Worse outcomes for early post-lumbar spinal fusion rehab

(HealthDay)—Beginning rehabilitation at six weeks as opposed to 12 weeks post-lumbar spinal fusion is associated with higher costs and poorer outcomes, according to a study published in the Nov. 1 issue of Spine.

Lisa G. Oestergaard, O.T., from Aarhus University Hospital in Denmark, and colleagues conducted a cost-effectiveness and cost-utility analysis alongside a randomized controlled trial in which 82 patients undergoing instrumented lumbar spinal fusion due to degenerative disc disease or spondylolisthesis were randomized to rehabilitation initiated at six or 12 weeks after surgery. The protocol was identical for both groups and included four sessions of group-based rehabilitation; participants were also instructed in home exercises focusing on active stability training.

The researchers found that the fast-track strategy tended to be costlier (by €6,869) and also correlated with significantly poorer outcomes of functional disability (−9 points on the Oswestry Disability Index) and a tendency for a reduced gain in quality-adjusted life years (−0.04). The fast-track strategy did not reach the 10 percent conventional threshold for cost-effectiveness.

"The uncertainty of this result did not seem to be sensitive to methodological issues, and clinical managements who have already adapted fast-track rehabilitation strategies have reason to reconsider their choice," the authors conclude.