This article is more than 5 years old. Information may no longer be current.
Continuum of care concept can improve lumbar surgery outcomes for delayed recovery patients
The period of disability was longer in workers compensation patients in the study who underwent fusions.
Click Here to Manage Email Alerts
NEW ORLEANS — A continuum of care concept that incorporates a functional restoration program and surgery can improve results in workers compensation patients with chronic disabling low back pain, according to the results of a prospective cohort study presented here.
“In this workers’ compensation population, early intervention after surgery in a continuum of care concept can avoid delayed recovery and presumably move up the time to where people become productive again after major spine surgeries. The study also shows that even complex patients with multiple prior surgeries can improve in outcomes if appropriate care is provided after the failure of initial nonoperative care,”
The study outcomes were based on an in-person or structured telephone interview done 1 year after the intervention, to look at return to work, work retention after 1 year, additional spine surgeries, any added workers compensation (WC) injury claims among patients who returned to work and WC cases settled during that time, according to Mayer.
He is clinical professor, orthopedic surgery at UT Southwestern Medical Center in Dallas and medical director, PRIDE Research Foundation, in Dallas.
Patient reported outcomes
Mayer and colleagues compared 349 patients who underwent fusion and 239 patients who had discectomy and/or decompression who formed the nonfusion group, all of whom underwent pre-rehab surgery and completed a functional restoration program. The two surgical groups were compared to 349 nonoperated controls matched to the surgical patients for length of disability.
According to the study abstract, the investigators used validated patient-reported outcome measures for pain, disability and depression that they administered before, as well as after the rehabilitation. They also conducted structured interviews of the patients at 1 year about their return to work, work retention, additional number of spine surgeries, subsequent number of WC claims for those who returned to work and number of WC cases that were settled.
Based on the results, patients in the fusion group had a significantly longer length of disability compared with the other cohorts. The time from surgery to participating in the continuum of care program was about 1 year for the nonfusion group and 1.5 years for the fusion cohort, Mayer said. Prior to treatment, there were marginal differences between the groups for pain and depression. However, these differences disappeared at the end of treatment, he said.
Variable return to work rates
“The only interesting psychosocial measure was opioid dependence,” Mayer said, noting there were dependence rates of 31% for the fusion group, 19% for the nonfusion group and 17% for the controls.
At the 1-year follow-up, there were no significant differences between the groups for the socioeconomic outcomes despite extensive prior evidence suggesting especially poor outcomes for fusion patients in the WC setting in the United States, Mayer said.
“The return to work varied from 81% to 85%; work retention [ranged] from 74% to 81%; 1.5% to 3.5% [of patients] had additional surgery and 1.5% to 2.5% had no additional injury claims,” he said.
“Another interesting finding was that only opioid dependence predicted work return and work retention,” he said. “The type of surgery — or whether they were operated — was not a predictor.”
Mayer advised surgeons to “pay attention to preventing opioid dependence following the surgical procedure to the greatest extent possible.”
When spine surgeons remain engaged with their patients, especially workers compensation patients, during postoperative rehabilitation, improved results can be anticipated, he said. – by Gina Brockenbrough, MA, and Susan M. Rapp
Reference:
For more information:
Disclosure: Mayer has no relevant financial disclosures.
Perspective
Back to Top
Michael A. Gleiber, MD, FAAOS, PA
I applaud the authors of this study for helping clarify some misconceptions and inconsistent data about the recovery that workers compensation patients have following spine surgery.The approach offered in this study is not only helpful for workers comp patients, but also for lumbar fusion patients at large. Attempting to use a multidisciplinary approach and wean off opioid dependency as early as possible is not only in the patient’s best interest but also signifies a growing trend that many spine surgeons, physiatrists and pain management experts have embraced in their practices.Additional prospective studies with a larger patient sample, focusing on a multidisciplinary approach as outlined in this study, may help refute older data on this subject in the spine literature.
Click Here to Manage Email Alerts