Lumbar spinal fusion patients' demands to the primary health sector: evaluation of three rehabilitation protocols. A prospective randomized study

• Published in: European spine journal 2006-05, Vol.15 (5), p.648-656
• Main Authors: Soegaard, Rikke, Christensen, Finn B, Lauerberg, Ida, Lauersen, Ida, Bünger, Cody E
• Format: Article
• Language: English
• Subjects: Activities of Daily Living - psychology; Adult; Cost-Benefit Analysis; Denmark; Exercise Therapy - economics; Exercise Therapy - statistics & numerical data; Exercise Therapy - trends; Female; Follow-Up Studies; Humans; Intervertebral Disc - pathology; Intervertebral Disc - surgery; Intervertebral Disc Displacement - rehabilitation; Intervertebral Disc Displacement - surgery; Lumbar Vertebrae - pathology; Lumbar Vertebrae - surgery; Male; Middle Aged; Needs Assessment; Original; Patient Acceptance of Health Care - statistics & numerical data; Physical Fitness - psychology; Physical Therapy Modalities - economics; Physical Therapy Modalities - utilization; Primary Health Care - economics; Primary Health Care - statistics & numerical data; Primary Health Care - utilization; Prospective Studies; Rehabilitation Centers - economics; Rehabilitation Centers - statistics & numerical data; Rehabilitation Centers - utilization; Social Support; Spinal Fusion - economics; Spinal Fusion - rehabilitation; Spinal Fusion - statistics & numerical data; Treatment Outcome
• ISSN: 0940-6719; 1432-0932
• DOI: 10.1007/s00586-005-0884-8

Very few studies have investigated the effects or costs of rehabilitation regimens following lumbar spinal fusion. The effectiveness of in-hospital rehabilitation regimens has substantial impact on patients' demands in the primary health care sector. The aim of this study was to investigate patient-articulated demands to the primary health care sector following lumbar spinal fusion and three different in-hospital rehabilitation regimens in a prospective, randomized study with a 2-year follow-up. Ninety patients were randomized 3 months post lumbar spinal fusion to either a 'video' group (one-time oral instruction by a physiotherapist and patients were then issued a video for home exercise), or a 'café' group (video regimen with the addition of three café meetings with other fusion-operated patients) or a 'training' group (exercise therapy; physiotherapist-guided; two times a week for 8 weeks). Register data of service utilization in the primary health care sector were collected from the time of randomization through 24 months postsurgery. Costs of in-hospital protocols were estimated and the service utilization in the primary health care sector and its cost were analyzed. A significant difference (P=0.023) in number of contacts was found among groups at 2-year follow-up. Within the periods of 3-6 months and 7-12 months postoperatively, the experimental groups required less than half the amount of care within the primary health care sector as compared to the video group (P=0.001 and P=0.008). The incremental costs of the café regimen respectively, the training regimen were compensated by cost savings in the primary health care sector, at ratios of 4.70 (95% CI 4.64; 4.77) and 1.70 (95% CI 1.68; 1.72). This study concludes that a low-cost biopsychosocial rehabilitation regimen significantly reduces service utilization in the primary health care sector as compared to the usual regimen and a training exercise regimen. The results stress the importance of a cognitive element of coping in a rehabilitation program.