Higher Levels of Postoperative Mobility and Activity as Measured by the AM-PAC 6 Clicks Instrument Are Associated with Improved Outcomes after Lumbar Fusion

Introduction: Previous studies have shown that early patient mobility and activity can improve patient outcomes after lumbar fusion procedures. This study aimed to explore the relationship between patient mobility and activity, measured by the Activity Measure for Post-acute Care (AM-PAC) “6-Clicks”...

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Main Authors: Parimal Rana, Jane C. Brennan, Andrea H. Johnson, Justin J. Turcotte, Chad M. Patton
Format: Article
Language:English
Published: The Japanese Society for Spine Surgery and Related Research 2025-01-01
Series:Spine Surgery and Related Research
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Online Access:https://www.jstage.jst.go.jp/article/ssrr/9/1/9_2024-0047/_pdf/-char/en
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author Parimal Rana
Jane C. Brennan
Andrea H. Johnson
Justin J. Turcotte
Chad M. Patton
author_facet Parimal Rana
Jane C. Brennan
Andrea H. Johnson
Justin J. Turcotte
Chad M. Patton
author_sort Parimal Rana
collection DOAJ
description Introduction: Previous studies have shown that early patient mobility and activity can improve patient outcomes after lumbar fusion procedures. This study aimed to explore the relationship between patient mobility and activity, measured by the Activity Measure for Post-acute Care (AM-PAC) “6-Clicks” assessment and postoperative outcomes in lumbar fusion patients. Methods: A retrospective review of 306 lumbar fusions (105 with 6-Clicks mobility and 289 with 6-Clicks activity scores) was conducted. Statistical analyses were performed to evaluate the relationship between 6-Clicks scores and postoperative outcomes, such as prolonged length of stay (LOS), nonhome discharge, 30-day emergency department (ED) returns and readmissions, and minimal clinically important difference (MCID) achievement on the PROMIS-PF instrument at 3-12 months postoperatively. Results: After controlling for age, body mass index, sex, race, number of levels, and preoperative PROMIS-PF, higher 6-Clicks mobility scores decreased the likelihood of 3+ day LOS (OR: 0.72; p=0.010), non-home discharge (OR: 0.68; p<0.001), and 30-day ED return (OR: 0.78; p=0.022) and increased the likelihood of PROMIS MCID achievement (OR: 1.28; p=0.004). The odds of LOS 3+ days, non-home discharge, and ED return for each one-point increase in mobility scores all decreased by 28%, 32%, and 22%, respectively, while the odds of achieving PROMIS MCID for every one-point increase in mobility increased by 28%. After risk adjustment, higher 6-Clicks activity scores were protective against 3+ day LOS (OR: 0.78; p<0.001) and non-home discharge (OR: 0.69; p<0.001). Conclusions: The AM-PAC 6-Clicks mobility and activity scores hold value as early indicators of prolonged LOS and nonhome discharge, while mobility scores may help identify patients who are at risk for ED returns and who fail to experience clinically significant improvement in physical function. These tools may be used to identify patients requiring additional resources and can inform discussions surrounding patient expectations.
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publisher The Japanese Society for Spine Surgery and Related Research
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spelling doaj-art-c5f5116cb0764dcb95622782647110702025-02-09T23:30:07ZengThe Japanese Society for Spine Surgery and Related ResearchSpine Surgery and Related Research2432-261X2025-01-0191717710.22603/ssrr.2024-00472024-0047Higher Levels of Postoperative Mobility and Activity as Measured by the AM-PAC 6 Clicks Instrument Are Associated with Improved Outcomes after Lumbar FusionParimal Rana0Jane C. Brennan1Andrea H. Johnson2Justin J. Turcotte3Chad M. Patton4Luminis Health Orthopedics, Anne Arundel Medical CenterLuminis Health Orthopedics, Anne Arundel Medical CenterLuminis Health Orthopedics, Anne Arundel Medical CenterLuminis Health Orthopedics, Anne Arundel Medical CenterLuminis Health Orthopedics, Anne Arundel Medical CenterIntroduction: Previous studies have shown that early patient mobility and activity can improve patient outcomes after lumbar fusion procedures. This study aimed to explore the relationship between patient mobility and activity, measured by the Activity Measure for Post-acute Care (AM-PAC) “6-Clicks” assessment and postoperative outcomes in lumbar fusion patients. Methods: A retrospective review of 306 lumbar fusions (105 with 6-Clicks mobility and 289 with 6-Clicks activity scores) was conducted. Statistical analyses were performed to evaluate the relationship between 6-Clicks scores and postoperative outcomes, such as prolonged length of stay (LOS), nonhome discharge, 30-day emergency department (ED) returns and readmissions, and minimal clinically important difference (MCID) achievement on the PROMIS-PF instrument at 3-12 months postoperatively. Results: After controlling for age, body mass index, sex, race, number of levels, and preoperative PROMIS-PF, higher 6-Clicks mobility scores decreased the likelihood of 3+ day LOS (OR: 0.72; p=0.010), non-home discharge (OR: 0.68; p<0.001), and 30-day ED return (OR: 0.78; p=0.022) and increased the likelihood of PROMIS MCID achievement (OR: 1.28; p=0.004). The odds of LOS 3+ days, non-home discharge, and ED return for each one-point increase in mobility scores all decreased by 28%, 32%, and 22%, respectively, while the odds of achieving PROMIS MCID for every one-point increase in mobility increased by 28%. After risk adjustment, higher 6-Clicks activity scores were protective against 3+ day LOS (OR: 0.78; p<0.001) and non-home discharge (OR: 0.69; p<0.001). Conclusions: The AM-PAC 6-Clicks mobility and activity scores hold value as early indicators of prolonged LOS and nonhome discharge, while mobility scores may help identify patients who are at risk for ED returns and who fail to experience clinically significant improvement in physical function. These tools may be used to identify patients requiring additional resources and can inform discussions surrounding patient expectations.https://www.jstage.jst.go.jp/article/ssrr/9/1/9_2024-0047/_pdf/-char/enam-pac 6-clickslumbar fusionmobilityactivitypromis-pfbundled-payment models
spellingShingle Parimal Rana
Jane C. Brennan
Andrea H. Johnson
Justin J. Turcotte
Chad M. Patton
Higher Levels of Postoperative Mobility and Activity as Measured by the AM-PAC 6 Clicks Instrument Are Associated with Improved Outcomes after Lumbar Fusion
Spine Surgery and Related Research
am-pac 6-clicks
lumbar fusion
mobility
activity
promis-pf
bundled-payment models
title Higher Levels of Postoperative Mobility and Activity as Measured by the AM-PAC 6 Clicks Instrument Are Associated with Improved Outcomes after Lumbar Fusion
title_full Higher Levels of Postoperative Mobility and Activity as Measured by the AM-PAC 6 Clicks Instrument Are Associated with Improved Outcomes after Lumbar Fusion
title_fullStr Higher Levels of Postoperative Mobility and Activity as Measured by the AM-PAC 6 Clicks Instrument Are Associated with Improved Outcomes after Lumbar Fusion
title_full_unstemmed Higher Levels of Postoperative Mobility and Activity as Measured by the AM-PAC 6 Clicks Instrument Are Associated with Improved Outcomes after Lumbar Fusion
title_short Higher Levels of Postoperative Mobility and Activity as Measured by the AM-PAC 6 Clicks Instrument Are Associated with Improved Outcomes after Lumbar Fusion
title_sort higher levels of postoperative mobility and activity as measured by the am pac 6 clicks instrument are associated with improved outcomes after lumbar fusion
topic am-pac 6-clicks
lumbar fusion
mobility
activity
promis-pf
bundled-payment models
url https://www.jstage.jst.go.jp/article/ssrr/9/1/9_2024-0047/_pdf/-char/en
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AT andreahjohnson higherlevelsofpostoperativemobilityandactivityasmeasuredbytheampac6clicksinstrumentareassociatedwithimprovedoutcomesafterlumbarfusion
AT justinjturcotte higherlevelsofpostoperativemobilityandactivityasmeasuredbytheampac6clicksinstrumentareassociatedwithimprovedoutcomesafterlumbarfusion
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