Best practice rehabilitation pathway for the management of single and double-level lumbar fusion surgery: a modified Delphi Study.
Journal
European journal of physical and rehabilitation medicine
ISSN: 1973-9095
Titre abrégé: Eur J Phys Rehabil Med
Pays: Italy
ID NLM: 101465662
Informations de publication
Date de publication:
Jun 2023
Jun 2023
Historique:
medline:
13
6
2023
pubmed:
30
3
2023
entrez:
29
3
2023
Statut:
ppublish
Résumé
There is limited evidence to guide the rehabilitation of patients following single or double-level lumbar fusion surgery (LFS). This is reflected in extensive variability in current rehabilitation regimes and subsequent low clinical success rates, which urges a call for a consensus rehabilitation pathway. To establish consensus on the optimal pre-, peri- and postoperative rehabilitation of LFS. A modified Delphi Study. Belgium and the Netherlands. A multidisciplinary panel of 31 experts in the field of LFS and rehabilitation participated. Nine patients validated the consensus pathway. A three-round online Delphi questionnaire was followed by an in-person consensus meeting. In each round, experts could suggest new statements, and received group summary statistics and feedback for reconsidered statements. Consensus threshold was set at ≥75% agreement. The resulting rehabilitation pathway was validated by patients through an online questionnaire and subsequent in-person focus group. A total of 31 experts participated in the first online round, with 27 (87%) completing all online rounds, and 17 (55%) attending the in-person consensus meeting. Consensus was reached on 122 statements relating to pre-, peri- and postoperative rehabilitation of LFS, and validated by patients. Key components of the rehabilitation pathway included prehabilitation, education, physiotherapy in every phase, early postoperative mobilization, and little movement restrictions. Patients emphasized the need for support during the return-to-work process. This process resulted in 122 expert-consensus statements on best practice rehabilitation for managing LFS, validated by patients. The proposed rehabilitation pathway can serve as guidance to support clinicians, reduce practice variability, and subsequently improve clinical outcomes after LFS.
Sections du résumé
BACKGROUND
BACKGROUND
There is limited evidence to guide the rehabilitation of patients following single or double-level lumbar fusion surgery (LFS). This is reflected in extensive variability in current rehabilitation regimes and subsequent low clinical success rates, which urges a call for a consensus rehabilitation pathway.
AIM
OBJECTIVE
To establish consensus on the optimal pre-, peri- and postoperative rehabilitation of LFS.
DESIGN
METHODS
A modified Delphi Study.
SETTING
METHODS
Belgium and the Netherlands.
POPULATION
METHODS
A multidisciplinary panel of 31 experts in the field of LFS and rehabilitation participated. Nine patients validated the consensus pathway.
METHODS
METHODS
A three-round online Delphi questionnaire was followed by an in-person consensus meeting. In each round, experts could suggest new statements, and received group summary statistics and feedback for reconsidered statements. Consensus threshold was set at ≥75% agreement. The resulting rehabilitation pathway was validated by patients through an online questionnaire and subsequent in-person focus group.
RESULTS
RESULTS
A total of 31 experts participated in the first online round, with 27 (87%) completing all online rounds, and 17 (55%) attending the in-person consensus meeting. Consensus was reached on 122 statements relating to pre-, peri- and postoperative rehabilitation of LFS, and validated by patients. Key components of the rehabilitation pathway included prehabilitation, education, physiotherapy in every phase, early postoperative mobilization, and little movement restrictions. Patients emphasized the need for support during the return-to-work process.
CONCLUSIONS
CONCLUSIONS
This process resulted in 122 expert-consensus statements on best practice rehabilitation for managing LFS, validated by patients.
CLINICAL REHABILITATION IMPACT
CONCLUSIONS
The proposed rehabilitation pathway can serve as guidance to support clinicians, reduce practice variability, and subsequently improve clinical outcomes after LFS.
Identifiants
pubmed: 36988564
pii: S1973-9087.23.07735-3
doi: 10.23736/S1973-9087.23.07735-3
pmc: PMC10272932
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
377-385Références
Spine (Phila Pa 1976). 2012 Jan 1;37(1):67-76
pubmed: 21311399
Medicina (Kaunas). 2019 Jul 07;55(7):
pubmed: 31284666
Spine (Phila Pa 1976). 2014 Nov 1;39(23):E1380-7
pubmed: 25188595
Eur Spine J. 2011 Oct;20(10):1626-34
pubmed: 21311916
Pilot Feasibility Stud. 2022 Apr 25;8(1):91
pubmed: 35468872
Eur Spine J. 2019 Feb;28(2):442-449
pubmed: 30488116
Spine (Phila Pa 1976). 2016 Jan;41(1):E28-36
pubmed: 26555833
Spine (Phila Pa 1976). 2019 Dec 1;44(23):E1369-E1378
pubmed: 31343618
J Spine Surg. 2020 Dec;6(4):752-761
pubmed: 33447679
Int J Spine Surg. 2017 Nov 28;11:29
pubmed: 29372133
Palliat Med. 2017 Sep;31(8):684-706
pubmed: 28190381
Spine J. 2018 Mar;18(3):458-463
pubmed: 28822826
J Neurosurg Spine. 2017 Jun;26(6):694-704
pubmed: 28291412
Spine J. 2013 Nov;13(11):1438-48
pubmed: 24200413
Eur Spine J. 2020 Aug;29(8):1909-1916
pubmed: 32472345
Health Expect. 2017 Aug;20(4):531-542
pubmed: 27669682
Spine (Phila Pa 1976). 2020 Jun 15;45(12):798-803
pubmed: 32004229
Arch Phys Med Rehabil. 2021 Jul;102(7):1324-1330.e3
pubmed: 33711278
Spine (Phila Pa 1976). 2020 Apr 1;45(7):465-472
pubmed: 31842110
Spine J. 2021 May;21(5):729-752
pubmed: 33444664
Spine (Phila Pa 1976). 2021 Apr 1;46(7):457-463
pubmed: 33181774
J Physiother. 2015 Apr;61(2):68-76
pubmed: 25812929
Med Care. 2012 Mar;50(3):217-26
pubmed: 22310560
BMJ. 2017 Aug 8;358:j3702
pubmed: 28790033
Lancet. 2017 Jul 8;390(10090):169-177
pubmed: 28077232
Eur Spine J. 2013 Apr;22(4):953-74
pubmed: 23575657
Spine (Phila Pa 1976). 2018 May 15;43(10):713-719
pubmed: 28885297
Int J Qual Health Care. 2007 Dec;19(6):349-57
pubmed: 17872937
Spine J. 2016 May;16(5):579-87
pubmed: 26363250
J Adv Nurs. 2006 Jan;53(2):205-12
pubmed: 16422719
Implement Sci. 2012 May 31;7:50
pubmed: 22651257
Med J Aust. 2023 Jan 16;218(1):40-45
pubmed: 36502448
BMC Med Res Methodol. 2005 Dec 01;5:37
pubmed: 16321161
Pain Pract. 2022 Sep;22 Suppl 2:65-70
pubmed: 36109843
Eur Spine J. 2016 May;25(5):1533-1541
pubmed: 26963761
J Clin Epidemiol. 2014 Apr;67(4):401-9
pubmed: 24581294
Spine (Phila Pa 1976). 2010 Jul 1;35(15):1489-94
pubmed: 20535050
Eur J Phys Rehabil Med. 2020 Apr;56(2):220-227
pubmed: 31556510
Eur Spine J. 2022 Jun;31(6):1525-1545
pubmed: 35258644