233. Does postoperative physical therapy improve patient-reported outcomes at one-year following cervical spine surgery?

Abstract

BACKGROUND CONTEXT Pain and disability can persist after spinal surgery for which physical therapy (PT) is commonly prescribed. Currently, there is limited evidence to support the effectiveness of postoperative PT following cervical spine surgery. PURPOSE The purpose of this study was to examine the association between attending outpatient PT during the postoperative period and patient-reported outcomes at 1 year following cervical spine surgery. STUDY DESIGN/SETTING Retrospective evaluation of prospectively collected data from a single-center, spine registry. PATIENT SAMPLE A total of 767 participants undergoing anterior cervical discectomy and fusion (ACDF) or posterior laminectomy with or without fusion for a degenerative condition. OUTCOME MEASURES The primary outcomes for this study were disability (Neck Disability Index: NDI), quality of life (EQ-5D), and neck and arm pain (11-point Numeric Rating Scale: NRS). METHODS Participants were enrolled into a spine registry prior to surgery and completed a preoperative assessment. Follow-up assessments occurred at 3 months and 1 year after surgery. A categorical variable to describe PT over the 1-year period was created (No PT [reference], PT 0-3 months only, PT 0-3 and 3-12 months, PT 3-12 months only). Linear mixed-effects models were used to examine the effect of PT group on outcomes over time (3 months and 1 year). All analyses controlled for preoperative outcome scores, time, age, gender, race, smoking status, insurance type, body mass index, ambulation status, comorbidities, duration of symptoms, surgery type, revision, discharge status, number of levels, ASA grade and preoperative depression/anxiety and narcotic use. Significance was set at p RESULTS Over the 1-year period, 351 patients had no PT (46%), 193 had PT from 0-3 months only (25%), 138 had PT from 0-3 and 3-12 months (18%), and 85 had PT from 3-12 months only (11%). The mixed-effects models found no significant relationship between PT 0-3 months only and all patient-reported outcomes at 1-year compared to the No PT group (p > .05). Patients who had PT between 3-12 months only had NDI scores 5.8-points higher, EQ-5D scores 0.03-points lower, and neck and arm pain scores 0.98-points and 0.68-points higher than the No PT group (p CONCLUSIONS Results from a retrospective multivariable analysis suggest that there is no difference in 1-year patient-reported outcomes between patients who utilize PT during the first 3 months only and patients who have No PT after cervical spine surgery. However, attending postoperative PT later in recovery, between 3 and 12 months, appears to result in increased disability and pain at 1-year after surgery, after accounting for patient and clinical characteristics. While the differences between groups are statistically significant, they do not appear to be clinically significant based on established MCID values. Overall, results suggest that attending PT after surgery may not lead to improved patient-reported outcomes compared to No PT. Additional research is needed to determine subgroups of patients who might benefit from traditional PT or alternative rehabilitation approaches that are informed by a biopsychosocial model. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.