Moving from Knowledge to Intervention to Improve Patient Health and Well-Being

Commentary With rare exceptions, patients seeking orthopaedic care do so in an elective manner with the hope of increasing function, decreasing pain, and improving quality of life. Although the surgical knowledge, skill, and precision that orthopaedic surgeons display within the 4 walls of an operating room (OR) are crucial to optimizing a patient’s clinical outcome and subsequent general health following a procedure, the reality is that surgery accounts for only a modest portion of a patient’s postoperative well-being. Numerous other factors outside of the OR may have a notable impact, including patient mental and emotional health1 and physical activity level2, among others. Although the relationship between physical activity and overall and musculoskeletal health has been well documented in the literature, assessments of interventions aimed at driving behavioral changes among patients to adopt a greater physical activity level have been much less common. The important step of turning into action our knowledge of relationships among a host of different factors and musculoskeletal and overall health is what is needed across orthopaedic surgery. Mancuso et al. should be commended for their investigation demonstrating that a multicomponent behavioral intervention administered to patients in orthopaedic surgery spine practices could increase lifestyle physical activity following recuperation from complex lumbar spine surgery. Importantly, not only does this work highlight—using a prospective, randomized design—that a psychosocial intervention to increase lifestyle activity (i.e., walking) postoperatively can actually work, but the intervention itself was elegantly designed to be simple and pragmatic. Thus, although some additional expertise and resources were needed, none were so substantial that such initiatives could not be planned and implemented widely. This is promising. Although the findings of this work are encouraging, several limitations should be considered by readers. First, the use of a self-reported activity level, despite involving a validated instrument, does raise the possibility of bias. Perhaps more accurate, unbiased ways of measuring the activity level, especially lifestyle walking, in future studies could be made via wearable devices. However, such an approach would be more costly unless patients already owned the appropriate technology; this must be considered, especially if the goal is for widespread implementation of similar programs. Second, this study focused on a select group of patients undergoing orthopaedic surgery, namely those who underwent complex lumbar spine surgery. Whether or not the same multicomponent behavioral intervention would have the desired positive impact on patients undergoing different orthopaedic procedures remains to be seen. However, the science underlying the intervention is sound and not specific to patients undergoing complex lumbar spine surgery, so there is no reason to believe that it would not deliver similar results. Lastly, although there was a significant improvement in physical activity among those in the intervention group, the degree of clinical importance remains unclear in the study. A better understanding, in simple terms, of the positive general and musculoskeletal health impact of the described behavioral intervention to increase physical activity is crucial for others seeking to develop similar programs. Indeed, such insights would be invaluable in convincing stakeholders elsewhere to designate appropriate financial and personnel resources to comparable initiatives. Overall, I applaud Mancuso et al. for their bold work to turn knowledge into action for the benefit of patients. This study shows us that we can continue to make great strides in helping our patients to better reach their general and musculoskeletal health goals during routine orthopaedic care.