McFarland Carol, Wang-Price Sharon, Gordon Charles R, Danielson Guy Otis, Crutchfield J Stuart, Medley Ann, Roddey Toni
Texas Woman's University, School of Physical Therapy, 5500 Southwestern Medical Avenue, Dallas, TX, USA 75235.
Precision Spine Care, Texas Spine and Joint Hospital, 1814 Roseland Blvd., Tyler, TX, USA 75701.
Rehabil Res Pract. 2020 Apr 24;2020:5946152. doi: 10.1155/2020/5946152. eCollection 2020.
Early physical therapy (PT) with specific stabilization training has been shown to benefit individuals after lumbar spinal surgery but has not been studied in patients after cervical spine surgery. The primary purpose of this study was to compare clinical outcomes between early cervical spine stabilizer (ECS) training and usual care (UC) in patients after anterior cervical discectomy and fusion (ACDF) surgery. The secondary purpose was to determine test-retest reliability of strength and endurance tests of cervical spinal stabilizers in this patient population.
Forty participants who were scheduled for ACDF surgery were randomized into either the ECS group or the UC group. After surgery, participants received their assigned group intervention during their hospital stay and continued their assigned intervention for 12 weeks. All participants had phone follow-ups twice during the first 6 weeks to address questions or problems. Clinical outcome measures including pain level using the Numeric Pain Rating Scale (NPRS), disability level using the Neck Disability Index (NDI), Craniocervical Flexor Strength (CCF-S), and Craniocervical Flexor Endurance (CCF-E) were collected three times: before surgery and 6 and 12 weeks after surgery. Test-retest reliability was assessed in the first 10 participants.
There was no significant interaction between the groups over time for any of the outcome measures. However, all participants made significant improvements in all four outcome measures at 6 and 12 weeks post surgery. The results showed good-to-excellent test-retest reliability for the CCF-S and CCF-E tests.
Both ECS training and UC resulted in the same amount of improvement at 6 and 12 weeks; therefore, both therapy approaches appear to have similar and positive effects on patients in their first 3 months of recovery after ACDF. Both the CCF-S and CCF-E tests can be used reliably to assess the strength and endurance of the cervical spinal stabilizers for patients after ACDF surgery. The study was registered with the ClinicalTrials.gov (NIH, U.S. National Library of Medicine, identifier # NCT01519115) Protocol Registration system.
早期物理治疗（PT）结合特定的稳定训练已被证明对腰椎手术后的个体有益，但尚未在颈椎手术后的患者中进行研究。本研究的主要目的是比较颈椎前路椎间盘切除融合术（ACDF）后患者早期颈椎稳定器（ECS）训练与常规护理（UC）的临床结果。次要目的是确定该患者群体中颈椎稳定器力量和耐力测试的重测信度。
40名计划进行ACDF手术的参与者被随机分为ECS组或UC组。手术后，参与者在住院期间接受指定的组干预，并持续12周。所有参与者在最初6周内进行两次电话随访，以解决问题。在手术前、术后6周和12周收集临床结果指标，包括使用数字疼痛评分量表（NPRS）的疼痛水平、使用颈部残疾指数（NDI）的残疾水平、颅颈屈肌力量（CCF-S）和颅颈屈肌耐力（CCF-E）。在前10名参与者中评估重测信度。
随着时间的推移，两组之间在任何结果指标上均无显著交互作用。然而，所有参与者在术后6周和12周时，所有四项结果指标均有显著改善。结果显示CCF-S和CCF-E测试具有良好到优秀的重测信度。
ECS训练和UC在术后6周和12周时改善程度相同；因此，两种治疗方法在ACDF术后恢复的前3个月对患者似乎都有相似的积极影响。CCF-S和CCF-E测试均可可靠地用于评估ACDF术后患者颈椎稳定器的力量和耐力。该研究已在ClinicalTrials.gov（美国国立医学图书馆国立卫生研究院，标识符#NCT01519115）方案注册系统中注册。
