6 week post operative outcomes following an accelerated recovery programme for lumbar spine discectomy and fusion procedures.

Purpose

To improve clinical outcomes for patients who have had lumbar spine surgery, by commencing outpatient physiotherapy at 2 weeks post op as opposed to 6 weeks post op.

Patients reported significant improvements
in the 6 week post-operative period compared to their pre-operative scores.
For future study, comparison of outcomes
could be made for rehabilitation commencing at 6 weeks post op, as opposed to the ARP of 2 weeks post-op.

Approach

A cohort of 57 patients were recruited at Cheltenham Nuffield Health Hospital following any lumbar discectomy or fusion surgery and undertook an ARP. Treatment included Pilates, light resistance work and advice on ADL's and graded return to work.

The outcome measures used pre-op and at 6 weeks post op were the Oswestry back disability score, the VAS (Visual Analogue Scale) for back and leg pain and the fear-avoidance belief questionnaire. It was decided that the minimal clinically important difference (MCID) for each measure would need to be achieved to indicate a good clinical outcome.

There were also regular meetings with the spinal consultants and Physiotherapy team to ensure there was a consistent message relayed to patients with regards to the advice and exercises given.

Outcomes

There was a clinically significant improvement in the Oswestry Disability Index score and the VAS scores from pre-operatively to 6 weeks post-operatively.

Some data was missing from the FABQW (work score) as this section did not apply for all patients. This may have weakened the outcome data.

Oswestry (%): Means - Pre: 39 (SDEV 14), Means - Post: 10 (SDEV 14), MCID: 12.8, Difference Change Pre and Post: 25.

VAS back: Means - Pre: 6 (SDEV 2), Means - Post: 1 (SDEV 2), MCID: 2, Difference Change Pre and Post: 3.

VAS Dom leg: Means - Pre: 6 (SDEV 3), Means - Post: 2 (SDEV 2), MCID: 2, Difference Change Pre and Post: 5.

VAS Opp leg: Means - Pre: 2 (SDEV 3), Means - Post: 1 (SDEV 0), MCID: 2, Difference Change Pre and Post: 2.

FABQW: Means - Pre: 17 (SDEV 15), Means - Post: 13 (SDEV 12), MCID: 13, Difference Change Pre and Post: 5.

FABQPA: Means - Pre: 17 (SDEV 15), Means - Post: 13 (SDEV 12), MCID: 13, Difference Change Pre and Post: 5.

Patients reported significant improvements in the 6 week post-operative period compared to their pre-operative scores. For future study, comparison of outcomes could be made for rehabilitation commencing at 6 weeks post op, as opposed to the ARP of 2 weeks post-op.

Implications

ARP´s following any lumbar discectomy or fusion surgery has a beneficial effect on functional outcomes in the medium-term. Patients value early advice and exercise, which leads to empowerment and taking ownership of their back health for the future. Collaboration with consultants with important so that a consistent message in the ´do´s and don'ts´ following back surgery aren´t misconstrued.

Fund acknowledgements

No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.

Additional notes

This work was presented at Physiotherapy UK 2019.