Using the available level 1 and 2 data regarding postoperative rehabilitation after lumbar fusion for degenerative disc disease, researchers of this systematic review found the literature generally backs formal therapy after this surgery. Based on their results, investigators created a model protocol for rehabilitation.
“This protocol forms a core around which we build individualized [physical therapy] PT prescriptions for our patients,” Eeric Truumees, MD, chief executive officer of Seton Brain and Spine Institute and professor of surgery at University of Texas, Dell Medical School, told Healio.com/Orthopedics. “We found that the literature supports ambulation as soon after surgery as possible, but that the yield of formal, outpatient rehabilitation increases when that process waits until 12 weeks postop. Education and psychosocial support are key elements. Those elements along with core strengthening and range of motion have greater impact than do nerve glides and modalities, such as heat and [transcutaneous electrical nerve stimulators] TENS.”
Truumees and colleagues performed a systematic review of multiple electronic databases using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and identified 21 studies with level 1 or level 2 evidence. Investigators focused their search on a few key terms with regard to post-lumbar fusion PT and rehabilitation. Level of evidence and the availability of accepted patient-reported outcome measures were used by two independent authors to review the studies. Any disagreements regarding study inclusion were resolved by a third author.
Investigators divided the literature review findings into groups that included rehabilitation terminology, timing and duration of the post-fusion rehabilitation, need for rehabilitation relative to surgery-related morbidity, the relationship of rehabilitation to the outcomes, and cognitive and psychosocial aspects of the postoperative rehabilitation. Findings showed current evidence supported formal rehabilitation following lumbar fusion.
According to results from the review, there were better outcomes at a lower cost with PT started at 12 weeks postoperatively vs. beginning PT at 6 weeks. High-grade evidence was not able to answer all questions and, with these cases, the authors used the “best evidence available” to offer recommendations.
“We have prepared a retrospective evaluation of this protocol and have a prospective study in the works,” Truumees, said. – by Monica Jaramillo
Disclosure: The researchers report no relevant financial disclosures.