Inpatient or Outpatient Rehabilitation after Herniated Disc Surgery? – Setting-Specific Preferences, Participation and Outcome of Rehabilitation

Abstract

ObjectiveTo examine rehabilitation preferences, participation and determinants for the choice of a certain rehabilitation setting (inpatient vs. outpatient) and setting-specific rehabilitation outcomes.MethodsThe longitudinal observational study referred to 534 consecutive disc surgery patients (18–55 years). Face-to-face baseline interviews took place about 3.6 days after disc surgery during acute hospital stay. 486 patients also participated in a follow-up interview via telephone three months later (dropout-rate: 9%). The following instruments were used: depression and anxiety (Hospital Anxiety and Depression Scale), pain intensity (numeric analog scale), health-related quality of life (Short Form 36 Health Survey), subjective prognosis of gainful employment (SPE-scale) as well as questions on rehabilitation attendance, return to work, and amount of sick leave days.ResultsThe vast majority of patients undergoing surgery for a herniated disc attended a post-hospital rehabilitation treatment program (93%). Thereby two-thirds of these patients took part in an inpatient rehabilitation program (67.9%). Physical, psychological, vocational and health-related quality of life characteristics differed widely before as well as after rehabilitation depending on the setting. Inpatient rehabilitees were significantly older, reported more pain, worse physical quality of life, more anxiety and depression and a worse subjective prognosis of gainful employment before rehabilitation. Pre-rehabilitation differences remained significant after rehabilitation. More than half of the outpatient rehabilitees (56%) compared to only one third of the inpatient rehabilitees (33%) returned to work three months after disc surgery (p<.001).ConclusionThe results suggest a “pre-selection” of patients with better health status in outpatient rehabilitation. Gaining better knowledge about setting-specific selection processes may help optimizing rehabilitation allocation procedures and improve rehabilitation effects such as return to work.

Determinants of patient satisfaction in outpatient musculoskeletal physiotherapy: a systematic, qualitative meta-summary, and meta-synthesis

“…Despite conducting an extensive search of the literature, across six databases augmented by a "berry-picking" method [22], some relevant studies may have been missed for inclusion in this synthesis. Although a specialist librarian was consulted throughout the systematic search process [22], the decision to not include the free text orthopaedic and neurological) [65], the patients' expectations, recovery times and treatment goals [66]. Moreover, inpatients are managed by a healthcare team thus their satisfaction is not directly attributable to the physiotherapy [6].…”

Assessment and Determinants of Spinal Pain in the Course of Disc Disorders Treated Surgically

“…As indicated by Fagan [34], spinal motion segment lesion caused by a disc hernia leads to inflammation, which in turn activates nociceptors responsible for pain sensation. The available literature mentions other factors that predispose to pain occurrence in these conditions, such as obesity [35], duration of the acute phase (the best results tend to be obtained with patients whose acute phase did not exceed 3 months [36]), or past history of spine operations [19]. Papadopoulos [37], however, did not find such a relationship.…”

Choosing the right rehabilitation setting after herniated disc surgery: Motives, motivations and expectations from the patients’ perspective

“…This study is a longitudinal cohort study. Detailed information on study design and sample is published elsewhere [ 5 ]. A total of 534 consecutive herniated disc surgery patients (response rate: 86%) participated in a baseline interview (T0) within acute care hospital.…”

“…Thus, the presented data refer to 452 study patients. Out of those 307 patients attended an inpatient rehabilitation setting (IPR) and 145 patients an outpatient setting (OPR) [ 5 ].…”