Department of Physical and Rehabilitation Medicine, University Hospitals Leuven, Leuven, Belgium -
REVAL Rehabilitation Research, Hasselt University, Diepenbeek, Belgium -
Eur J Phys Rehabil Med. 2023 Jun;59(3):377-385. doi: 10.23736/S1973-9087.23.07735-3. Epub 2023 Mar 29.
There is limited evidence to guide the rehabilitation of patients following single or double-level lumbar fusion surgery (LFS). This is reflected in extensive variability in current rehabilitation regimes and subsequent low clinical success rates, which urges a call for a consensus rehabilitation pathway.
To establish consensus on the optimal pre-, peri- and postoperative rehabilitation of LFS.
A modified Delphi Study.
Belgium and the Netherlands.
A multidisciplinary panel of 31 experts in the field of LFS and rehabilitation participated. Nine patients validated the consensus pathway.
A three-round online Delphi questionnaire was followed by an in-person consensus meeting. In each round, experts could suggest new statements, and received group summary statistics and feedback for reconsidered statements. Consensus threshold was set at ≥75% agreement. The resulting rehabilitation pathway was validated by patients through an online questionnaire and subsequent in-person focus group.
A total of 31 experts participated in the first online round, with 27 (87%) completing all online rounds, and 17 (55%) attending the in-person consensus meeting. Consensus was reached on 122 statements relating to pre-, peri- and postoperative rehabilitation of LFS, and validated by patients. Key components of the rehabilitation pathway included prehabilitation, education, physiotherapy in every phase, early postoperative mobilization, and little movement restrictions. Patients emphasized the need for support during the return-to-work process.
This process resulted in 122 expert-consensus statements on best practice rehabilitation for managing LFS, validated by patients.
The proposed rehabilitation pathway can serve as guidance to support clinicians, reduce practice variability, and subsequently improve clinical outcomes after LFS.
目前仅有有限的证据可以指导单节段或双节段腰椎融合术（LFS）后的患者康复。这反映在当前康复方案的高度变异性和随后的低临床成功率上，因此迫切需要建立一个共识的康复途径。
确定 LFS 术前、术中和术后最佳康复的共识。
改良 Delphi 研究。
比利时和荷兰。
由 31 名 LFS 和康复领域的多学科专家组成的小组参与。9 名患者验证了共识途径。
进行了三轮在线 Delphi 问卷调查，随后进行了一次面对面的共识会议。在每一轮中，专家可以提出新的陈述，并且会收到小组汇总统计数据和重新审议的陈述的反馈。共识阈值设定为≥75%的一致性。通过患者在线问卷调查和随后的面对面焦点小组，验证了由此产生的康复途径。
共有 31 名专家参加了第一轮在线调查，其中 27 名（87%）完成了所有在线轮次，17 名（55%）参加了面对面的共识会议。就 LFS 术前、术中和术后康复达成了 122 项共识声明，并得到了患者的验证。康复途径的关键组成部分包括术前康复、教育、各阶段的物理治疗、早期术后活动以及较少的运动限制。患者强调了在重返工作岗位过程中需要得到支持。
通过该过程，针对 LFS 管理的最佳实践康复达成了 122 项专家共识声明，并得到了患者的验证。
所提出的康复途径可以作为指导，支持临床医生，减少实践中的变异性，并随后提高 LFS 后的临床结果。
