title: The prognostic value of preoperative participation in activities of daily living on postoperative outcomes following lumbar discectomy.
abstract: OBJECTIVE
  In other surgical fields, preoperative level of participation in activities of daily living (ADLs) has been found to be important in predicting outcomes. To date, postoperative ADL measurements have only been used to characterize outcomes following lumbar discectomy. The present study's goal was to determine if patients' preoperative ability to perform ADLs correlates with their postoperative outcomes after lumbar discectomy at 3 months and 1 year.
  
  
  METHODS
  This retrospective study was performed using prospectively collected data from patients prospectively enrolled in a randomized clinical trial. All patients were 18 years or older, spoke English, had not previously had lumbar surgery, and underwent discectomy for a single-level lumbar disc herniation. Oswestry disability index (ODI) and visual analogue scale (VAS) back and leg pain scores were collected preoperatively and at 3 months and 1 year postoperatively. Simple linear regression analysis was performed to detect any significant correlations between three preoperative ODI domain values and postoperative scores. Additionally, regression analysis was used to determine the correlation between the preoperative ODI domains and percentage of good and poor outcomes, where an improvement of at least 18.8 points for ODI and at least 2 points for VAS constituted a good outcome.
  
  
  RESULTS
  90 subjects satisfied inclusion criteria (average age 42, 53 males, 37 females). Patients' ability to take care of themselves and to stand preoperatively were correlated with improvement in ODI postoperatively, with worse ability corresponding to more improvement (p<0.001 for both). Only personal care scores correlated with good improvement in leg pain. No significant correlations were found with back pain. When evaluating patients by dichotomized outcome (good or poor), only preoperative ability to participate in personal care was consistently significantly correlated to a good outcome.
  
  
  CONCLUSIONS
  This is the first study to suggest that lower preoperative ability to take part in personal care might predict better surgical outcomes after discectomy. The current data might prompt reassessment of the importance of ADLs in pre-operative patient evaluation and may help anticipate outcomes following lumbar discectomy.
authors.affiliation: Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, United States. Electronic address: dleonard7@partners.org.
authors.forename: Dana A
authors.initials: DA
authors.lastname: Leonard
authors.affiliation: Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, United States. Electronic address: ajschoen@neomed.edu.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Schoenfeld
authors.affiliation: Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, United States. Electronic address: mbharris@partners.org.
authors.forename: Mitchel B
authors.initials: MB
authors.lastname: Harris
authors.affiliation: Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, United States. Electronic address: cmbono@me.com.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Bono
mesh_terms: D000203:Activities of Daily Living; D004185:Disability Evaluation; D017586:Diskectomy / Q000379:methods; D005260:Female; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000601:surgery*; D008161:Lumbosacral Region / Q000601:surgery; D008297:Male; D010147:Pain Measurement; D057234:Preoperative Period; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Activities of daily living; Discectomy; Oswestry Disability Index; Personal care; Prognostic