Determining clinical practice of expert physiotherapy for patients undergoing lumbar spinal fusion: a cross-sectional survey study

Abstract

Purpose To determine the content of current Dutch expert hospital physiotherapy practice for patients undergoing lumbar spinal fusion (LSF), to gain insight into expert-based clinical practice. Methods At each hospital where LSF is performed, one expert physiotherapist received an e-mailed questionnaire, about pre-and postoperative physiotherapy and discharge after LSF. The level of uniformity in goals and interventions was graded on a scale from no uniformity (50-60 %) to very strong uniformity (91-100 %).Results LSF was performed at 34 of the 67 contacted hospitals. From those 34 hospitals, 28 (82 %) expert physiotherapists completed the survey. Twenty-one percent of the respondents saw patients preoperatively, generally to provide information. Stated postoperative goals and administered interventions focused mainly on performing transfers safely and keeping the patient informed. Outcome measures were scarcely used. There was no uniformity regarding advice on the activities of daily living. Conclusion Dutch perioperative expert physiotherapy for patients undergoing LSF is variable and lacks structural outcome assessment. Studies evaluating the effectiveness of best-practice physiotherapy are warranted.

A Critical Analysis of the Exercise Prescription and Return to Activity Advice That Is Provided in Patient Information Leaflets Following Lumbar Spine Surgery

“…The findings of this study are similar to others [4,6], whereby there is a significant amount of inconsistency and variation in advice provided across the majority of domains of clinical practice and patient management. Variation exists in the prescription of exercise, the advice to return to normal activities and also returning to work.…”

“…However, there appears to be significant variation in the delivery of postoperative spine rehabilitation in the United Kingdom (UK), with a variability of practice, mode of delivery, and with a limited use of outcome measures [4]. Perioperative physiotherapy has been reported as inconsistent [5], with no uniformity regarding advice on activities of daily living, and a lack of structured outcome evaluation [6]. The reason for this inconsistency may be due to the complex multidimensional nature of low back-related pain that encompasses a bio-psychosocial context, and as such there is limited evidence to support the effectiveness of one particular rehabilitation intervention over another [7,8].…”

Early postoperative physical activity and function: a descriptive case series study of 53 patients after lumbar spine surgery

“…Coupled with the finding that most patients in our cohort attended PT, these results suggest standard PT is limited in altering physical activity following orthopaedic surgery. While postoperative education on physical activity is considered an important component of early postoperative care [29], several surveys have reported variable patterns on the type or extent of education or instruction on physical activity or exercise [25,70,71]. Structured behavioral strategies which target physical activity may need to be integrated within PT or provided as an adjunct strategy.…”

Spinal Surgeons’ Opinions on Pre- and Postoperative Rehabilitation in Patients Undergoing Lumbar Spinal Fusion Surgery

“…The number of surgeons analyzed is comparable to other recently conducted cross-sectional studies. 11,20 We discovered consistent opinions valuable for consensus guidelines, as well as inconsistent opinions and variability in practice leading to new research topics. We believe this study can act as a starting point for future research and will be valuable for the spinal community.…”