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Abstract：
BACKGROUND: Lumbar spinal stenosis (LSS) and spondylolisthesis (SPL) are characterized as degenerative spinal pathologies and share considerable similarities. However, opinions vary on whether to recommend exercise or restrict it for these diseases. Few studies have objectively compared the effects of daily physical activity on LSS and SPL because it is impossible to restrict activities ethnically and practically. We investigated the effect of restricting physical activity due to social distancing (SoD) on LSS and SPL, focusing on the aspect of healthcare burden changes during the 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 the implementation of the 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 to control for temporal effects on dependent variables.
RESULTS: Among 33,484 patients, 2,615 with LSS and 446 with SPL were included. A significant decrease in hospital visits was observed in 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 SoD. This decrease was not observed in the data from the control group. Concerning medical costs, the LSS group showed a statistically significant reduction in median copayment (difference, -$45/month·patient; p < 0.001) after SoD, whereas a significant change was not observed in the SPL group (difference, -$19/month·patient; p = 0.160).
CONCLUSIONS: Restricted physical activity during the SoD period decreased the healthcare burden for patients with LSS or, conversely, it did not significantly affect patients with SPL. Under circumstances of physical inactivity, patients with LSS may underrate their symptoms, while maintaining an appropriate activity level may be beneficial for patients with SPL.
METHODS: We included first-visit patients diagnosed exclusively with LSS and SPL in 2017 and followed them up for two years before and after the implementation of the 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 to control for temporal effects on dependent variables.
RESULTS: Among 33,484 patients, 2,615 with LSS and 446 with SPL were included. A significant decrease in hospital visits was observed in 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 SoD. This decrease was not observed in the data from the control group. Concerning medical costs, the LSS group showed a statistically significant reduction in median copayment (difference, -$45/month·patient; p < 0.001) after SoD, whereas a significant change was not observed in the SPL group (difference, -$19/month·patient; p = 0.160).
CONCLUSIONS: Restricted physical activity during the SoD period decreased the healthcare burden for patients with LSS or, conversely, it did not significantly affect patients with SPL. Under circumstances of physical inactivity, patients with LSS may underrate their symptoms, while maintaining an appropriate activity level may be beneficial for patients with SPL.
摘要：
背景：腰椎管狭窄（LSS）和腰椎滑脱（SPL）的特征是退行性脊柱病变，并且具有相当大的相似性。然而,对于这些疾病是否建议运动或限制运动，意见不一。很少有研究客观地比较了日常体力活动对LSS和SPL的影响，因为不可能在种族和实践上限制活动。我们调查了由于社交距离（SoD）而限制体力活动对LSS和SPL的影响，重点关注大流行期间医疗负担变化的方面。
方法：我们纳入了2017年首次诊断为LSS和SPL的患者，并在实施SoD政策前后随访了两年。作为控制，我们对2015年首次访视并随访4年无SoD的患者进行了分析.通用数据模型用于分析每个患者的诊断代码和治疗。通过回归时间不连续性来分析医院就诊和医疗费用，以控制对因变量的时间影响。
结果：在33,484名患者中，包括2,615个LSS和446个SPL。在LSS中观察到住院次数显着减少(差异，-3.94次/月·100例；p=0.023）和SPL（差异，-3.44次/月·100例患者；p=0.026）SoD后组。在对照组的数据中未观察到这种降低。关于医疗费用，LSS组显示中位数共付额在统计学上显着降低(差异，-$45/月·患者；p<0.001)SoD后，而在SPL组中未观察到显着变化（差异，-19美元/月·患者；p=0.160）。
结论：在SoD期间限制体力活动降低了LSS患者的医疗负担，相反,对SPL患者无显著影响.在身体不活动的情况下，LSS患者可能会低估他们的症状，同时保持适当的活动水平可能对SPL患者有益。
方法：我们纳入了2017年首次诊断为LSS和SPL的患者，并在实施SoD政策前后随访了两年。作为控制，我们对2015年首次访视并随访4年无SoD的患者进行了分析.通用数据模型用于分析每个患者的诊断代码和治疗。通过回归时间不连续性来分析医院就诊和医疗费用，以控制对因变量的时间影响。
结果：在33,484名患者中，包括2,615个LSS和446个SPL。在LSS中观察到住院次数显着减少(差异，-3.94次/月·100例；p=0.023）和SPL（差异，-3.44次/月·100例患者；p=0.026）SoD后组。在对照组的数据中未观察到这种降低。关于医疗费用，LSS组显示中位数共付额在统计学上显着降低(差异，-$45/月·患者；p<0.001)SoD后，而在SPL组中未观察到显着变化（差异，-19美元/月·患者；p=0.160）。
结论：在SoD期间限制体力活动降低了LSS患者的医疗负担，相反,对SPL患者无显著影响.在身体不活动的情况下，LSS患者可能会低估他们的症状，同时保持适当的活动水平可能对SPL患者有益。
