ABSTRACT
Objectives: To improve our understanding of patients' perspectives regarding: (1) the decision-making and prehabilitation before lumbar spinal stenosis (LSS) surgery and (2) their postoperative experiences. Design: Qualitative research with semi-structured interviews. Setting: General community. Participants: Individuals who received (N=10) and who did not receive (N=15) prehabilitation before LSS surgery were recruited at the 6-month postoperative follow-up (8 females; average age: 67.7±6.7 years) by purposive sampling. Additionally, 1 participant invited her daughter to accompany her in an interview. Interventions: Not applicable. Main Outcome Measures: Concerns and experiences of patients with LSS regarding prehabilitation and recovery after spine surgery. Results: Thematic analysis was conducted to identify 4 themes inductively: (1) sources of information about LSS surgery; (2) factors affecting the surgical decision-making; (3) attitudes toward prehabilitation; and (4) postoperative recovery. All participants desired to have more preoperative education to inform their surgical decision-making. There were mixed opinions regarding the perceived benefits of prehabilitation because some individuals hesitated to participate in prehabilitation because of their symptoms, or the cost or time of traveling. Many participants expected some or even complete relief of LSS-related symptoms after surgery. However, not all participants experienced the expected postoperative improvements. Some participants only experienced temporary symptomatic relief, while others experienced new postoperative symptoms. Patients generally found that postoperative exercises taught by physiotherapists were useful although their compliance decreased over time. Conclusions: Our study highlights the need for better preoperative LSS education. Because face-to-face prehabilitation or postoperative rehabilitation may not be feasible for all patients, future studies should explore whether online-based prehabilitation or postoperative rehabilitation may benefit certain patient subgroups.
ABSTRACT
BACKGROUND: Static sitting is thought to be related to low back pain. Of various common seated postures, slouched sitting has been suggested to cause viscoelastic creep. This, in turn, may compromise trunk muscle activity and proprioception, and heightening the risk of low back pain. To date, no research has evaluated immediate and short-term effects of brief exposures to different sitting postures on spinal biomechanics and trunk proprioception. RESEARCH QUESTION: This study aimed to compare the impacts of 20 min of static slouched, upright and supported sitting with a backrest on trunk range of motion, muscle activity, and proprioception immediately after and 30 min after the sitting tasks. METHODS: Thirty-seven adults were randomly assigned to the three sitting posture groups. Surface electromyography of six trunk muscles during maximum voluntary contractions were measured at baseline for normalization. Pain intensity, lumbar range of motion, and proprioceptive postural control strategy were assessed at baseline, 20 min (immediately post-test) and at 50 min (recovery). Trunk muscle activity during sitting was continuously monitored by surface electromyography. RESULTS: While the slouched sitting group demonstrated the lowest bilateral obliquus internus/transversus abdominis activity as compared to other sitting postures (F = 4.87, p < 0.05), no significant temporal changes in pain intensity, lumbar range of motion nor proprioceptive strategy were noted in any of the groups. SIGNIFICANCE: Sitting for 20 min of duration appears to have no adverse effects on symptoms or spinal biomechanics regardless of the posture adopted. Future research should determine if there is a point at which does slouched sitting cause significant changes in pain/spinal biomechanics in people both with and without low back pain.
