Preoperative Functional Disability and Perioperative Life-space Mobility in Older Patients with Lumbar Spinal Stenosis: A Generalized Linear Mixed-effects Model Analysis

Abstract

Objectives: This prospective cohort study investigated the relationship between preoperative functional disability, as determined by the Oswestry Disability Index (ODI), and perioperative Life-Space Assessment (LSA) scores using generalized linear mixed-effects models (GLMM). Methods: We included 262 patients (mean age, 76.1 ± 6.0 years; male, n = 140; female, n = 122) with lumbar spinal stenosis scheduled for surgery. LSA was examined preoperatively and at 3 and 6 months postoperatively, while ODI was assessed preoperatively. Patients were classified based on ODI quartiles (Q1: 0%–28.89%, Q2: 28.89%–40.0%, Q3: 40.0%–53.33%, and Q4: 53.33%–86.67%). We explored the relationship between ODI and LSA using GLMM. Results: The mean preoperative ODI score was 41.2% ± 17.1%. In the crude model, ODI showed a significant negative association with LSA (β = −0.38, 95% CI: −0.58 to −0.18); this relationship remained significant in the adjusted model (β = −0.30, 95% CI: −0.49 to −0.11). Older age (β = −1.20, 95% CI: −1.76 to −0.65) and female sex (β = −11.81, 95% CI: −18.24 to −5.38) were associated with life-space restriction; body mass index, number of decompressed levels, and comorbidity burden did not show any such significant associations. Conclusions: Preoperative functional disability significantly affected perioperative life-space mobility among older patients with lumbar spinal stenosis. A comprehensive assessment from the preoperative period is important for older female patients.