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Shields LBE, Clark L, Reed J, Tichenor S. Implementing a nurse-led prehabilitation program for patients undergoing spinal surgery. Nursing 2024; 54:42-50. [PMID: 38913927 DOI: 10.1097/nsg.0000000000000025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/26/2024]
Abstract
ABSTRACT Prehabilitation, or "prehab," helps patients optimize strength, function, and nutrition before surgery. This evidence-based practice project presents strategies for implementing a prehab program to prepare patients for spinal surgery. Nurses play an integral role in educating patients preoperatively about the myriad lifestyle changes associated with spinal surgery.
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Affiliation(s)
- Lisa B E Shields
- Lisa Shields is a medical research associate at Norton Neuroscience Institute, Norton Healthcare. Lisa Clark is the program manager for Neurosurgery at Norton Healthcare. Jenna Reed is the rehabilitation supervisor at the Norton Neurosciences and Spine Rehabilitation Center. Stephanie Tichenor is a neurosurgery nurse practitioner at the Norton Neuroscience Institute
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Zhong Y, Ding Y, Fu B, Ma G, Cui H, Li M, Yu Y, Guan L. The effectiveness of postoperative exercise based on gait analysis compared with conventional exercise in patients with lumbar spinal stenosis: A randomized clinical trial. J Back Musculoskelet Rehabil 2023; 36:1399-1409. [PMID: 37482981 DOI: 10.3233/bmr-220409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/25/2023]
Abstract
BACKGROUND Despite being used as a program of postoperative rehabilitation, few randomized controlled trials have compared the effectiveness of postoperative exercise based on gait analysis in patients with lumbar spinal stenosis (LSS). OBJECTIVE To investigate the effectiveness of postoperative exercise based on gait analysis in patients with LSS and to compare it with the effectiveness of conventional exercise. METHODS This was a double-blind, randomized clinical trial. Sixty-eight participants with LSS were randomly assigned to one of two groups. After receiving a standardized surgical procedure, the observation group received exercises based on 3-D gait analysis, and the control group received empirical physiotherapy containing 4 basic interventions. Both groups took a one-hour session twice daily for 2 weeks. The Oswestry Disability Index (ODI) scale and the Visual Analog Scale (VAS) were measured before and 2 weeks and 6 months after intervention. The gait indicators were measured before and 6 months after intervention. RESULTS At baseline, there were no significant differences in the ODI, VAS or absolute symmetry index (ASI) of the gait variables between the observation group and the control group. However, at 6 months, pain intensity, walking, standing, social life and summary scores of ODI and VAS of the leg demonstrated significant differences (p< 0.05, respectively) between groups, and the observation group had greater reductions in ASI of stride length, hip flexion, knee flexion and ankle dorsiflexion compared with the control group (p< 0.05, respectively). CONCLUSIONS The postoperative rehabilitation scheme based on gait analysis resulted in significant short- to medium-term improvements in pain intensity, walking, standing, social life and the summary score of ODI, VAS of leg and symmetry of stride length, hip flexion, knee flexion and ankle dorsiflexion compared with empirical exercise in patients with LSS.
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Affiliation(s)
- Yuxian Zhong
- Medical School of Chinese PLA, Beijing, China
- Department of Rehabilitation Medicine, The Six Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Yu Ding
- Orthopedics of Traditional Chinese Medicine Unit, The Six Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Bensheng Fu
- Department of Rehabilitation Medicine, The Six Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Guanghao Ma
- Department of Rehabilitation Medicine, The Six Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Hongpeng Cui
- Orthopedics of Traditional Chinese Medicine Unit, The Six Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Minyue Li
- Department of Rehabilitation Medicine, The Six Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Yang Yu
- Department of Rehabilitation Medicine, The Six Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Ling Guan
- Acupuncture Department of Traditional Chinese Medicine Unit, The Six Medical Center of Chinese PLA General Hospital, Beijing, China
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Aubry C, Nüesch C, Fiebig O, Stoll TM, Köhler M, Barth A, Mündermann A. Accelerometry-based physical activity, disability and quality of life before and after lumbar decompression surgery from a physiotherapeutic perspective: An observational cohort study. NORTH AMERICAN SPINE SOCIETY JOURNAL 2021; 8:100087. [PMID: 35141652 PMCID: PMC8819940 DOI: 10.1016/j.xnsj.2021.100087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 10/18/2021] [Accepted: 10/18/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND The effect of lumbar decompression on physical activity (PA) measures (measured as number of steps/day and as moderate to vigorous PA (MVPA)) is poorly understood. The aim of the current study was to compare PA in patients before and after lumbar decompression and to determine the association between change in steps/day and MVPA with change in disability, health-related quality of life (HRQOL) and pain. METHODS Patients undergoing lumbar decompression surgery were recruited. Steps/day and MVPA MVPA were recorded with an accelerometer. Oswestry Disability Index (ODI), HRQOL (Short Form 36 questionnaire (SF-36)) and pain levels (visual analogue scale (VAS)) were collected prior to surgery and six and twelve weeks postoperatively. Steps/day were compared to the lower bound of steps/day in healthy persons (7,000 steps per day), and the relationship between changes in steps/day, MVPA, ODI, SF-36, and VAS were calculated. RESULTS Twenty-six patients aged 37 to 75 years met inclusion criteria and were included in the study. Lumbar decompressions were performed for stenosis and/or disc herniation. Preoperatively, patients took an average 5,073±2,621 (mean±standard deviation) steps/day. At 6 weeks postoperatively, patients took 6,131±2,343 steps/day. At 12 weeks postoperatively, patients took 5,683±2,128 steps/day. Postoperative MVPA minutes per week increased compared to preoperative MVPA (preoperative: 94.6±122.9; 6 weeks: 173.9±181.9; 12 weeks: 145.7±132.8). From preoperative to 12 weeks postoperative, change in steps correlated with MVPA (R=0.775; P<0.001), but not with ODI (R=0.069; P=0.739), SF-36 (R=0.138; P=0.371), VAS in the back (R=0.230; P=0.259) or VAS in the leg (R=-0.123; P=0.550). CONCLUSIONS During the first 12 postoperative weeks, daily steps did not reach the lower bound of normal step activity of 7,000 steps/day, however postoperative steps/day were higher than before surgery. Steps/day and MVPA appear to be independent of ODI and SF-36 and represent additional outcome parameters in patients undergoing lumbar decompression surgery and should be considered e.g., by physiotherapists especially from 6 to 12 weeks postoperatively. LEVEL OF EVIDENCE 2, prospective cohort study.
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Affiliation(s)
- Caroline Aubry
- Department of Physiotherapy, Bethesda Hospital AG, Basel, Switzerland
- Zurich University of Applied Sciences, School of Health Professions, Institute of Physiotherapy, Winterthur, Switzerland
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland
| | - Corina Nüesch
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland
- Department of Spine Surgery, University Hospital Basel, Basel, Switzerland
- Department of Biomedical Engineering, University of Basel, Allschwil, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Oliver Fiebig
- Department of Spine Surgery, University Hospital Basel, Basel, Switzerland
- Department of Neurosurgical and Orthopaedic Spine Surgery, Bethesda Hospital AG, 4052 Basel, Switzerland
| | - Thomas M. Stoll
- Department of Neurosurgical and Orthopaedic Spine Surgery, Bethesda Hospital AG, 4052 Basel, Switzerland
| | - Markus Köhler
- Department of Neurosurgical and Orthopaedic Spine Surgery, Bethesda Hospital AG, 4052 Basel, Switzerland
| | - Alain Barth
- Department of Neurosurgical and Orthopaedic Spine Surgery, Bethesda Hospital AG, 4052 Basel, Switzerland
| | - Annegret Mündermann
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland
- Department of Spine Surgery, University Hospital Basel, Basel, Switzerland
- Department of Biomedical Engineering, University of Basel, Allschwil, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
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Does fear impede the success of spinal surgery in patients with chronic Back pain? Potential prognosticative factors in spinal surgery failure. CURRENT PSYCHOLOGY 2021. [DOI: 10.1007/s12144-021-02069-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Dupeyron A, Ribinik P, Rannou F, Kabani S, Demoulin C, Dufour X, Foltz V, Godard J, Huppert J, Nizard J, Petit A, Silvestre C, Kouyoumdjian P, Coudeyre E. Rehabilitation and lumbar surgery: the French recommendations for clinical practice. Ann Phys Rehabil Med 2021; 64:101548. [PMID: 34192564 DOI: 10.1016/j.rehab.2021.101548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 05/24/2021] [Accepted: 06/01/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Indications and techniques of rehabilitation differ widely across types of lumbar surgery, including timing (before or after surgery) and prescriptions (surgeons but also medical or paramedical professionals). OBJECTIVES This project aimed to build consensual recommendations for practice in this context. METHODS The SOFMER methodology was used to establish recommendations for physical medicine and rehabilitation: a steering committee defined the types of lumbar surgery involved and developed the main questions to be addressed; a scientific committee performed a literature review for grading evidence and proposed the first version of recommendations, which were discussed during a dedicated session at the national Physical and Rehabilitation Medicine congress; then an e-Delphi method with cross-professional experts was used to finalise recommendations and reach a multidisciplinary consensus. RESULTS The main questions developed were the value of rehabilitation before and after surgery, timing and type of rehabilitation, benefit of supervision and instrumental rehabilitation, value of patient education, and complementary interventions concerning rehabilitation for discectomy, fusion, and disc prosthesis (excluding decompression for spinal stenosis). The literature review identified 60 articles, but for several of the questions, no article in the literature addressed the issue. The multidisciplinary scientific committee analysed the literature and addressed the questions to propose the first version of a set of 23 recommendations. The congress session failed to answer all questions or to reach consensus for all items. After a three-step e-Delphi, 20 recommendations were retained, for which consensus among experts was reached. The recommendations are applicable only to patients without a neurological lesion. CONCLUSIONS These recommendations provide important and consensual knowledge to assist clinicians in decision-making for rehabilitation in lumbar surgery. Despite many of the recommendations relying exclusively on expert opinion rather than published evidence, this approach is an important advance to improve concordance among healthcare professionals.
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Affiliation(s)
- Arnaud Dupeyron
- Service de Médecine Physique et de Réadaptation, CHU Nîmes, Univ Montpellier, Nîmes, France.
| | - Patricia Ribinik
- Service de Médecine Physique et de Réadaptation, CH de Gonesse, Gonesse, France
| | - François Rannou
- Service de Rééducation et de Réadaptation de l'appareil locomoteur et des pathologies du Rachis, hôpitaux universitaires Paris centre-groupe hospitalier Cochin, AP-HP, Paris, France
| | - Sarah Kabani
- Service de Biostatistique, Epidémiologie, Santé Publique, Innovation Méthodologique (BESPIM), CHU Nîmes, Univ Montpellier, Nîmes, France
| | - Christophe Demoulin
- Department of Sport and Rehabilitation Sciences, University of Liege, Liege, Belgium
| | | | - Violaine Foltz
- Service de Rhumatologie, Hôpitaux universitaires Paris centre-groupe hospitalier Pitié-Salpétrière, AP-HP, Paris, France
| | - Joel Godard
- Service de Neurochirurgie et de chirurgie de la douleur et du rachis, CHRU Besançon, Université de Franche Comté, Besançon, France
| | - Jean Huppert
- Service de Neurochirurgie, Clinique du Parc, Saint-Priest-en-Jarez, France
| | - Julien Nizard
- Centre fédératif douleur soins de support, UIC 22, équipe mobile de soins palliatifs et de support, CHU Nantes, Nantes, France
| | - Audrey Petit
- Centre de consultation de pathologie professionnelle, CHU d'Angers, Angers, France
| | - Clement Silvestre
- Département de Chirurgie Orthopédique, Clinique Médico-Chirurgicale des Massues, Lyon, France
| | - Pascal Kouyoumdjian
- Service de Chirurgie Orthopédique, CHU Nîmes, Univ Montpellier, Nîmes, France
| | - Emmanuel Coudeyre
- Service de Médecine Physique et de Réadaptation, CHU Clermont-Ferrand, Université Clermont Auvergne, INRAE, UNH, F-63000 Clermont-Ferrand, France
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Daniels CJ, Cupler ZA, Gliedt JA, Walters S, Schielke AL, Hinkeldey NA, Golley DJ, Hawk C. Manipulative and manual therapies in the management of patients with prior lumbar surgery: A systematic review. Complement Ther Clin Pract 2020; 42:101261. [PMID: 33276229 DOI: 10.1016/j.ctcp.2020.101261] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 11/12/2020] [Accepted: 11/12/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND AND PURPOSE Pain and disability may persist following lumbar spine surgery and patients may subsequently seek providers trained in manipulative and manual therapy (MMT). This systematic review investigates the effectiveness of MMT after lumbar surgery through identifying, summarizing, assessing quality, and grading the strength of available evidence. Secondarily, we synthesized the impact on medication utilization, and reports on adverse events. METHODS Databases and grey literature were searched from inception through August 2020. Article extraction consisted of principal findings, pain and function/disability, medication consumption, and adverse events. RESULTS Literature search yielded 2025 articles,117 full-text articles were screened and 51 citations met inclusion criteria. CONCLUSION There is moderate evidence to recommend neural mobilization and myofascial release after lumbar fusion, but inconclusive evidence to recommend for or against most manual therapies after most surgical interventions. The literature is primarily limited to low-level studies. More high-quality studies are needed to make recommendations.
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Affiliation(s)
| | | | | | | | | | | | | | - Cheryl Hawk
- Texas Chiropractic College, Pasadena, TX, USA
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Zhong Y, Liu J, Zhou W, Yu D. Relationship between straight leg-raising test measurements and area of fat infiltration in multifidus muscles in patients with lumbar disc hernation. J Back Musculoskelet Rehabil 2020; 33:57-63. [PMID: 31006661 DOI: 10.3233/bmr-181304] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND A few studies have noted that paraspinal muscle training is important to reduce pain for patients with lumbar disc herniation (LDH). However, little is known about the exact signs for necessary training of lumbar multifidus muscles (LMM). OBJECTIVE The study aimed to analyze the relationship between the straight leg-raising test (SLR) and the area of fat infiltration in LMM for patients with LDH. METHOD One hundred and fourteen LDH patients were involved in this study. Clinical data were collected from a medical record system. On the MRI images, the cross-sectional areas (CSA) of bilateral fat infiltration in LMM were measured by picture archiving and communication system (PACS). RESULT For 61 patients with inclusive LDH, the positive side of SLR was positively correlated with the side of the larger total CSA of fat infiltration in LMM of L2-S1 (r= 0.75, pï¼ 0.01), and the CSA of fat infiltration on the side of SLR with a positive result was significantly larger than that on the side of SLR with a negative result only at L3-4 and L4-5 levels (pï¼ 0.01). CONCLUSION SLR may be used as an important sign for dysfunction of LMM and can identify the more severe side.
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Hua A, Chaudhari P, Johnson N, Quinton J, Schatz B, Buchner D, Hernandez ME. Evaluation of Machine Learning Models for Classifying Upper Extremity Exercises Using Inertial Measurement Unit-Based Kinematic Data. IEEE J Biomed Health Inform 2020; 24:2452-2460. [PMID: 32750927 DOI: 10.1109/jbhi.2020.2999902] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The amount of home-based exercise prescribed by a physical therapist is difficult to monitor. However, the integration of wearable inertial measurement unit (IMU) devices can aid in monitoring home exercise by analyzing exercise biomechanics. The objective of this study is to evaluate machine learning models for classifying nine different upper extremity exercises, based upon kinematic data captured from an IMU-based device. Fifty participants performed one compound and eight isolation exercises with their right arm. Each exercise was performed ten times for a total of 4500 trials. Joint angles were calculated using IMUs that were placed on the hand, forearm, upper arm, and torso. Various machine learning models were developed with different algorithms and train-test splits. Random forest models with flattened kinematic data as a feature had the greatest accuracy (98.6%). Using triaxial joint range of motion as the feature set resulted in decreased accuracy (91.9%) with faster speeds. Accuracy did not decrease below 90% until training size was decreased to 5% from 50%. Accuracy decreased (88.7%) when splitting data by participant. Upper extremity exercises can be classified accurately using kinematic data from a wearable IMU device. A random forest classification model was developed that quickly and accurately classified exercises. Sampling frequency and lower training splits had a modest effect on performance. When the data were split by subject stratification, larger training sizes were required for acceptable algorithm performance. These findings set the basis for more objective and accurate measurements of home-based exercise using emerging healthcare technologies.
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Gilmore SJ, Hahne AJ, Davidson M, McClelland JA. Predictors of substantial improvement in physical function six months after lumbar surgery: is early post-operative walking important? A prospective cohort study. BMC Musculoskelet Disord 2019; 20:418. [PMID: 31506099 PMCID: PMC6737667 DOI: 10.1186/s12891-019-2806-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Accepted: 08/30/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Resuming walking after lumbar surgery is a common focus of early post-operative rehabilitation, however there is no knowledge about whether increased walking is associated with better functional outcomes. This study aimed to determine whether time spent walking in the week after lumbar surgery, along with co-morbidities, pre-operative pain duration, pre-operative physical activity or function, or surgical variables predict substantial improvement in physical function six months after lumbar surgery. METHODS A prospective cohort study design was utilized. Participants undergoing lumbar surgery (discectomy, decompression, fusion) were recruited between April and November 2016. Predictor variables were collected pre-operatively (age, sex, smoking status, obesity, diabetes, depression, anxiety, pre-operative pain duration, neurological deficit, physical activity levels, mobility restriction, function) and early post-operatively (post-operative walking time, surgical procedure, single/multi-level surgery). Outcome variables (physical function, back pain and leg pain severity) were measured pre-operatively and six-months post-operatively. Logistic regression analysis was used to establish prediction of substantial improvement in outcome at six months. RESULTS Participants (N = 233; 50% female; age 61 (SD = 14) years) who walked more in the first post-operative week were more likely to have substantially improved function on the Oswestry Disability Questionnaire at six months (OR 1.18, 95%CI 1.02-1.37), as were participants with < 12 months pre-operative pain (OR 2.71, 95%CI 1.28-5.74), and those with lower pre-operative function (OR 4.02, 95%CI 2.33-6.93). Age < 65 years (OR 2.36, 95%CI 1.14-4.85), and < 12 months pre-operative pain (OR 3.52 95%CI 1.69-7.33) predicted substantial improvement on the SF-36 Physical Component Summary. There were no significant predictors for substantial improvement in either leg or back pain. CONCLUSIONS Walking time in the week after lumbar surgery is one of several predictors of substantial improvement in function at six months. Further research is required to determine whether intervention designed to increase walking early after lumbar surgery results in improved longer-term recovery of function. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry (ANZCTR), registration number 12616000747426 . Retrospectively registered on the 7th of June 2016.
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Affiliation(s)
- Sarah J Gilmore
- St Vincent's Private Hospital Melbourne, 59 Victoria Parade, Fitzroy, VIC, 3065, Australia.
- La Trobe University, Plenty Rd, Bundoora, Melbourne, VIC, 3086, Australia.
| | - Andrew J Hahne
- La Trobe University, Plenty Rd, Bundoora, Melbourne, VIC, 3086, Australia
| | - Megan Davidson
- La Trobe University, Plenty Rd, Bundoora, Melbourne, VIC, 3086, Australia
| | - Jodie A McClelland
- La Trobe University, Plenty Rd, Bundoora, Melbourne, VIC, 3086, Australia
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Lotzke H, Brisby H, Gutke A, Hägg O, Jakobsson M, Smeets R, Lundberg M. A Person-Centered Prehabilitation Program Based on Cognitive-Behavioral Physical Therapy for Patients Scheduled for Lumbar Fusion Surgery: A Randomized Controlled Trial. Phys Ther 2019; 99:1069-1088. [PMID: 30951604 PMCID: PMC6665875 DOI: 10.1093/ptj/pzz020] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Accepted: 01/24/2019] [Indexed: 01/04/2023]
Abstract
BACKGROUND Prehabilitation programs have led to improved postoperative outcomes in several surgical contexts, but there are presently no guidelines for the prehabilitation phase before lumbar fusion surgery. OBJECTIVE The objective was to investigate whether a person-centered physical therapy prehabilitation program, based on a cognitive-behavioral approach, is more effective than conventional care in reducing disability and improving functioning after lumbar fusion surgery in patients with degenerative disk disease. DESIGN This study was a randomized controlled trial. SETTING The study took place at 2 private spine clinics and 1 university hospital. PATIENTS We prospectively enrolled 118 patients scheduled for lumbar fusion surgery. INTERVENTION The active intervention used a person-centered perspective and focused on promoting physical activity and targeting psychological risk factors before surgery. The control group received conventional preoperative care. MEASUREMENTS The primary outcome was the Oswestry Disability Index score. Secondary outcomes were back and leg pain intensity, catastrophizing, kinesiophobia, self-efficacy, anxiety, depression, health-related quality of life, and patient-specific functioning, physical activity, and physical capacity. Data were collected on 6 occasions up to 6 months postoperatively. A linear mixed model was used to analyze the change scores of each outcome. RESULTS No statistically significant between-group difference was found on the primary outcome (disability) over time (baseline to 6 months). Among secondary outcome measures, a statistically significant interaction effect ("Group × Time") was seen for the European Quality of Life 5 Dimensions Questionnaire. The largest between-group difference on the European Quality of Life 5 Dimensions Questionnaire index was seen 1 week prior to surgery and favored the active intervention. The largest between-group effect sizes at the 6-month follow-up favored the active intervention, and were seen for physical activity intensity, steps per day, and the One Leg Stand Test. Both groups reached the minimal important change for the primary outcome and, in several secondary outcomes (pain intensity, back and leg; pain catastrophizing; anxiety; health-related quality of life [EQ5D VAS]), already at 8-week follow-up. LIMITATIONS The participants' preoperative level of disability was lower than normative values, which suggests selection bias. CONCLUSIONS Both interventions led to clinically important changes, but it is not clear what kind of prehabilitation program is the most effective.
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Affiliation(s)
- Hanna Lotzke
- Department of Orthopaedics at Sahlgrenska Academy, Institute of the Clinical Sciences, University of Gothenburg, Göteborg, Sweden; and Spine Center Göteborg, Västra Frölunda, Sweden
| | - Helena Brisby
- Department of Orthopaedics at Sahlgrenska Academy, Institute of the Clinical Sciences, University of Gothenburg; and Department of Orthopaedics, Sahlgrenska University Hospital, Göteborg, Sweden
| | - Annelie Gutke
- Division of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, University of Gothenburg
| | - Olle Hägg
- Department of Orthopaedics at Sahlgrenska Academy, Institute of the Clinical Sciences, University of Gothenburg; and Spine Center Göteborg
| | - Max Jakobsson
- Department of Orthopaedics at Sahlgrenska Academy, Institute of the Clinical Sciences, University of Gothenburg; and Division of Rehabilitation, District Department North, Borås Stad, Borås, Sweden
| | - Rob Smeets
- Department of Rehabilitation Medicine, Maastricht University, Maastricht, the Netherlands; and Libra Rehabilitation and Audiology, Eindhoven/Weert, the Netherlands
| | - Mari Lundberg
- Department of Orthopaedics at Sahlgrenska Academy, Institute of the Clinical Sciences, University of Gothenburg; Department of Orthopaedics, Sahlgrenska University Hospital; Division of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, University of Gothenburg, Box 455, 405 30 Göteborg, Sweden; and Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
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Gilmore SJ, Hahne AJ, Davidson M, McClelland JA. Physical activity patterns of patients immediately after lumbar surgery. Disabil Rehabil 2019; 42:3793-3799. [DOI: 10.1080/09638288.2019.1610512] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- Sarah J. Gilmore
- St Vincent’s Private Hospital Melbourne, Fitzroy, Australia
- Department of Physiotherapy, Podiatry, Prosthetics and Orthotics, School of Allied Health, La Trobe University, Bundoora, Australia
| | - Andrew J. Hahne
- Department of Physiotherapy, Podiatry, Prosthetics and Orthotics, School of Allied Health, La Trobe University, Bundoora, Australia
| | - Megan Davidson
- Department of Physiotherapy, Podiatry, Prosthetics and Orthotics, School of Allied Health, La Trobe University, Bundoora, Australia
| | - Jodie A. McClelland
- Department of Physiotherapy, Podiatry, Prosthetics and Orthotics, School of Allied Health, La Trobe University, Bundoora, Australia
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Postural stability and trunk muscle responses to the static and perturbed balance tasks in individuals with and without symptomatic degenerative lumbar disease. Gait Posture 2018; 64:159-164. [PMID: 29909230 DOI: 10.1016/j.gaitpost.2018.06.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 05/20/2018] [Accepted: 06/10/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Degenerative lumbar diseases (DLDs) are characterized by motor functional deficits and postural instability. In this study, we investigated the differences in the trunk muscle responses to postural control between the presurgical DLD patients and healthy individuals while performing the static and perturbed balance tasks. METHODS Thirty-five DLD patients (aged 61.1 ± 8.0 years) and thirty-five asymptomatic controls (aged 62.9 ± 3.7 years) participated in this study. All participants stood on a force plate and performed the quiet standing (QS) and in situ weight-lifting (WL) tasks. The participants' performance in the QS task was tested under the eyes-open, eyes-closed, wide-base, and narrow-base conditions. Center of pressure (CoP) movements and electromyography of the erector spinae (ES) were recorded. The Mann-Whitney U test was applied for statistical analysis. RESULTS The DLD group showed a significantly greater CoP movements and muscle activations during the QS task. Nevertheless, smaller CoP movements were noted during the WL task in the DLD group. Under the eyes-closed and narrow-base conditions, the DLD group showed even higher muscle activations and CoP movements. SIGNIFICANCE The DLD patients demonstrated a poor postural control ability and tended to rely on the visual feedback and wide-base standing posture. A rigid and restricted posture was also adopted during the perturbed WL task. A high level of ES activation was required to maintain their postural steadiness. This study reveals an aberrant pattern of postural control and trunk muscle activations in symptomatic DLD patients which potentially contributes to the development of beneficial rehabilitation programs.
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Gometz A, Maislen D, Youtz C, Kary E, Gometz EL, Sobotka S, Choudhri TF. The Effectiveness of Prehabilitation (Prehab) in Both Functional and Economic Outcomes Following Spinal Surgery: A Systematic Review. Cureus 2018; 10:e2675. [PMID: 30050730 PMCID: PMC6059529 DOI: 10.7759/cureus.2675] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Rehabilitation prior to orthopedic surgery (prehab) has been studied with more frequency and studies have shown reduced costs and improved functional outcomes among patients who have undergone total hip arthroplasty (THA) and total knee arthroplasty (TKA). This literature review is to determine whether prehab improves functional outcomes and reduces costs following spinal surgery. PubMed, CINHAL via EBSCO and EMBASE via Ovid were searched with publication date restrictions from May 2006 to May 2016 for the terms 'physical therapy', 'physiotherapy', 'prehabilitation' or 'prehab', 'spine' or 'spinal', and 'preoperative' or 'pre-op'. The search yielded 737 eligible articles which were screened by two independent reviewers. Randomized controlled trials (RCT) with adults who participated in preoperative exercise interventions as part of a prehab or preoperative exercise program for spinal surgery versus standard care were included. Methodology and results of the studies were critically appraised in conformity with PRISMA guidelines. Three RCTs were included, all of which analyzed outcomes of prehab following lumbar spinal surgery. Two of the articles were of high quality and three were of low quality. None of the studies demonstrated a statistically significant difference in pain scores or disability questionnaires in the intervention groups postoperatively, however, no negative effects were reported either. With neuroscience education, patient's reported feeling prepared for surgery and expressed positive outlook regarding the intervention. Two of the studies found perioperative intervention reduced the total cost of healthcare spending associated with spinal surgery. Due to the heterogeneity of the outcome measures, a meta-analysis was not possible. There is lack of significant evidence looking at functional outcomes using physical therapy prior to spinal surgery. Prehab should continue to be researched prior to spinal surgery to determine effectiveness in patient outcomes.
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Affiliation(s)
- Alex Gometz
- Neurosurgery, Mount Sinai School of Medicine, New York, USA
| | - Diana Maislen
- New York University, New York University Medical Center, New York, USA
| | - Chelsea Youtz
- New York University, New York University Medical Center, New York, USA
| | - Erinn Kary
- New York University, New York University Medical Center, New York, USA
| | | | - Stanislaw Sobotka
- Neurosurgery, The Icahn School of Medicine at Mount Sinai, New York, USA
| | - Tanvir F Choudhri
- Neurosurgery, The Icahn School of Medicine at Mount Sinai, New York, USA
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Lumbar Spinous Process Fixation and Fusion: A Systematic Review and Critical Analysis of an Emerging Spinal Technology. Clin Spine Surg 2017; 30:E1279-E1288. [PMID: 27438402 DOI: 10.1097/bsd.0000000000000411] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
STUDY DESIGN A systematic review. OBJECTIVE The available literature on interspinous rigid fixation/fusion devices (IFD) was systematically reviewed to explore the devices' efficacy and complication profile. SUMMARY OF BACKGROUND DATA The clinical application of new spinal technologies may proceed without well-established evidence, as is the case with IFDs. IFDs are plate-like devices that are attached to the lateral aspects of 2 adjacent spinous processes to promote rigidity at that segment. Despite almost a decade since the devices' introduction, the literature regarding efficacy and safety is sparse. Complications have been reported but no definitive study is known to the authors. METHODS A systematic review of the past 10 years of English literature was conducted according to PRISMA guidelines. The timeframe was chosen based on publication of the first study containing a modern IFD, the SPIRE, in 2006. All PubMed publications containing MeSH headings or with title or abstract containing any combination of the words "interspinous," "spinous process," "fusion," "fixation," "plate," or "plating" were included. Exclusion criteria consisted of dynamic stabilization devices (X-Stop, DIAM, etc.), cervical spine, pediatrics, and animal models. The articles were blinded to author and journal, assigned a level of evidence by Oxford Centre of Evidence-Based Medicine (OCEBM) criteria, and summarized in an evidentiary table. RESULTS A total of 293 articles were found in the initial search, of which 15 remained after examination for exclusion criteria. No class I or class II evidence regarding IFDs was found. IFDs have been shown by methodologically flawed and highly biased class III evidence to reduce instability at 1 year, without statistical comparison of complication rates against other treatment modalities. CONCLUSIONS Although IFDs are heavily marketed and commonly applied in modern practice, data on safety and efficacy are inadequate. The paucity of evidence warrants reexamination of these devices' value and indications by the spine surgery community.
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Hodgson MM, Bevan JM, Evans RB, Johnson TI. Influence of in-house rehabilitation on the postoperative outcome of dogs with intervertebral disk herniation. Vet Surg 2017; 46:566-573. [PMID: 28233909 DOI: 10.1111/vsu.12635] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 10/26/2016] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine the influence of in-house rehabilitation on the postoperative outcome of dogs with intervertebral disk herniation (IVDH). DESIGN Retrospective cohort study. ANIMALS Dogs (n = 248) under 20 kg of weight, with single site, thoracolumbar, Hansen Type I IVDH. PROCEDURES Medical records of non-ambulatory dogs with IVDH treated via hemilaminectomy were reviewed. Dogs were classified in 2 groups depending on whether their postoperative management included an in-house rehabilitation program. Preoperative and sequential postoperative modified Frankel scores (MFSs) were recorded. Time to ambulation, time to normal conscious proprioception, final MFS, and complications were compared between the groups. RESULTS More dogs returned to full neurologic function (final MFS of Grade 5) when in-house rehabilitation was included in the postoperative management (33% compared to 9%). Normal conscious proprioception and ambulation returned earlier in the control group (42 days and 14 days, respectively) compared to the group with rehabilitation (49 days and 28 days, respectively). The complication rate was higher in the control group (29%) compared with the group with rehabilitation (16%). CONCLUSIONS AND CLINICAL RELEVANCE In-house rehabilitation should be included in the postoperative management in dogs after surgical treatment of IVDH to improve neurologic function and reduce postoperative complications.
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Affiliation(s)
| | - John M Bevan
- Central Texas Veterinary Specialty Hospital, Austin, Texas
| | | | - Thai I Johnson
- Central Texas Veterinary Specialty Hospital, Austin, Texas
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16
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Gilmore S, McClelland JA, Davidson M. Does walking after lumbar spinal surgery predict recovery of function at six months? Protocol for a prospective cohort study. BMC Musculoskelet Disord 2016; 17:472. [PMID: 27842523 PMCID: PMC5109719 DOI: 10.1186/s12891-016-1296-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 10/13/2016] [Indexed: 02/06/2023] Open
Abstract
Background Physiotherapists are commonly involved in the management of patients immediately following lumbar spinal surgery. There is however, very little research to guide physiotherapy intervention in the acute post-operative period, and the advice provided to patients regarding post-operative walking and physical activity has been shown to be highly variable. The primary aim of this research is to establish whether the amount of walking patients perform in the week following lumbar spinal surgery predicts improvement in function at 6 months. Methods This study will be a prospective cohort study design, with a projected sample size of 250 participants. Patients undergoing surgery for the management of a disc prolapse, degenerative disc disease, lumbar spinal stenosis and/or degenerative spondylolysthesis will be invited to participate in this study. Outcome measurement will take place pre-operatively and at six months post-operatively. The primary outcome variable will be self-reported function, measured using the Modified Oswestry Disability Questionnaire and the physical component summary of the SF-36. Each participant will be fitted with an activPAL3 accelerometer to be worn for the first seven post-operative days. This accelerometer will record time spent in active versus sedentary postures, step count and time spent walking. Multivariable logistic regression analysis will be used to investigate the relationship between the total time spent walking over the first seven post-operative days, and outcome at six months. Discussion The results from this research will help to guide patient management during the inpatient phase, by identifying patients who are at risk of poorer outcome due to limited walking time. These patients may benefit from ongoing rehabilitation and outpatient physiotherapy services. This information will also provide a foundation for further research into interventions designed to optimise post-operative activity. Trial registration ACTRN12616000747426, retrospectively registered 7th June 2016.
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Affiliation(s)
- Sarah Gilmore
- St Vincent's Private Hospital, Melbourne, Australia. .,La Trobe University, Melbourne, Australia.
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17
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Marchand AA, O’Shaughnessy J, Châtillon CÉ, Sorra K, Descarreaux M. Current Practices in Lumbar Surgery Perioperative Rehabilitation: A Scoping Review. J Manipulative Physiol Ther 2016; 39:668-692. [DOI: 10.1016/j.jmpt.2016.08.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 07/14/2016] [Accepted: 08/11/2016] [Indexed: 10/20/2022]
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Lotzke H, Jakobsson M, Brisby H, Gutke A, Hägg O, Smeets R, den Hollander M, Olsson LE, Lundberg M. Use of the PREPARE (PREhabilitation, Physical Activity and exeRcisE) program to improve outcomes after lumbar fusion surgery for severe low back pain: a study protocol of a person-centred randomised controlled trial. BMC Musculoskelet Disord 2016; 17:349. [PMID: 27538757 PMCID: PMC4991107 DOI: 10.1186/s12891-016-1203-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 08/04/2016] [Indexed: 11/21/2022] Open
Abstract
Background Following lumbar fusion surgery, a successful outcome is empirically linked to effective rehabilitation. While rehabilitation is typically postoperative, the phase before surgery – termed prehabilitation – is reportedly an ideal time to prepare the patient. There are presently no guidelines for prehabilitation before lumbar fusion surgery. Physical activity has well-known health benefits, and staying physically active despite pain is a major principle in non-pharmacological chronic low back pain treatment. Psychological factors such as fear of movement, pain catastrophizing and low self-efficacy are known to be barriers to staying active. No studies have investigated prehabilitation protocols that promote physical activity and target psychological risk factors before lumbar fusion surgery. The aim of our proposed randomised controlled trial is to investigate whether patients who undergo lumbar fusion surgery for degenerative disc disease experience better functioning with a physiotherapeutic prehabilitation program (PREPARE) based on a cognitive behavioural approach compared to conventional care. Methods/Design We will recruit 110 patients between 18–70 years of age with degenerative disc disease who are waiting for lumbar fusion surgery. These patients will be randomly assigned to receive either PREPARE or conventional care. PREPARE uses a person-centred perspective and focuses on promoting physical activity and targeting psychological risk factors before surgery. The primary outcome will be disability measured using the Oswestry Disability Index 2.0. Secondary outcomes will include functioning (patient-reported and performance-based), physical activity (accelerometer), health-related quality of life, back and leg pain intensity, pain catastrophizing, kinesiophobia, self-efficacy, depression, anxiety, satisfaction with treatment results and health economic factors. Data will be collected at baseline (preoperatively) after the intervention (preoperatively), 3 and 8 weeks, 3, 6, 12, 24 and 60 months postoperatively. Discussion We hypothesise that the focus on promoting physical activity and targeting psychological risk factors before surgery will decrease disability and help the patients to be more active despite pain both before and after surgery. We will use a combination of outcome measures both patient-reported and performance-based, as well as accelerometer data. This will provide a more comprehensive picture of the patient’s functioning than just patient-reported outcomes alone. Trial registration Current Controlled Trials ISCRTN17115599, Retrospectively Registered 18 May 2015.
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Affiliation(s)
- Hanna Lotzke
- Department of Orthopaedics, Institute of Clinical Science, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. .,Spine Center Göteborg, Västra Frölunda, Sweden. .,Physiotherapy Department Spine Center AB, 430 21, Västra Frölunda, Sweden.
| | - Max Jakobsson
- Department of Orthopaedics, Institute of Clinical Science, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,District Department North, Division of Rehabilitation, Borås Stad, Borås, Sweden
| | - Helena Brisby
- Department of Orthopaedics, Institute of Clinical Science, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Division of Physiotherapy, Department of Neurobiology, Care Sciences and Sociology, Karolinska Institutet, Stockholm, Sweden
| | - Annelie Gutke
- Division of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Olle Hägg
- Department of Orthopaedics, Institute of Clinical Science, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Spine Center Göteborg, Västra Frölunda, Sweden
| | - Rob Smeets
- Department of Rehabilitation Medicine, Maastricht University, Maastricht, The Netherlands.,Libra Rehabilitation and Audiology, Eindhoven/Weert, The Netherlands
| | - Marlies den Hollander
- Department of Rehabilitation Medicine, Maastricht University, Medical Centre, Maastricht, The Netherlands.,Department of Clinical Psychological Science, Maastricht University, Maastricht, The Netherlands
| | - Lars-Eric Olsson
- Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden.,Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Gothenburg Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden
| | - Mari Lundberg
- Department of Orthopaedics, Institute of Clinical Science, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Division of Physiotherapy, Department of Neurobiology, Care Sciences and Sociology, Karolinska Institutet, Stockholm, Sweden.,Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden
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Parker SL, McGirt MJ, Bekelis K, Holland CM, Davies J, Devin CJ, Atkins T, Knightly J, Groman R, Zyung I, Asher AL. The National Neurosurgery Quality and Outcomes Database Qualified Clinical Data Registry: 2015 measure specifications and rationale. Neurosurg Focus 2015; 39:E4. [DOI: 10.3171/2015.9.focus15355] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Meaningful quality measurement and public reporting have the potential to facilitate targeted outcome improvement, practice-based learning, shared decision making, and effective resource utilization. Recent developments in national quality reporting programs, such as the Centers for Medicare & Medicaid Services Qualified Clinical Data Registry (QCDR) reporting option, have enhanced the ability of specialty groups to develop relevant quality measures of the care they deliver. QCDRs will complete the collection and submission of Physician Quality Reporting System (PQRS) quality measures data on behalf of individual eligible professionals. The National Neurosurgery Quality and Outcomes Database (N2QOD) offers 21 non-PQRS measures, initially focused on spine procedures, which are the first specialty-specific measures for neurosurgery. Securing QCDR status for N2QOD is a tremendously important accomplishment for our specialty. This program will ensure that data collected through our registries and used for PQRS is meaningful for neurosurgeons, related spine care practitioners, their patients, and other stakeholders. The 2015 N2QOD QCDR is further evidence of neurosurgery’s commitment to substantively advancing the health care quality paradigm. The following manuscript outlines the measures now approved for use in the 2015 N2QOD QCDR. Measure specifications (measure type and descriptions, related measures, if any, as well as relevant National Quality Strategy domain[s]) along with rationale are provided for each measure.
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Affiliation(s)
| | - Matthew J. McGirt
- 2Department of Neurosurgery, Carolina Neurosurgery & Spine Associates and Neuroscience Institute, Carolinas Healthcare System, Charlotte, North Carolina
| | - Kimon Bekelis
- 3Section of Neurosurgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | | | - Jason Davies
- 5Department of Neurological Surgery, State University of New York at Buffalo, New York
| | - Clinton J. Devin
- 6Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Tyler Atkins
- 2Department of Neurosurgery, Carolina Neurosurgery & Spine Associates and Neuroscience Institute, Carolinas Healthcare System, Charlotte, North Carolina
| | - Jack Knightly
- 7Department of Neurological Surgery, Atlantic Neurosurgical Specialists, Morristown, New Jersey
| | - Rachel Groman
- 8Clinical Affairs and Quality Improvement, Hart Health Strategies, Washington, DC; and
| | - Irene Zyung
- 9American Association of Neurological Surgeons, Rolling Meadows, Illinois
| | - Anthony L. Asher
- 2Department of Neurosurgery, Carolina Neurosurgery & Spine Associates and Neuroscience Institute, Carolinas Healthcare System, Charlotte, North Carolina
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