title: Timing and predictors of return to short-term functional activity in adolescent idiopathic scoliosis after posterior spinal fusion: a prospective study.
abstract: METHODS
  Prospective study.
  
  
  OBJECTIVE
  To assess the timing and predictors of return to short-term functional activity in patients with adolescent idiopathic scoliosis (AIS) after posterior spinal fusion (PSF).
  
  
  BACKGROUND
  Few studies have examined the timing and rate of return to short-term functional activity in patients with AIS after PSF. No study has yet evaluated the timing and factors that predict a delayed return to school/college--a topic relevant to patients who have had or anticipate having spinal fusion, and their treating surgeons.
  
  
  METHODS
  Seventy-seven eligible subjects with AIS who underwent PSF and correction (January 2010 to April 2012) were followed up until return to the functional outcomes under analysis. Timing of return to school/college and physical activity, as per the patients' preoperative level or better, was assessed. Binary logistic regression analysis was used to determine predictors of delayed return to school/college full-time (>16 wk) and unrestricted physical activity (>32 wk) relative to sociodemographic, anthropometric, radiographical, clinical, and surgical factors. In the present study, a "delayed" return to all the functional outcomes recorded was defined as "greater than the 75th percentile" of the continuous distribution.
  
  
  RESULTS
  Mean follow-up was 12.8 months (SD, 5.7). Mean age was 15.04 years (SD, 1.89). The median time to return to school/college full-time (n = 75) was 10 weeks; the majority returned by 16 weeks (77.3%). Preoperative curves greater than 70° (relative risk, 3.38; P = 0.008), postoperative weight loss greater than 5 kg (relative risk, 3.02; P = 0.012), and minor perioperative respiratory complication incidence (relative risk, 2.89; P = 0.024) independently predicted delayed return to school/college full-time. By 24 and 52 weeks, 51.4% and 88.5% of subjects, respectively, returned to unrestricted physical activity. At final follow-up, nonreturn to unrestricted physical activity was identified in only 3 subjects (4.3%) because of chronic back pain.
  
  
  CONCLUSIONS
  The majority of patients with AIS can expect to return to school/college full-time by 16 weeks and unrestricted physical activity by 52 weeks after PSF. Preoperative curves greater than 70°, postoperative weight loss greater than 5 kg, and minor perioperative respiratory complication incidence independently predicted a delayed return to school/college full-time. These findings add to the current knowledge base regarding actual versus anticipated timing of return to short-term functional outcomes in this population.
  
  
  METHODS
  3.
authors.affiliation: *Department of Orthopaedic Surgery, Our Lady's Children's Hospital, Crumlin, Dublin 12, Ireland †National Children's Research Centre, Crumlin, Dublin 12, Ireland ‡Department of Anaesthetics, Our Lady's Children's Hospital, Crumlin, Dublin 12, Ireland; and §Blackrock Clinic, Blackrock, Dublin, Ireland.
authors.forename: Roslyn C
authors.initials: RC
authors.lastname: Tarrant
authors.forename: Padhraig F
authors.initials: PF
authors.lastname: OʼLoughlin
authors.forename: Sam
authors.initials: S
authors.lastname: Lynch
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Queally
authors.forename: Padraig
authors.initials: P
authors.lastname: Sheeran
authors.forename: David P
authors.initials: DP
authors.lastname: Moore
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Kiely
mesh_terms: D000203:Activities of Daily Living; D000293:Adolescent; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D008297:Male; D011379:Prognosis; D011446:Prospective Studies; D011597:Psychomotor Performance / Q000502:physiology*; D012574:Schools; D012600:Scoliosis / Q000503:physiopathology* / Q000601:surgery*; D013123:Spinal Fusion / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome; D014495:Universities