A survey of post-operative management for patients following first time lumbar discectomy

Abstract

This study aimed to identify current NHS physiotherapy practice following first time lumbar discectomy in the United Kingdom (UK) in order to inform future research priorities and design. Descriptive survey methodology was utilised employing a postal questionnaire. A total population sample was identified and questionnaires were posted to 87 NHS physiotherapy departments throughout the UK. Participants were senior physiotherapists working with spinal surgery patients. In the inpatient phase, the majority of patients receive physiotherapy. Management focused on mobility and education to facilitate early discharge with most patients being given exercises. However, there was a wide variation in the actual exercises prescribed. There was more variation in the provision of outpatient physiotherapy treatment. Not all patients have access to physiotherapy treatment post discharge in the UK and when treatment was available the content and amount was variable. There is evidence to support rehabilitation classes to assist early improvements in function and return to work but such classes are only available in around half of the centres involved in this study. Regarding the content of exercise classes and individual treatment sessions, a wide range of clinical practice was evident. This study raises many research questions and highlights the need for future research to optimise patient rehabilitation following first time lumbar discectomy.

Time Courses of Adaptation in Lumbar Extensor Performance of Patients With a Single-Level Microdiscectomy During a Physical Therapy Exercise Program

“…This is almost double the normal amount of sessions a patient typically receives following SLM. 25 Due to the highly individualized starting levels of endurance and responses to the exercise program, our statistical model predicts that some patients may require close to an additional year of therapy after the initial 8 sessions to achieve the longest recommended hold time (if they could achieve it at all).…”

“…When compared to normative endurance times, the results of this study indicate that the number of sessions and duration of therapy needed to generate meaningful adaptations of the paraspinal musculature is longer than what is typically provided in the clinic postsurgery. 25 there are at least 2 findings that highlight the need for a postoperative, therapeutic exercise program. First, the success rate of first time SLM is approximately 75% to 80%.…”

“…15 Second, sessions that patients received following SLM. 25 Because the outcome or performance criteria to terminate therapy were not listed, the reasons for the number of clinical visits could not be determined. This wide range of visits may be indicative of the great level of variability in the number of visits needed by each patient, which would suggest that a standard number of sessions in clinical practice for the management of SLM might be well below that necessary to bring about positive changes in musculoskeletal performance in some patients.…”

“…Patients who met the program objective before the 35th session were given a special advanced program. 21 During the advanced phase, patients continued to use the Backstrong apparatus with a weighted vest that provided overload above body interventions, 25 we felt this was an adequate number. Following a 2½-week (8-session) training and adaptation phase, the program alternated between 2 strength phases (2 weeks, 6 sessions each) and 2 endurance phases (3 weeks, 9 sessions each).…”

Proprioceptive use and sit-to-stand-to-sit after lumbar microdiscectomy: The effect of surgical approach and early physiotherapy

“…Active over passive treatment after lumbar surgery (Carragee et al, 1999), and an early start of physiotherapy is suggested (Hebert et al, 2010;Millisdotter and Strömqvist, 2007). However, utilization of these parameters appears to be low (Williamson et al, 2007), and significant variability in routine treatment and advice in outpatient care after surgery is observed (Karikari and Isaacs, 2010;Williamson et al, 2007). Moreover, until now only low-quality evidence of physiotherapy after lumbar microdiscectomy was found, due to the lack of individualized and targeted care (Oosterhuis et al, 2014).…”