A Preoperative Spinal Education intervention for spinal fusion surgery designed using the Rehabilitation Treatment Specification System is safe and could reduce hospital length of stay, normalize expectations, and reduce anxiety

Edwards, Richard; Gibson, Jamie; Mungin-Jenkins, Escye; Pickford, R.; Lucas, Jonathan; Jones, Gareth D.

doi:10.1302/2633-1462.32.bjo-2021-0160.r1

Cited by 11 publications

(20 citation statements)

References 51 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…24 A recent prospective study conducted by Edwards et al found that a preoperative spinal education (POSE) program was associated with a significant reduction in the length of hospital stay post lumbar fusion surgery, thereby supporting the use of preoperative programs. 22 Overall, these study results strengthen the case for incorporating prehabilitation education programs in spine surgery.…”

Section: General Education-based Prehabilitation (N = 6)supporting

confidence: 58%

“…General education-based prehabilitation made up 26% of the 23 eligible studies. These studies consisted of randomized clinical trials (n = 2, 8.6%), 20,21 prospective cohort studies (n = 2, 8.6%), 22,23 and retrospective cohort studies (n = 2, 8.6%). 24,25 These studies used different prehabilitation education strategies including in-depth information about the surgical procedure, reasons for having the surgery, expectations, risks, limitations, recovery process, and pain experience.…”

Section: General Education-based Prehabilitation (N = 6)mentioning

confidence: 99%

See 1 more Smart Citation

Prehabilitation for spine surgery: A scoping review

Eubanks

Carlesso

Sundaram

et al. 2023

PM&R

View full text Add to dashboard Cite

We aimed to identify and describe the current interventions used in preoperative programs (“prehabilitation”) for spine surgery. Knowledge gaps in approaches, feasibility, timing, patient experience, clinical outcomes, and health care costs were explored while describing their potential benefits on physical and psychological outcomes. An electronic search was conducted from January 2004 to February 2022 in Ovid Medline, Embase, EBSCO CINAHL, the Cochrane Database of Systematic Reviews, and PEDro to identify studies in English evaluating adults enrolled in prehabilitation before undergoing elective spine surgeries. Studies were uploaded into DistillerSR for systematic screening after removing duplicates. Four reviewers screened nested references for inclusion based on titles and abstracts, followed by their full‐text review. Two reviewers subsequently extracted data and summarized the results. The results were reported using Preferred Reporting Items for Systematic reviews and Meta‐Analyses extension for Scoping Reviews guidelines. Studies were rated for quality using National Health and Medical Research Council criteria. Out of 18,879 potential studies, a total of 23 studies (0.12%) met the eligibility criteria and were included in this scoping review. The prehabilitation programs included general education (n = 6, 26%), exercise (n = 6, 26%), cognitive behavioral therapy (n = 3, 13%), pain neuroscience education (n = 3, 13%), health behavior counseling (n = 3, 13%), and mindfulness (n = 2, 9%). Additional studies are needed to identify optimal patient characteristics, intervention dosage, and whether multimodal approaches using a combination of physical and psychological strategies lead to more favorable outcomes. Although studies on prehabilitation for spine surgery are limited, they seem to demonstrate that prehabilitation programs are feasible, reduce medical expenditures, and improve patients' postoperative pain, disability, self‐efficacy, psychological behaviors, and satisfaction with surgical outcomes. The available literature suggests there is an opportunity to improve patient experience, clinical outcomes and reduce medical costs with the use of prehabilitation in spine surgery.

show abstract

Section: General Education-based Prehabilitation (N = 6)supporting

confidence: 58%

Section: General Education-based Prehabilitation (N = 6)mentioning

confidence: 99%

Prehabilitation for spine surgery: A scoping review

Eubanks

Carlesso

Sundaram

et al. 2023

PM&R

View full text Add to dashboard Cite

show abstract

Section: Discussionmentioning

confidence: 99%

“…37 Given the importance of adherence to postoperative instructions and physiotherapy, preoperative intervention to lessen the psychological burden and properly define the patient's expectations from surgery may be vital in improving both the patientreported and structural outcomes of ASD surgery. 38,39 Osteoporosis and obesity were more problematic conditions in younger patients, and their impact was modulated by the severity of baseline deformity. The adverse impact of obesity and osteoporosis has also been highlighted in several areas of spine surgery, including deformity correction.…”

Section: Discussionmentioning

confidence: 99%

Assessing the influence of modifiable patient-related factors on complication rates after adult spinal deformity surgery

Williamson

Passfall

Ihejirika-Lomedico

et al. 2022

The Bone & Joint Journal

View full text Add to dashboard Cite

Aims Postoperative complication rates remain relatively high after adult spinal deformity (ASD) surgery. The extent to which modifiable patient-related factors influence complication rates in patients with ASD has not been effectively evaluated. The aim of this retrospective cohort study was to evaluate the association between modifiable patient-related factors and complications after corrective surgery for ASD. Methods ASD patients with two-year data were included. Complications were categorized as follows: any complication, major, medical, surgical, major mechanical, major radiological, and reoperation. Modifiable risk factors included smoking, obesity, osteoporosis, alcohol use, depression, psychiatric diagnosis, and hypertension. Patients were stratified by the degree of baseline deformity (low degree of deformity (LowDef)/high degree of deformity (HighDef): below or above 20°) and age (Older/Younger: above or below 65 years). Complication rates were compared for modifiable risk factors in each age/deformity group, using multivariable logistic regression analysis to adjust for confounders. Results A total of 480 ASD patients met the inclusion criteria. By two years, complication rates were 72% ≥ one complication, 28% major, 21% medical, 27% surgical, 11% major radiological, 8% major mechanical, and 22% required reoperation. Younger LowDef patients with osteoporosis were more likely to suffer either a major mechanical (odds ratio (OR) 5.9 (95% confidence interval (CI) 1.1 to 36.9); p = 0.048) or radiological complication (OR 7.0 (95% CI 1.9 to 25.9); p = 0.003). Younger HighDef patients were much more likely to develop complications if obese, especially major mechanical complications (OR 2.8 (95% CI 1.1 to 8.6); p = 0.044). Older HighDef patients developed more complications when diagnosed with depression, including major radiological complications (OR 3.5 (95% CI 1.1 to 10.6); p = 0.033). Overall, a diagnosis of depression proved to be a risk factor for the development of major radiological complications (OR 2.4 (95% CI 1.3 to 4.5); p = 0.005). Conclusion Certain modifiable patient-related factors, especially osteoporosis, obesity, and mental health status, are associated with an increased risk of complications after surgery for spinal deformity. Surgeons should look for these conditions when assessing a patient for surgery, and optimize them to the fullest extent possible before proceeding to surgical correction so as to minimize the prospect of postoperative morbidity. Cite this article: Bone Joint J 2022;104-B(11):1249–1255.

show abstract

“…how the ingredients affect the target) (8). To date, published application of the RTSS have demonstrated the ability of the RTSS to map targets and ingredients to a patient population or therapy discipline using previous research (9)(10)(11)(12)(13)(14). Yet understanding clinicians' experiences utilizing the RTSS and any effects it has on clinical rehabilitation practice remains to be understood.…”

Section: Introductionmentioning

confidence: 99%

Embedding the Rehabilitation Treatment Specification System into clinical practice: An evaluation of a pilot teaching programme

Gibson

Sampford

Myers-Ingram

et al. 2022

Preprint

View full text Add to dashboard Cite

Background: Deficiency in the provision and quality of treatment specification by rehabilitation clinicians impairs the ability to differentiate effective from ineffective elements of treatment. The standardized language of the rehabilitation treatment specification system (RTSS) has been proposed as a countermeasure. To date, there is no evidence of its use in clinical practice and what effect it may have. This study aimed to assess the ability of a pilot teaching programme to embed the RTSS into the clinical practice of an inpatient oncology physiotherapy team. The objectives were to evaluate the teaching programme’s effect on; participants’ familiarity and perceived benefit of the RTSS, its uptake, participants’ clinical reasoning, and their feelings and attitudes towards adopting the RTSS. This study provides an evaluation of the pilot teaching programme which will subsequently inform a larger iteration in an ongoing Health Education England (HEE) project aiming to disseminate and embed the RTSS into physiotherapy practice to improve physiotherapists’ treatment specification. Methods A 6-week, multi-modal RTSS pilot teaching programme based upon socio-constructivist theory was delivered to 10 inpatient oncology physiotherapists at a large urban UK trust in 2021. Self-reported measures and clinical case note audits were assessed before and after the RTSS teaching programme to evaluate its effect on RTSS familiarity and perceived benefit, uptake, and clinical reasoning. A post-teaching focus group was undertaken. It was qualitatively analysed using an inductive, independent thematic approach to evaluate clinicians’ reflection and adoption. Results Ten participants (8F, 29.4(±3.5) years) with variable clinical experience completed the RTSS teaching programme (six 1-hour lecture/case-based-learning sessions weekly) with 85% mean attendance. Nine yielded complete data for analyses, and 7 participated in the focus group. There was significant improvement in self-reported familiarity and confidence using the RTSS. Furthermore, there was a significant effect of the teaching on self-reported clinical reasoning overall and specifically in knowledge and theory application. But this was not reflected in clinicians’ uptake of RTSS language, nor in the quality of clinical reasoning emergent in their case notes. Qualitative analyses revealed that while clinicians’ conceptual understanding and the relative advantage of using the RTSS in practice was pervasive, they articulated that translating its perceived academic disposition into their clinical practice a challenge. Conclusions: The RTSS teaching programme was shown to be effective in improving self-reported measures of clinical reasoning, despite clinical uptake of the RTSS remaining low. Future iterations should be tested across physiotherapy specialisms and in a greater sample with consideration of pedagogical and cultural measures to support the clinical diffusion of the RTSS including longer teaching periods, introducing pre-teaching e-learning approaches, incorporating how to document RTSS language into clinical case-notes, and designing the teaching to influence clinical leaders.

show abstract

A Preoperative Spinal Education intervention for spinal fusion surgery designed using the Rehabilitation Treatment Specification System is safe and could reduce hospital length of stay, normalize expectations, and reduce anxiety

Cited by 11 publications

References 51 publications

Prehabilitation for spine surgery: A scoping review

Prehabilitation for spine surgery: A scoping review

Assessing the influence of modifiable patient-related factors on complication rates after adult spinal deformity surgery

Embedding the Rehabilitation Treatment Specification System into clinical practice: An evaluation of a pilot teaching programme

Contact Info

Product

Resources

About