In work involving 52 patients, London-based researchers have determined that a program of 10 consecutive weekly group rehabilitation sessions following lumbar fusion (education, low-tech cardiovascular, limb and spine strengthening exercises, and peer support), “appears to convey a meaningful clinical improvement in functional ability.”
Study: Structured Rehab Post-Lumbar Fusion Improves Outcomes
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Secondary#lumbarfusion#surgicalrehabilitation
Their work, “Rehabilitation following lumbar fusion surgery (REFS) a randomised controlled feasibility study,” appeared in the February 20, 2019 edition of the European Spine Journal.
" data-large-file="https://i0.wp.com/ryortho.com/wp-content/uploads/2019/03/StudyStructured_REFSprogram_WEB2.jpg?fit=730%2C1022&ssl=1" src="https://i0.wp.com/ryortho.com/wp-content/uploads/2019/03/StudyStructured_REFSprogram_WEB2.jpg?resize=730%2C1022&ssl=1" alt="" width="730" height="1022">REFS program / Source: James Greenwood
James Greenwood, B.Sc. (hons), M.Res., with the Victor Horsley Department of Neurosurgery at the National Hospital for Neurology and Neurosurgery and co-author explained the genesis of the study to OTW, “The data that led to this research program related to the well documented sub-optimal patient outcomes following lumbar fusion surgery, especially back-related disability.”
“We conducted a systematic review and meta-analysis which was published in Spine which showed the potential for complex rehabilitation. Interestingly, we were able to use theoretical modelling to inform the content of the program and the outcomes; this approach is recommended by the medical research council.”
“It was interesting that by providing structured rehabilitation as opposed to usual care we were able to improve clinical outcomes. This is being further explored with a qualitative study to identify valued program content and thus explain the numerical divergence.”
“The take home message is, ‘Do not provide surgery in isolation. If you are providing fusion of lumbar spine, ideally you should be providing a structured rehabilitation group such as REFS to help improve your outcomes.’”
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Discussion
This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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