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Costs higher for fast track spine fusion rehab vs. program started at 12 weeks
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SCOTTSDALE, Ariz., USA — A rehabilitation program that patients started at 12 weeks after lumbar spine fusion surgery proved more cost-effective overall than the same program started at 6 postoperative weeks, according to results of a study presented at the International Society for the Study of the Lumbar Spine Meeting, here.
The economic evaluation was linked to a previously presented and published randomized controlled trial with 1-year follow-up.
“We showed rehab 6 weeks as opposite to 12 weeks after lumbar spinal fusion is associated with poorer outcomes as shown last year and a higher cost leading to the conclusion that early initiation of rehabilitation is unlikely to be cost-effective to this patient population — a challenge to fast track strategies,” Finn B. Christensen, MD, PhD, DMSc, in the Department of Orthopaedic Surgery at Aarhus University Hospital, in Aarhus, Denmark, said.
Timing of rehabilitation
A previous investigation showed the group-based rehabilitation program used by study participants worked, according to Christensen and colleagues. Their goal for this study was to find out which time point after instrumented lumbar fusion is the most cost-effective to start the rehabilitation program.
They randomized 82 patients into either a group that began four sessions of the rehabilitation program 6 weeks after surgery or a group that began the same four rehabilitation sessions 12 weeks after surgery. For the final analysis there were 34 patients in each group, and all patients underwent instrumented lumbar spine fusion for degenerative disc disease, or grade 1 or 2 spondylolisthesis.
For the rehabilitation, patients followed “an identical protocol of four sessions of group-based rehabilitation and were instructed in home exercises focusing on active stability training,” Christensen and colleagues wrote in their study abstract.
Results in detail
The investigators assessed the patients’ outcomes with the rehabilitation program using the Oswestry Disability Index (ODI) and Quality-adjust Life Year (QALY) instruments.
The per person costs presented were based on 2011 prices, Christensen said.
He noted that they assessed other aspects of how the patients responded to the rehabilitation program using a variety of methods, such as identifying health services the patients received from the Danish national patient register, enumerating visits to the doctor or physical therapy from a national health insurance register and determining when patients were on sick leave or paid expenses out-of-pocket.
“We ended up having 82% follow-up,” Christensen said.
“What we realize is, using a bootstrapping strategy, that the new — and that is at 6 weeks, the early start —[program] was less effective and it was also more expensive,” based on ODI results, he said.
The same tendency was seen when investigators looked at the QALY results.
During the discussion of his study, Christensen said one reason that costs were higher for the group that started rehab early, at 6 weeks, was an increased rate of “visits” to the hospital between 6 weeks and 12 weeks postoperatively. But, “It is not necessarily that they went to the doctor,” he said. – by Susan M. Rapp
- References:
- Christensen FB. Paper #36. Presented at: International Society for the Study of the Lumbar Spine Meeting. May 13-17, 2013; Scottsdale, Ariz., USA.
- Oestergaard LG. Spine. 2012;doi:10.1097/BRS.0b013e31825a17ab.
- For more information:
- Finn B. Christensen, MD, PhD, DMSc, can be reached at Norrebrogade 44, DK-8000 Aarhus, Denmark; email: fb.christensen@ki.au.dk.
Disclosure: Christensen has no relevant financial disclosures. Support for the study came from the Lundbeck Foundation (UCSF), Danish Rheumatism Associations (Gigtforeningen), Health Insurance Foundation (Helsefonden), Danish Strategic Research Council, Central Denmark Region and the Occupational Therapy and Physiotherapy Department, University Hospital of Aarhus.