Postoperative Physiotherapie im Akutbereich – wann, welche und wieviel?

[Structured rehabilitation after lumbar spine surgery : subacute treatment phase]

BACKGROUND

There are currently no uniform standards regarding rehabilitation of patients after lumbar spine surgery. Due to significant improvements in surgical methods in recent years, an increase in postoperative training intensity is now possible. Conservative rehabilitation has yet to adapt to this reality. Earlier initiation of structured rehabilitation after the acute phase is often regarded with skepticism.

OBJECTIVE

To evaluate the effect of structured rehabilitation after lumbar spine surgery in the early phase of treatment (2 weeks after surgery), a group of seven spinal surgery clinics, two inpatient and three outpatient rehabilitation centers in the Rhine-Main area in Germany was formed.

MATERIALS AND METHODS

In this prospective study, 124 patients were divided into groups (A/B/C) by their surgeon, regardless of diagnosis and surgical procedure. For each group of participants, the content of therapy was preplanned.

RESULTS

The statistical analysis using the visual analog scale (VAS), Oswestry Disability Index (ODI), and short form-12 health survey (SF-12) to evaluate changes in impairment caused by back pain and in health-related quality of life was evaluated. In all three groups, significant improvements in VAS, ODI, and SF-12 were shown. Re-operation was unnecessary due to the absence of postoperative complications.

CONCLUSION

A structured postoperative rehabilitation program results in significant improvements in the parameters of pain and quality of life, and does not increase the risk of postoperative complications.

Intervention goals determine physical therapists' workload in the acute care setting

BACKGROUND

Investigating determinants of physical therapy workload in the acute care setting is essential for planning interventions, for justifying resource allocation, and for reimbursement.

OBJECTIVE

The objective of this study was to examine whether International Classification of Functioning, Disability and Health (ICF) intervention goals (ICF categories representing goals of physical therapy interventions typical for an acute care hospital) could predict physical therapy workload in the acute care hospital setting.

DESIGN

This investigation was a multicenter, observational cohort study.

METHODS

Patients were recruited from a representative sample of 32 acute care hospitals across Switzerland if they received physical therapy during their inpatient stay for the treatment of any injury or disease in 1 of 3 main diagnostic categories: musculoskeletal, neurological, and cardiopulmonary conditions. Physical therapists completed questionnaires at the time of the patients' discharge to report on ICF intervention goals. Information on workload was collected retrospectively from hospital documentation systems. Multivariable regression models were used to identify the intervention goals independently associated with workload.

RESULTS

The mean workload for 642 patients (mean age=61 years [SD=18 years], 45% women) was 370 minutes. The daily workload for interventions ranged from 33 minutes (cardiopulmonary conditions) to 49 minutes (neurological conditions). There were significant variations in workload across hospital sites and medical disciplines. The goal "maintaining a body position" emerged as a significant indicator of a higher workload for all condition groups; the goals "attention functions" and "transferring oneself" were indicators for neurological and musculoskeletal conditions, respectively.

LIMITATIONS

Not all potential predictors of workload could be examined. Other, person- or setting-specific variables might have been relevant to workload. Case mix and clinical practice were representative only for Swiss hospitals.

CONCLUSIONS

A small set of intervention goals were the major factors influencing physical therapy workload, independent of diagnosis or clinical specialty. Describing variability in physical therapists' practices in the acute care setting and relating these data to relevant patient-centered outcomes are the initial steps for improving resource allocation and reimbursement for interventions that maintain or improve functioning.

Rehabilitation after hallux valgus surgery: importance of physical therapy to restore weight bearing of the first ray during the stance phase

BACKGROUND

Operative treatment of people with hallux valgus can yield favorable clinical and radiographic results. However, plantar pressure analysis has demonstrated that physiologic gait patterns are not restored after hallux valgus surgery.

OBJECTIVE

The purpose of this study was to illustrate the changes of plantar pressure distribution during the stance phase of gait in patients who underwent hallux valgus surgery and received a multimodal rehabilitation program.

DESIGN

This was a prospective descriptive study.

METHODS

Thirty patients who underwent Austin (n=20) and scarf (n=10) osteotomy for correction of mild to moderate hallux valgus deformity were included in this study. Four weeks postoperatively they received a multimodal rehabilitation program once per week for 4 to 6 weeks. Plantar pressure analysis was performed preoperatively and 4 weeks, 8 weeks, and 6 months postoperatively. In addition, range of motion of the first metatarsophalangeal joint was measured, and the American Orthopaedic Foot and Ankle Society (AOFAS) forefoot questionnaire was administered preoperatively and at 6 months after surgery.

RESULTS

The mean AOFAS score significantly increased from 60.7 points (SD=11.9) preoperatively to 94.5 points (SD=4.5) 6 months after surgery. First metatarsophalangeal joint range of motion increased at 6 months postoperatively, with a significant increase in isolated dorsiflexion. In the first metatarsal head region, maximum force increased from 117.8 N to 126.4 N and the force-time integral increased from 37.9 N.s to 55.6 N.s between the preoperative and 6-month assessments. In the great toe region, maximum force increased from 66.1 N to 87.2 N and the force-time integral increased from 18.7 N.s to 24.2 N.s between the preoperative and 6-month assessments.

LIMITATIONS

A limitation of the study was the absence of a control group due to the descriptive nature of the study.

CONCLUSIONS

The results suggest that postoperative physical therapy and gait training may lead to improved function and weight bearing of the first ray after hallux valgus surgery.