Division of Biokinesiology and Physical Therapy, Herman Ostrow School of Dentistry.
Department of Orthopaedic Surgery, Keck School of Medicine, USC Spine Center, University of Southern California, Los Angeles, CA.
Clin Spine Surg. 2021 Oct 1;34(8):291-307. doi: 10.1097/BSD.0000000000001108.
Systematic review.
To characterize the effects of postoperative physical therapy (PT) after surgery for cervical spondylosis on patient-reported outcomes and impairments. Secondarily, to identify associated complications, adverse effects, and health care costs with postoperative PT, and to describe the content, timing, and duration of the PT.
Cervical spine surgery is common; however, it is unclear if the addition of postoperative PT leads to improved patient outcomes and decreased health care costs.
PubMed, Embase, Cochrane Central Register of Controlled Trials, Physiotherapy Evidence Database, and Web of Science were searched until July 2019. All peer-reviewed articles involving cervical spine surgery with postoperative PT for cervical spondylosis were considered for inclusion. Risk of bias was assessed using the Revised Cochrane risk-of-bias tool for randomized trials. Findings were described narratively, and GRADE approach was used to define the quality of evidence.
A total of 10,743 studies were screened. Six studies met inclusion criteria; 2 randomized controlled trials and 4 subsequent follow-up studies containing study arms that included postoperative PT after cervical spine surgery. Meta-analysis was not performed due to study heterogeneity and no study compared PT+surgery to surgery alone. PT treatment included exercise therapy, cognitive behavioral therapy, and optional vestibular rehabilitation. Included studies indicated PT appeared to have positive effects on patient outcomes, however, there were no treatment control groups and the quality of evidence was very low to low. Timing, duration, and content of PT programs varied. No studies reported complications, adverse effects, or cost-effectiveness relating to PT after surgery.
Current literature prevents a definitive conclusion regarding the impact of postoperative PT, given the lack of treatment control groups. PT treatment was limited to exercise therapy, cognitive behavioral therapy, and optional vestibular rehabilitation in the included studies. PT treatment varied, limiting consistent recommendations for content, timing, and treatment duration. Controlled trials are needed to determine the effectiveness of the addition of postoperative PT following cervical spine surgery for cervical spondylosis.
Level II.
系统评价。
描述颈椎病手术后物理治疗（PT）对患者报告结果和功能障碍的影响。其次，确定与术后 PT 相关的并发症、不良影响和医疗保健费用，并描述 PT 的内容、时间和持续时间。
颈椎手术很常见；然而，尚不清楚术后 PT 是否会改善患者的预后并降低医疗保健成本。
检索了 PubMed、Embase、Cochrane 对照试验中心注册库、物理治疗证据数据库和 Web of Science，检索时间截至 2019 年 7 月。所有涉及颈椎病手术后行颈椎病术后 PT 的同行评审文章均被认为符合纳入标准。使用修订后的 Cochrane 随机试验偏倚风险工具评估偏倚风险。结果以叙述性方式描述，并使用 GRADE 方法定义证据质量。
共筛选出 10743 项研究。6 项研究符合纳入标准；2 项随机对照试验和 4 项后续随访研究包含了颈椎手术后行术后 PT 的研究臂。由于研究异质性且没有研究将 PT+手术与单独手术进行比较，因此未进行荟萃分析。PT 治疗包括运动疗法、认知行为疗法和可选的前庭康复。纳入的研究表明，PT 似乎对患者的结果有积极的影响，但是没有治疗对照组，并且证据质量非常低至低。PT 方案的时间、持续时间和内容各不相同。没有研究报告与手术后 PT 相关的并发症、不良影响或成本效益。
鉴于缺乏治疗对照组，目前的文献无法确定术后 PT 的影响。纳入的研究中，PT 治疗仅限于运动疗法、认知行为疗法和可选的前庭康复。PT 治疗方式多样，限制了对内容、时间和治疗持续时间的一致建议。需要进行对照试验来确定颈椎病手术后添加术后 PT 的有效性。
II 级。
