284. Activity Goals of Patients Considering Spine Surgery: a Pilot Study

BACKGROUND CONTEXT Quality of life (QoL) is impacted by the ability for patients to participate in physical activities which interest them. Surgeons may not systematically ask about related activity goals. PURPOSE To determine what specific physical activity goals elective spine surgery patients have and which of these goals surgeons suggest modifying. STUDY DESIGN/SETTING Retrospective cohort. PATIENT SAMPLE Elective spine surgery patients at Hospital for Special Surgery (NY, USA). OUTCOME MEASURES Patient reported outcome measures (PROMs). METHODS A standard-of-care survey previously developed for hip and knee arthroplasty patients was adapted for the elective spine surgery population with degenerative spinal conditions to solicit patient physical activity goals, current and future desired performance, current difficulty performing these activities, and time since the activities could last be performed at the desired level. This pilot survey was administered to new adult patients contemplating spine surgery for degenerative pathology between May 2019 and July 2019. Patient responses were individually reviewed by their respective spine surgeon (seven surgeons participated). Each surgeon recorded whether they agreed with the patient's goal or discussed how to modify the goal. These data were retrospectively assessed for significant associations (p<0.05). RESULTS During this study, 173 patients were surveyed with 169 (97.7%) having one or more reported physical activity goals (215 total goals). After excluding workers compensation patients (n=5), average patient age was 59.9 years (σ=16.4, range: 19.0–93.0 years). Average patient BMI was 27.4 (σ=5.3, range: 16.0–47.9). This study population included patients with lumbar spine degeneration (72.0%), cervical spine degeneration (23.8%), as well as thoracic and combined regional degeneration (4.3%). Patient activity goals involved: exercise (31.1%), walking (28.2%), recreational activities not including golf (12.9%), golf (7.2%), activities of daily living or ADLs (11.5%), and hobbies (9.1%). Activity goals could be performed at a satisfactory level on average 3.2 years prior to being surveyed (range: 2.0 days–28.0 years) with a longer period associated with higher BMI (p=0.046). Older age was associated with having exercise goals (p<0.001) and walking goals (p<0.001). Higher BMI was associated with having ADL goals (p=0.014) and not having exercise goals (p<0.001). Cervical patients (compared to lumbar patients) were more likely to have ADL goals (p=0.003) and hobby goals (p<0.001) and were less likely to have walking goals (p=0.002) and recreation goals (p=0.016). Surgeons suggested modification of 9.1% of patient activity goals, generally towards less intensity. Goal modification did not vary between surgeons (p=.224, 2-Tail FET). Modification was concentrated among lumbar spine patients (p=0.004, 2-Tail FET). No cervical spine patient goals were modified. CONCLUSIONS Patient activity goals were related to region of spinal degeneration, age and BMI. The low rate of suggested goal modification by surgeons in this study reflects the central role of communication, education, as well as shared decision-making during presurgical assessment and care planning when treating patients with spine conditions. Most patients undergoing elective spine surgery have very particular activity goals that are not currently captured by patient-reported outcome measure (PROM) questionnaires. However, these activity goals are generally not systematically communicated to surgeons. Awareness of patient physical activity goals is important and may ultimately impact patient satisfaction with spine surgery. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs. Quality of life (QoL) is impacted by the ability for patients to participate in physical activities which interest them. Surgeons may not systematically ask about related activity goals. To determine what specific physical activity goals elective spine surgery patients have and which of these goals surgeons suggest modifying. Retrospective cohort. Elective spine surgery patients at Hospital for Special Surgery (NY, USA). Patient reported outcome measures (PROMs). A standard-of-care survey previously developed for hip and knee arthroplasty patients was adapted for the elective spine surgery population with degenerative spinal conditions to solicit patient physical activity goals, current and future desired performance, current difficulty performing these activities, and time since the activities could last be performed at the desired level. This pilot survey was administered to new adult patients contemplating spine surgery for degenerative pathology between May 2019 and July 2019. Patient responses were individually reviewed by their respective spine surgeon (seven surgeons participated). Each surgeon recorded whether they agreed with the patient's goal or discussed how to modify the goal. These data were retrospectively assessed for significant associations (p<0.05). During this study, 173 patients were surveyed with 169 (97.7%) having one or more reported physical activity goals (215 total goals). After excluding workers compensation patients (n=5), average patient age was 59.9 years (σ=16.4, range: 19.0–93.0 years). Average patient BMI was 27.4 (σ=5.3, range: 16.0–47.9). This study population included patients with lumbar spine degeneration (72.0%), cervical spine degeneration (23.8%), as well as thoracic and combined regional degeneration (4.3%). Patient activity goals involved: exercise (31.1%), walking (28.2%), recreational activities not including golf (12.9%), golf (7.2%), activities of daily living or ADLs (11.5%), and hobbies (9.1%). Activity goals could be performed at a satisfactory level on average 3.2 years prior to being surveyed (range: 2.0 days–28.0 years) with a longer period associated with higher BMI (p=0.046). Older age was associated with having exercise goals (p<0.001) and walking goals (p<0.001). Higher BMI was associated with having ADL goals (p=0.014) and not having exercise goals (p<0.001). Cervical patients (compared to lumbar patients) were more likely to have ADL goals (p=0.003) and hobby goals (p<0.001) and were less likely to have walking goals (p=0.002) and recreation goals (p=0.016). Surgeons suggested modification of 9.1% of patient activity goals, generally towards less intensity. Goal modification did not vary between surgeons (p=.224, 2-Tail FET). Modification was concentrated among lumbar spine patients (p=0.004, 2-Tail FET). No cervical spine patient goals were modified. Patient activity goals were related to region of spinal degeneration, age and BMI. The low rate of suggested goal modification by surgeons in this study reflects the central role of communication, education, as well as shared decision-making during presurgical assessment and care planning when treating patients with spine conditions. Most patients undergoing elective spine surgery have very particular activity goals that are not currently captured by patient-reported outcome measure (PROM) questionnaires. However, these activity goals are generally not systematically communicated to surgeons. Awareness of patient physical activity goals is important and may ultimately impact patient satisfaction with spine surgery.