Prognostic factors for outcome following lumbar spine fusion surgery: a systematic review and narrative synthesis.

PURPOSE: The objective of this study was to identify and evaluate the value of prognostic factors related to disability, pain and quality of life (QoL) for adult patients undergoing lumbar spine fusion surgery (LSFS). METHODS: Two reviewers independently searched the literature, assessed eligibility, extracted data and assessed risk of bias and certainty of evidence. Key electronic databases were searched [PubMed, CINAHL, EMBASE, MEDLINE, PEDro and ZETOC] using pre-defined terms [e.g. LSFS] to 20/9/2020; with additional searching of journals, reference lists and unpublished literature. Prospective cohort studies with ≥ 12-month follow-up after LSFS were included. Narrative synthesis was based on recommendations by Cochrane Consumers and Communication Review Group. The GRADE tool enabled assessment of certainty of evidence. Prognostic factors and outcome were analysed and summarised when examined in ≥ 2 studies and when results pointed in the same direction in ≥ 75% of studies. RESULTS: Sixteen studies (n = 8388, 2 low and 14 high risk of bias) were included with 39 prognostic factors identified. There is low certainty evidence that higher pre-operative severity of leg pain predicts greater improvement of leg pain and that pre-operative working predicts less post-operative disability both at 1-2-year follow-up. Other found associations were of very low certainty evidence. CONCLUSION: No moderate to high certainty evidence exists. Use of leg pain and pre-operative working may be valuable predictors of outcome to inform clinical decision-making and advice regarding LSFS surgery. There is need for adequately powered low-risk-of-bias prospective observational studies to further investigate candidate prognostic factors.

The decline in physical activity in aging people is not modified by gender or the presence of cardiovascular disease.

BACKGROUND: A physically active lifestyle decreases the progression of atherosclerosis and consequently reduces cardiovascular mortality. However, activity levels are hampered by aging. The association between aging and physical inactivity might be gender-specific or be modified by the presence of cardiovascular disease (CVD). In this study, we investigated if the association between aging and physical inactivity was different between men and women and between primary and secondary prevention patients. METHODS: We performed a cross-sectional analysis of three primary care samples including primary and/or secondary prevention patients (total n = 4726). Baseline data for sample 1 were collected in the years 2013-14, for sample 2 in 2009-10 and for sample 3 in 2009. Activity levels were measured by the patient reported Rapid Assessment of Physical Activity questionnaire. A multilevel regression analysis was used to explore the association between aging and physical inactivity, adjusted for confounders. We examined potential effect modification by gender and the presence of CVD on the association between aging and physical inactivity. RESULTS: Multilevel regression revealed that aging was consistently associated with physical inactivity in three out of three samples. This association was, however, not modified by gender or the presence of CVD. CONCLUSIONS: Cardiovascular risk management interventions should aim at increasing or maintaining physical activity levels in aging primary care population. This study does not support the notion that extra emphasis should be put in targeting men or women, or people with or without the presence of CVD.