Friday, September 28, 2018 8:00 AM–9:00 AM interdisciplinary spine forum: abstract presentations: 145. The impact of postoperative physical therapy on patient-reported outcomes in patients undergoing spine surgery

Abstract

BACKGROUND CONTEXT Physical therapy (PT) is commonly used after lumbar spine surgery, without strong evidence for its effectiveness. Randomized controlled trials outside the United States have found no significant difference between PT and educational controls. Additional research is needed to understand the benefit of PT for postoperative management in order to justify its continued use for patients following 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 lumbar spine surgery. STUDY DESIGN/SETTING Retrospective evaluation of prospectively collected data from a longitudinal spine registry. PATIENT SAMPLE A total of 782 participants undergoing a lumbar laminectomy with or without fusion for a degenerative lumbar condition. OUTCOME MEASURES The primary outcomes for this study were disability (Oswestry Disability Index: ODI), quality of life (EQ-5D), and back 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, PT 0–3 months, PT 0–3 and 3–12 months, PT 3–12 months). 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 baseline outcome scores, age, gender, smoking status, insurance type, body mass index, presence of neurogenic claudication, surgery type, number of levels, ASA grade, and preoperative depression and narcotic use. Significance was set at p RESULTS Over the 1-year period, 238 patients had no PT (31%), 285 had PT from 0 to 3 months only (36%), 197 had PT from 0 to 3 and 3 to 12 months (25%), and 62 had PT from 3 to 12 months only (8%). The mixed-effects models found a significant relationship between PT and all patient-reported outcomes, with patients in the PT 0-3 months only group having ODI scores 3.5-points higher, EQ-5D scores 0.03-points lower, and back pain scores 0.35-points higher than the No PT group (p CONCLUSIONS This retrospective analysis of prospectively collected registry data found that patients utilizing PT after lumbar spine surgery had worse postoperative outcomes at 1-year in terms of higher disability and pain and lower quality of life, after controlling for demographic and clinical characteristics. Traditional postoperative PT may not be the most effective rehabilitation approach after spine surgery. Randomized controlled trials have demonstrated that psychologically informed rehabilitation may be more appropriate due to the high levels of depression, anxiety and fear of movement found in this surgical patient population.