**1. Introduction**

The coronavirus disease 2019 (COVID-19) pandemic has continued worldwide since early 2020 [1]. The pandemic was declared by the World Health Organization on 11 March 2020, with alarming levels of spread and severity [2]. In Japan, a state of emergency in response to the COVID-19 pandemic was declared between 7 April and 25 May 2020. People were required to stay at home during this period, with their lifestyles changing even after the end of the declaration. During this period, most gyms for elderly people were closed because the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is primarily transmitted through direct routes, including respiratory droplets and direct person-to-person contact [3,4]. Specifically, age ≥ 65 years is a known risk factor for severe

**Citation:** Terai, H.; Takahashi, S.; Tamai, K.; Hori, Y.; Iwamae, M.; Hoshino, M.; Ohyama, S.; Yabu, A.; Nakamura, H. Impact of the COVID-19 Pandemic on Elderly Patients with Spinal Disorders. *J. Clin. Med.* **2022**, *11*, 602. https:// doi.org/10.3390/jcm11030602

Academic Editor: Panagiotis Korovessis

Received: 3 December 2021 Accepted: 25 January 2022 Published: 25 January 2022

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acute respiratory infection by COVID-19 [5]. Consequently, people within that age category have more compromised activity compared with younger adults. Additionally, disuse in the elderly population increases their vulnerability to rapid skeletal muscle atrophy, functional strength loss, and multiple related negative health consequences [6].

The Japanese Orthopedic Association recommends the guidelines of the Centers for Medicare and Medicaid Services and American College of Surgeons [7,8], that is, that low acuity and intermediate acuity practice should be postponed or rescheduled. The North American Spine Society has provided guidelines for applying injections, interventional procedures, and surgeries, with the understanding that decision-making is strongly influenced by multiple factors, as follows [9]. The current pandemic might negatively affect patients with spinal disorders, including by reducing quality of life (QoL) and activities of daily living (ADLs), especially in the elderly population. However, there has been no study of this impact. Therefore, the present study aimed to reveal the changes in the QoL and ADLs of patients with spinal disorders after the first and second waves of the pandemic according to age, and to investigate the factors related to deterioration in ADLs.

#### **2. Materials and Methods**

#### *2.1. Study Design*

This was a multicenter cross-sectional study in four spine clinics. All patients who visited the spine clinics for any symptoms were asked to participate in a survey. Patients who provided informed consent were enrolled and were allowed to withdraw at any point if they wished (i.e., during or after completing the questionnaire). The participants were asked to answer questions from several questionnaires at two points: pre-pandemic and post-second wave. This survey was conducted between 1 November 2020 and 31 December 2020 in Osaka, Japan. In Japan, the first and second waves of the COVID-19 pandemic occurred in April and August, respectively, and the third wave occurred during the study period.

All study participants provided written informed consent. The study protocol was approved by the Institutional Review Board of the representative institution (approval No: 2020-242).
