Identifying modifiable factors that influence walking in patients undergoing surgery for neurogenic claudication: a prospective longitudinal study

Neurogenic claudication, caused by lumbar spinal stenosis, is the most common reason for spinal surgery in older adults, aiming to improve pain and walking. However, most people do not increase walking post-operatively. This study aimed to identify modifiable physical and psychosocial factors that could be targeted with rehabilitation. A prospective longitudinal study recruited 97 adults, aged > 50 years, awaiting surgery for neurogenic claudication. Walking measures (six-minute walk test, daily step count, self-rated maximum walking distance) were assessed pre-surgery and 12-weeks post-surgery. Modifiable variables, mapped to a behaviour change model (COM-B; e.g. falls, lower limb performance, fear of movement, illness perceptions), were evaluated using mixed-effects regression models. All walking measures demonstrated statistically significant improvements (p < .001). However, 50% did not achieve minimum clinically important differences. The strongest correlation with post-operative walking was pre-operative walking. Cross-sectionally, lower limb performance (b:.75; 95CI .64, .86 to b:.35; 95%CI .19, .52), pre-surgery history of falls (b:-.29; 95%CI-.44,-.13), fear of falling (b:-.55; 95%CI-.69,-.41 to b:-.32; 95%CI -.48, -.15), fear of movement (b:-.48; 95%CI-.63,-.33 to -.22; 95%CI -.40, -.03), coherence of condition (b:-.23; 95%CI -.41, -.05 to b:-.17; 95%CI-.33,-.01) and perceived personal control (b:.26; 95%CI .09, .43 to b:.14; 95%CI.02,.31), were significantly associated with pre-surgical walking (p < .05). Most pre-surgical variables were not longitudinally associated with change in walking post-surgery. Six-weeks post-surgery fear of falling (b:-.35; 95%CI -.57, -.13 to b:-.18; 95%CI-.33,-.02), fear of movement (b:-.32; 95%CI-.53,-.11 to b:-.19; 95%CI -.33, -.05), and emotional response (b-.24; 95%CI -.38, -.11 to b:-.22; 95%CI -.41, -.03) were significantly associated with less improvement in walking at 12-weeks post-surgery. Prehabilitation and post-operative rehabilitation targeting walking, balance, and psychosocial factors is recommended to optimise post-surgical walking.