The role of physical therapy and rehabilitation after lumbar fusion surgery for degenerative disease: a systematic review.

Madera M , Brady J , Deily S , McGinty T , Moroz L , Singh D , Tipton G , Truumees E ; for the Seton Spine
Rehabilitation Study Group.

Author Information
OBJECTIVE The purpose of this study was to provide a systematic and comprehensive review of the
existing literature regarding postfusion rehabilitation. METHODS Using the Preferred Reporting
Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, the authors conducted an
exhaustive review of multiple electronic databases. Potential articles were screened using
inclusion/exclusion criteria. Two authors independently analyzed these studies using predefined data
fields, including study quality indicators such as level of evidence and availability of accepted patient-reported
outcomes measures. These findings were synthesized in a narrative format. A third author
resolved disagreements regarding the inclusion of a study. RESULTS Twenty-one
articles with I or II levels of evidence were included in the review. The authors divided the findings of the literature
review into several groups: rehabilitation terminology, timing and duration of postfusion rehabilitation,
the need for rehabilitation relative to surgery-related morbidity, rehabilitation’s relationship to outcomes, and cognitive and psychosocial aspects of postsurgical rehabilitation. Current evidence generally supports formal rehabilitation after lumbar fusion surgery. Starting physical therapy at the
12-week postoperative mark results in better outcomes at lower cost than an earlier, 6-week start.
Where available, psychosocial support improves outcomes. However, a number of the questions could not be answered with high-grade
evidence. In these cases, the authors used “best evidence available” to make recommendations. There are many cases in which different types of caregivers use clinical terminology differently. The data supporting an optimal protocol for postfusion
rehabilitation remains elusive but, using the data available, the authors have crafted
recommendations and a model protocol, which is currently undergoing prospective study.
CONCLUSIONS Rehabilitation has long been a common feature in the postoperative management
of patients undergoing spinal fusion. Although caregivers from multiple disciplines agree that the
majority of their patients will benefit from this effort, the supporting data remain sparse. In creating a
model protocol for postlumbar fusion rehabilitation, the authors hope to share a starting point for
future postoperative lumbar fusion rehabilitation research.
CBT = cognitive behavioral therapy; LOE = level of evidence; LOS = length of stay; NASS = North
American Spine Society; ODI = Oswestry Disability Index; PRISMA; ROM = range of motion; degenerative; lumbar
fusion surgery; outcome; physical therapy; rehabilitation; systematic review
PMID: 28291412 DOI: 10.3171/2016.10.SPINE16627


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