Lorentz Nathan A, Galetta Matthew S, Zabat Michelle A, Raman Tina, Protopsaltis Themistocles S, Fischer Charla
Orthopaedic Surgery, New York University (NYU) Grossman School of Medicine, New York, USA.
Cureus. 2023 Jun 17;15(6):e40559. doi: 10.7759/cureus.40559. eCollection 2023 Jun.
Introduction Post-operative physical therapy (PT) following anterior cervical discectomy and fusion (ACDF) surgery is often performed to improve a patient's functional ability and reduce neck pain. However, current literature evaluating the benefits of post-operative PT using patient-reported outcomes (PROs) is limited and remains inconclusive. Here we compare post-operative improvement between patients who did and did not undergo formal PT after ACDF using Patient-Reported Outcomes Measurement Information System (PROMIS) scores. Methods A retrospective observational study examining patients who underwent one- or two-level primary ACDF or cervical disc replacement (CDR) at an academic orthopedic hospital and who had PROMIS scores recorded pre-operatively and through two-year follow-up. Patients were stratified according to whether or not they attended formal postoperative PT. PROMIS scores and patient demographics were compared using the Mann-Whitney U test, Fisher's exact test, chi-square test of independence, and Student's t-test within and between cohorts. Results Two hundred and twenty patients were identified. Demographic differences between PT and no PT groups include age (PT 54.1 vs. no PT 49.5, p=0.005) and BMI (PT 28.1 vs. no PT 29.8, p=0.028). The only significant difference in post-operative PROMIS scores was in physical health scores at three months post-operatively (no PT 43.9 vs. PT 39.1, p=0.008). Physical health scores improved from baseline to one-year follow-up in both cohorts (PT +3.5, p=0.025; no PT +6.6, p=0.008). There were no significant differences when comparing improvements in physical health scores between groups at six months and one year. Conclusion In conclusion, there was no significance to support the benefits of post-operative PT as measured by PROMIS scores. No significant differences in PROMIS were observed between groups from pre-operative baseline scores to six-month and one-year follow-ups.
引言 颈椎前路椎间盘切除融合术（ACDF）术后的物理治疗（PT）通常用于提高患者的功能能力并减轻颈部疼痛。然而，目前使用患者报告结局（PROs）评估术后PT益处的文献有限且尚无定论。在此，我们使用患者报告结局测量信息系统（PROMIS）评分比较了ACDF术后接受和未接受正规PT的患者的术后改善情况。
方法 一项回顾性观察研究，对在一家学术性骨科医院接受单节段或双节段初次ACDF或颈椎间盘置换术（CDR）且术前及两年随访期间记录了PROMIS评分的患者进行研究。患者根据是否接受正规术后PT进行分层。使用Mann-Whitney U检验、Fisher精确检验、独立性卡方检验以及队列内和队列间的学生t检验对PROMIS评分和患者人口统计学数据进行比较。
结果 共纳入220例患者。接受PT组和未接受PT组的人口统计学差异包括年龄（接受PT组54.1岁 vs. 未接受PT组49.5岁，p = 0.005）和体重指数（接受PT组28.1 vs. 未接受PT组29.8，p = 0.028）。术后PROMIS评分的唯一显著差异在于术后三个月的身体健康评分（未接受PT组43.9 vs. 接受PT组39.1，p = 0.008）。两个队列的身体健康评分从基线到一年随访均有所改善（接受PT组提高3.5，p = 0.025；未接受PT组提高6.6，p = 0.008）。在六个月和一年时比较两组间身体健康评分的改善情况时，未发现显著差异。
结论 总之，尚无证据支持以PROMIS评分衡量的术后PT的益处。从术前基线评分到六个月和一年随访，各队列之间在PROMIS评分方面未观察到显著差异。
