess safety. | From 2-weeks to 3-months after spine surgery |
| Measure | Description | Time Frame |
|---|---|---|
| Oswestry Disability Index | A 10-item questionnaire will be used to measure condition-specific disability that assesses the impact of lumbar spinal disorders on activities of daily living. Each item is measured from 0 to 5, representing low and high disability, respectively. Total score ranges from 0 to 50. | Preoperative, and at 2 weeks (baseline), 3-, and 6-months after spine surgery |
| Measure | Description | Time Frame |
|---|---|---|
| Opioid Use | A single-item Patient-reported opioid use questionnaire (yes vs. no). | Preoperative, and at 2 weeks (baseline), 3-, and 6-months after spine surgery |
Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Kristin R Archer, DPT, PhD | Vanderbilt University Medical Center | Study Director |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Vanderbilt University Medical Center | Nashville | Tennessee | 37212 | United States |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 37478463 | Derived | Master H, Coronado RA, Whitaker S, Block S, Vanston SW, Pennings JS, Gupta R, Robinette P, Stephens B, Abtahi A, Schwarz J, Archer KR. Combining Wearable Technology and Telehealth Counseling for Rehabilitation After Lumbar Spine Surgery: Feasibility and Acceptability of a Physical Activity Intervention. Phys Ther. 2024 Feb 1;104(2):pzad096. doi: 10.1093/ptj/pzad096. |
| Label | URL |
|---|---|
| Website that provides brief description of the PASS trial | View source |
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Given the pilot nature of the trial, the IPD will not be available to other researchers.
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| ID | Term |
|---|---|
| D013130 | Spinal Stenosis |
| D055009 | Spondylosis |
| D009043 | Motor Activity |
| D010146 | Pain |
| ID | Term |
|---|---|
| D013122 | Spinal Diseases |
| D001847 | Bone Diseases |
| D009140 | Musculoskeletal Diseases |
| D001519 | Behavior |
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Two-group, single-center randomized, controlled study in 30 patients undergoing spine surgery for a lumbar degenerative condition to examine the feasibility and acceptability of an 8-week remote physical activity intervention.
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| Usual care | Other | Participants will receive postoperative care as determined by their treating surgeon. This includes lifting restrictions, advice to stay active, and oral analgesics as needed. Physical therapy referral will be at the discretion of the surgeon. However, physical therapy is not typically started until 12 weeks after surgery. |
|
| PROMIS Physical Function | PROMIS Physical Function 4-item short form will be used to measure physical function. Each item is measured from 1 to 5, representing low to high physical function, respectively. Total score ranges from 4 to 20. | Preoperative, and at 2 weeks (baseline), 3-, and 6-months after spine surgery |
| Numeric rating scale for back pain | Numeric rating scale will be used to assess the pain intensity using the single-item for back, which is scored from 0 to 10, representing no pain and the worst pain, respectively. | Preoperative, and at 2 weeks (baseline), 3-, and 6-months after spine surgery |
| Numeric rating scale for leg pain | Numeric rating scale will be used to assess the pain intensity using the single-item for leg, which is scored from 0 to 10, representing no pain and the worst pain, respectively. | Preoperative, and at 2 weeks (baseline), 3-, and 6-months after spine surgery |
| Intensity of physical activity | A research-grade triaxial accelerometer (Actigraph GT3x) will be used to quantify time spent in different intensities of physical activity per day. | Preoperative, and at 2 weeks (baseline), 3-, and 6-months after spine surgery |
| Physical activity volume | A research-grade triaxial accelerometer (Actigraph GT3x) will be used to quantify total number of steps per day. | Preoperative, and at 2 weeks (baseline), 3-, and 6-months after spine surgery |
| Depressive symptoms | PROMIS Depression 4 item short form will be used to measure depressive symtpoms. Each item is measured from 1 to 5, representing low to high depressive symptoms. Total score ranges from 4 to 20. | Preoperative, and at 2 weeks (baseline), 3-, and 6-months after spine surgery |
| Fear of movement | A 13-item Tampa Scale for Kinesiophobia will be used to measure fear of movement. It has two sub-scales (activity avoidance and fear of pain) and the total score ranges from 13 to 52 with higher scores indicating greater fear of movement. | Preoperative, and at 2 weeks (baseline), 3-, and 6-months after spine surgery |
| D009461 |
| Neurologic Manifestations |
| D012816 | Signs and Symptoms |
| D013568 | Pathological Conditions, Signs and Symptoms |