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Background Lumbar degenerative disease has become more common, and surgery is performed in severe cases. However, some patients have residual disabilities. Although psychological factors are the most studied predictors of disability after lumbar spine surgery, it is unclear which factors strongly influence them. Thus, this study aimed to examine multidimensional factors that predict disability in patients postoperatively. Methods This was a retrospective longitudinal study. We collected data on pain intensity, disability, and psychosocial factors a day before surgery. In addition, pain intensity and disability were assessed for the same participants more than 1 year after surgery. Hierarchical multiple regression analysis was used to analyze the preoperative factors associated with the degree of disability in participants at postoperative lumbar surgery. The dependent variable was the Roland Morris disability questionnaire score postoperatively. The independent variables were the preoperative Roland Morris disability questionnaire scores in step 1; the participant's characteristics (age and sex) and numerical rating scale in step 2; Pain Catastrophizing Scale, Tampa Scale for Kinesiophobia, and Hospital Anxiety and Depression Scales as step 3; and the interaction of age with the other variables was added in step 4. Results There were 176 participants in this study. The preoperative Roland Morris disability questionnaire scores (B = 0.140; p < 0.05), age (B = 0.059; p < 0.05), Tampa Scale for Kinesiophobia (B=-0.107; p < 0.05) and preoperative Roland Morris disability questionnaire scores with age interaction (B = 0.014; p < 0.01) were significantly related to disability. The explanatory power was 26.7%. Conclusions This study showed that the preoperative fear of movement was the strongest predictor of postoperative disability after surgery for degenerative diseases of the lumbar spine.

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Objectives. This study assessed the validity of a hypothesized model predicting that physical activity improves health-related quality of life (HRQOL) in older Japanese adults with pain, dysesthesia, and kinesiophobia following lumbar surgery. Methods. We included 431 elderly patients who underwent surgery for lumbar spinal stenosis at two hospitals. The frequency of physical activity, pain, dysesthesia, kinesiophobia (somatic focus and activity avoidance), and HRQOL were investigated using a questionnaire. Missing values were complemented by the stochastic regression imputation. We constructed the following model. (i) physical activity affects pain, dysesthesia, and kinesiophobia. (ii) pain, dysesthesia, and kinesiophobia separately affect HRQOL. This hypothetical model was tested by structural equation modeling. The model was improved based on a modified index. Results. Of the 431 respondents, 297 (median age 72 years, range 65–91 years; 158 men and 139 women) were analyzed (68.9%). The fit of the model improved based on the modification index and was acceptable comparative fit index, 0.948; Tucker–Lewis index, 0.919; root mean square error of approximation, 0.048 (90% confidence interval, 0.026–0.069), and standardized root mean square residual (0.046). The paths by which physical activities reduced pain or dysesthesia (standardized pass coefficients, −0.406) and somatic focus (−0.301) and consequently improved HRQOL were significant (pain/dysesthesia, −0.684; somatic focus, −0.218). Discussion. Our hypothesized model predicting that physical activity improves HRQOL in terms of pain, dysesthesia, and kinesiophobia in older Japanese adults after lumbar surgery was validated using cross-sectional data. Interventional studies on physical activity based on this model are required to establish the model.