The Impact of Physical Therapy after Lumbar Fusion Surgery

Jeremy C. Heard; Yunsoo A. Lee; Mark Lambrechts; Parker Brush; Tariq Z. Issa; Arun Kanhere; John Bodner; Caroline Purtill; Yashas C. Reddy; Sanath Patil; Sydney Somers; Nicholas D. D'Antonio; John J. Mangan; Jose A. Canseco; Barrett R. Woods; Ian D. Kaye; Jeff A. Rihn; Alan S. Hilibrand; Alexander R. Vaccaro; Christopher K. Kepler; Gregory D. Schroeder

doi:10.1097/BSD.0000000000001483

The Impact of Physical Therapy after Lumbar Fusion Surgery

Jeremy C. Heard, Yunsoo A. Lee, Mark Lambrechts, Parker Brush, Tariq Z. Issa, Arun Kanhere, John Bodner, Caroline Purtill, Yashas C. Reddy, Sanath Patil, Sydney Somers, Nicholas D. D'Antonio, John J. Mangan, Jose A. Canseco, Barrett R. Woods, Ian D. Kaye, Jeff A. Rihn, Alan S. Hilibrand, Alexander R. Vaccaro, Christopher K. KeplerGregory D. Schroeder

Division of Spine

Research output: Contribution to journal › Review article › peer-review

5 Scopus citations

Abstract

Study Design: Retrospective Cohort. Objective: To determine if outcomes varied between patients based on physical therapy (PT) attendance after lumbar fusion surgery. Summary of Background Data: The literature has been mixed regarding the efficacy of postoperative PT to improve disability and back pain, as measured by patient-reported outcome measures. Given the prevalence of PT referrals and lack of high-quality evidence, there is a need for additional studies investigating the efficacy of PT after lumbar fusion surgery to aid in developing robust clinical guidelines. Methods: We retrospectively identified patients receiving lumbar fusion surgery by current procedural terminology codes and separated them into 2 groups based on whether PT was prescribed. Electronic medical records were reviewed for patient and surgical characteristics, PT utilization, and surgical outcomes. Patient-reported outcome measures (PROMs) were identified and compared preoperatively, at 90 days postoperatively and one year postoperatively. Results: The two groups had similar patient characteristics and comorbidities and demonstrated no significant differences between readmission, complication, and revision rates after surgery. Patients that attended PT had significantly more fused levels (1.41 ± 0.64 vs. 1.32 ± 0.54, P=0.027), longer operative durations (234 ± 96.4 vs. 215 ± 86.1 min, P=0.012), and longer postoperative hospital stays (3.35 ± 1.68 vs. 3.00 ± 1.49 days, P=0.004). All groups improved similarly by Oswestry Disability Index, short form-12 physical and mental health subsets, and back and leg pain by Visual Analog Scale at 90-day and 1-year follow-up. Conclusion: Our data suggest that physical therapy does not significantly impact PROMs after lumbar fusion surgery. Given the lack of data suggesting clear benefit of PT after lumbar fusion, surgeons should consider more strict criteria when recommending physical therapy to their patients after lumbar fusion surgery. Level of Evidence: Level-.

Original language	English
Pages (from-to)	419-425
Number of pages	7
Journal	Clinical spine surgery
Volume	36
Issue number	10
DOIs	https://doi.org/10.1097/BSD.0000000000001483
State	Published - Dec 1 2023

Keywords

Lumbar Vertebrae
Patient-Reported Outcomes
Physical Therapy
Postoperative Period

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10.1097/BSD.0000000000001483

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Heard, J. C., Lee, Y. A., Lambrechts, M., Brush, P., Issa, T. Z., Kanhere, A., Bodner, J., Purtill, C., Reddy, Y. C., Patil, S., Somers, S., D'Antonio, N. D., Mangan, J. J., Canseco, J. A., Woods, B. R., Kaye, I. D., Rihn, J. A., Hilibrand, A. S., Vaccaro, A. R., ... Schroeder, G. D. (2023). The Impact of Physical Therapy after Lumbar Fusion Surgery. Clinical spine surgery, 36(10), 419-425. https://doi.org/10.1097/BSD.0000000000001483

@article{09182da4cefa44848f05e2cec8798cad,

title = "The Impact of Physical Therapy after Lumbar Fusion Surgery",

abstract = "Study Design: Retrospective Cohort. Objective: To determine if outcomes varied between patients based on physical therapy (PT) attendance after lumbar fusion surgery. Summary of Background Data: The literature has been mixed regarding the efficacy of postoperative PT to improve disability and back pain, as measured by patient-reported outcome measures. Given the prevalence of PT referrals and lack of high-quality evidence, there is a need for additional studies investigating the efficacy of PT after lumbar fusion surgery to aid in developing robust clinical guidelines. Methods: We retrospectively identified patients receiving lumbar fusion surgery by current procedural terminology codes and separated them into 2 groups based on whether PT was prescribed. Electronic medical records were reviewed for patient and surgical characteristics, PT utilization, and surgical outcomes. Patient-reported outcome measures (PROMs) were identified and compared preoperatively, at 90 days postoperatively and one year postoperatively. Results: The two groups had similar patient characteristics and comorbidities and demonstrated no significant differences between readmission, complication, and revision rates after surgery. Patients that attended PT had significantly more fused levels (1.41 ± 0.64 vs. 1.32 ± 0.54, P=0.027), longer operative durations (234 ± 96.4 vs. 215 ± 86.1 min, P=0.012), and longer postoperative hospital stays (3.35 ± 1.68 vs. 3.00 ± 1.49 days, P=0.004). All groups improved similarly by Oswestry Disability Index, short form-12 physical and mental health subsets, and back and leg pain by Visual Analog Scale at 90-day and 1-year follow-up. Conclusion: Our data suggest that physical therapy does not significantly impact PROMs after lumbar fusion surgery. Given the lack of data suggesting clear benefit of PT after lumbar fusion, surgeons should consider more strict criteria when recommending physical therapy to their patients after lumbar fusion surgery. Level of Evidence: Level-.",

keywords = "Lumbar Vertebrae, Patient-Reported Outcomes, Physical Therapy, Postoperative Period",

author = "Heard, {Jeremy C.} and Lee, {Yunsoo A.} and Mark Lambrechts and Parker Brush and Issa, {Tariq Z.} and Arun Kanhere and John Bodner and Caroline Purtill and Reddy, {Yashas C.} and Sanath Patil and Sydney Somers and D'Antonio, {Nicholas D.} and Mangan, {John J.} and Canseco, {Jose A.} and Woods, {Barrett R.} and Kaye, {Ian D.} and Rihn, {Jeff A.} and Hilibrand, {Alan S.} and Vaccaro, {Alexander R.} and Kepler, {Christopher K.} and Schroeder, {Gregory D.}",

year = "2023",

month = dec,

day = "1",

doi = "10.1097/BSD.0000000000001483",

language = "English",

volume = "36",

pages = "419--425",

journal = "Clinical spine surgery",

issn = "2380-0186",

number = "10",

}

Heard, JC, Lee, YA, Lambrechts, M, Brush, P, Issa, TZ, Kanhere, A, Bodner, J, Purtill, C, Reddy, YC, Patil, S, Somers, S, D'Antonio, ND, Mangan, JJ, Canseco, JA, Woods, BR, Kaye, ID, Rihn, JA, Hilibrand, AS, Vaccaro, AR, Kepler, CK & Schroeder, GD 2023, 'The Impact of Physical Therapy after Lumbar Fusion Surgery', Clinical spine surgery, vol. 36, no. 10, pp. 419-425. https://doi.org/10.1097/BSD.0000000000001483

TY - JOUR

T1 - The Impact of Physical Therapy after Lumbar Fusion Surgery

AU - Heard, Jeremy C.

AU - Lee, Yunsoo A.

AU - Lambrechts, Mark

AU - Brush, Parker

AU - Issa, Tariq Z.

AU - Kanhere, Arun

AU - Bodner, John

AU - Purtill, Caroline

AU - Reddy, Yashas C.

AU - Patil, Sanath

AU - Somers, Sydney

AU - D'Antonio, Nicholas D.

AU - Mangan, John J.

AU - Canseco, Jose A.

AU - Woods, Barrett R.

AU - Kaye, Ian D.

AU - Rihn, Jeff A.

AU - Hilibrand, Alan S.

AU - Vaccaro, Alexander R.

AU - Kepler, Christopher K.

AU - Schroeder, Gregory D.

PY - 2023/12/1

Y1 - 2023/12/1

N2 - Study Design: Retrospective Cohort. Objective: To determine if outcomes varied between patients based on physical therapy (PT) attendance after lumbar fusion surgery. Summary of Background Data: The literature has been mixed regarding the efficacy of postoperative PT to improve disability and back pain, as measured by patient-reported outcome measures. Given the prevalence of PT referrals and lack of high-quality evidence, there is a need for additional studies investigating the efficacy of PT after lumbar fusion surgery to aid in developing robust clinical guidelines. Methods: We retrospectively identified patients receiving lumbar fusion surgery by current procedural terminology codes and separated them into 2 groups based on whether PT was prescribed. Electronic medical records were reviewed for patient and surgical characteristics, PT utilization, and surgical outcomes. Patient-reported outcome measures (PROMs) were identified and compared preoperatively, at 90 days postoperatively and one year postoperatively. Results: The two groups had similar patient characteristics and comorbidities and demonstrated no significant differences between readmission, complication, and revision rates after surgery. Patients that attended PT had significantly more fused levels (1.41 ± 0.64 vs. 1.32 ± 0.54, P=0.027), longer operative durations (234 ± 96.4 vs. 215 ± 86.1 min, P=0.012), and longer postoperative hospital stays (3.35 ± 1.68 vs. 3.00 ± 1.49 days, P=0.004). All groups improved similarly by Oswestry Disability Index, short form-12 physical and mental health subsets, and back and leg pain by Visual Analog Scale at 90-day and 1-year follow-up. Conclusion: Our data suggest that physical therapy does not significantly impact PROMs after lumbar fusion surgery. Given the lack of data suggesting clear benefit of PT after lumbar fusion, surgeons should consider more strict criteria when recommending physical therapy to their patients after lumbar fusion surgery. Level of Evidence: Level-.

AB - Study Design: Retrospective Cohort. Objective: To determine if outcomes varied between patients based on physical therapy (PT) attendance after lumbar fusion surgery. Summary of Background Data: The literature has been mixed regarding the efficacy of postoperative PT to improve disability and back pain, as measured by patient-reported outcome measures. Given the prevalence of PT referrals and lack of high-quality evidence, there is a need for additional studies investigating the efficacy of PT after lumbar fusion surgery to aid in developing robust clinical guidelines. Methods: We retrospectively identified patients receiving lumbar fusion surgery by current procedural terminology codes and separated them into 2 groups based on whether PT was prescribed. Electronic medical records were reviewed for patient and surgical characteristics, PT utilization, and surgical outcomes. Patient-reported outcome measures (PROMs) were identified and compared preoperatively, at 90 days postoperatively and one year postoperatively. Results: The two groups had similar patient characteristics and comorbidities and demonstrated no significant differences between readmission, complication, and revision rates after surgery. Patients that attended PT had significantly more fused levels (1.41 ± 0.64 vs. 1.32 ± 0.54, P=0.027), longer operative durations (234 ± 96.4 vs. 215 ± 86.1 min, P=0.012), and longer postoperative hospital stays (3.35 ± 1.68 vs. 3.00 ± 1.49 days, P=0.004). All groups improved similarly by Oswestry Disability Index, short form-12 physical and mental health subsets, and back and leg pain by Visual Analog Scale at 90-day and 1-year follow-up. Conclusion: Our data suggest that physical therapy does not significantly impact PROMs after lumbar fusion surgery. Given the lack of data suggesting clear benefit of PT after lumbar fusion, surgeons should consider more strict criteria when recommending physical therapy to their patients after lumbar fusion surgery. Level of Evidence: Level-.

KW - Lumbar Vertebrae

KW - Patient-Reported Outcomes

KW - Physical Therapy

KW - Postoperative Period

UR - http://www.scopus.com/inward/record.url?scp=85178497812&partnerID=8YFLogxK

U2 - 10.1097/BSD.0000000000001483

DO - 10.1097/BSD.0000000000001483

M3 - Review article

C2 - 37491717

AN - SCOPUS:85178497812

SN - 2380-0186

VL - 36

SP - 419

EP - 425

JO - Clinical spine surgery

JF - Clinical spine surgery

IS - 10

ER -

The Impact of Physical Therapy after Lumbar Fusion Surgery

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Keywords

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