Comparative Analysis of The Impact of Limitied Physical Activity on Lumbar Spinal Stenosis and Spondylolisthesis: A Retrospective Cohort Study between COVID-19 Pandemic Period and Control Period

Abstract

Abstract BACKGROUND The primary treatment for lumbar spinal stenosis (LSS) and spondylolisthesis (SPL) is conservative care, including exercise. Regarding exercise, physical activity has a different therapeutic role in the two diseases. We investigated the effect of physical inactivity on LSS and SPL by analyzing changes in hospital visits and medical costs during the COVID-19 pandemic period. METHODS We included first-visit patients diagnosed exclusively with LSS and SPL in 2017 and followed them up for two years before and after implementation of social distancing (SoD) policy. As controls, patients who first visited in 2015 and were followed for four years without SoD were analyzed. The common data model was employed to analyze each patient’s diagnostic codes and treatments. Hospital visits and medical costs were analyzed by regression discontinuity in time (RDiT) to control for temporal effects on dependent variables. RESULTS Among 33,484 patients, 2,615 LSS and 446 SPL were included. A significant decrease in hospital visits was observed in both the LSS (difference,-3.94 times/month·100 patients; p = 0.023) and SPL (difference,-3.44 times/month·100 patients; p = 0.026) groups after the SoD. This decrement was not observed in the data from the control. Concerning the medical cost, the LSS group showed a statistically significant decrease in median copayment (difference,-$45/month·patient; p < 0.001) after the SoD, while a significant change was not observed in the SPL group (difference,-$19/month·patient; p = 0.160). CONCLUSION After the implementation of SoD, both hospital visits and medical costs were reduced in only the LSS group. Limited physical activity due to SOD may reduce the medical demand for patients with LSS.