Heard Jeremy C, D'Antonio Nicholas D, Lambrechts Mark J, Boere Payton, Issa Tariq Z, Lee Yunsoo A, Canseco Jose A, Kaye Ian David, Woods Barrett R, Hilibrand Alan S, Vaccaro Alexander R, Kepler Christopher K, Schroeder Gregory D
Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA, USA.
Department of Orthopaedic Surgery, Washington University, St Louis, MO, USA.
J Craniovertebr Junction Spine. 2023 Jul-Sep;14(3):230-235. doi: 10.4103/jcvjs.jcvjs_61_23. Epub 2023 Sep 18.
The objectives of our study were to (1) determine if physical therapy (PT) impacts patient-reported outcomes (PROMs) after lumbar decompression surgery and (2) determine if PT impacts postsurgical readmissions or reoperations after lumbar decompression surgery.
Patients 18 years of age who underwent primary one- or two-level lumbar decompression at our institution were identified. Patient demographics, surgical characteristics, surgical outcomes (all-cause 90 days readmissions and 90 days surgical readmissions), and patient-reported outcomes (PROMs) were compared between the groups. Multivariate linear regression was utilized to determine the individual predictors of 90 days readmissions and PROMs at the 1-year postoperative point. Alpha was set at < 0.05.
Of the 1003 patients included, 421 attended PT postoperatively. On univariate analysis, PT attendance did not significantly impact 90-day surgical reoperations ( = 0.225). Although bivariate analysis suggests that attendance of PT is associated with worse improvement in physical function ( = 0.041), increased preoperative Visual Analogue Scale leg pain (0 = 0.004), and disability ( = 0.006), as measured by the Oswestry Disability Index, our multivariate analysis, which accounts for confounding variables found there was no difference in PROM improvement and PT was not an independent predictor of 90-day all-cause readmissions ( = 0.06). Instead, Charlson Comorbidity Index ( = 0.025) and discharge to a skilled nursing facility ( = 0.013) independently predicted greater 90-day all-cause readmissions.
Postoperative lumbar decompression PT attendance does not significantly affect clinical improvement, as measured by PROMs or surgical outcomes including all-cause 90 days readmissions and 90-day surgical readmissions.
我们研究的目的是（1）确定物理治疗（PT）对腰椎减压手术后患者报告结局（PROMs）的影响，以及（2）确定PT对腰椎减压手术后的再次入院或再次手术的影响。
确定在我们机构接受初次单节段或双节段腰椎减压手术的18岁患者。比较两组患者的人口统计学、手术特征、手术结局（全因90天再次入院和90天手术再次入院）以及患者报告结局（PROMs）。采用多变量线性回归确定术后1年时90天再次入院和PROMs的个体预测因素。设定α<0.05。
在纳入的1003例患者中，421例术后接受了PT治疗。单因素分析显示，接受PT治疗对90天手术再次手术无显著影响（P=0.225）。尽管双因素分析表明，接受PT治疗与身体功能改善较差有关（P=0.041），术前视觉模拟量表腿痛增加（P=0.004），以及由Oswestry功能障碍指数测量的残疾增加（P=0.006），但我们的多变量分析考虑了混杂变量，发现PROM改善无差异，PT不是90天全因再次入院的独立预测因素（P=0.06）。相反，Charlson合并症指数（P=0.025）和转至专业护理机构（P=0.013）独立预测90天全因再次入院率更高。
腰椎减压术后接受PT治疗对临床改善无显著影响，临床改善通过PROMs或手术结局衡量，包括全因90天再次入院和90天手术再次入院。
