Determining clinical practice of expert physiotherapy for patients undergoing lumbar spinal fusion: a cross-sectional survey study

Eur Spine J DOI 10.1007/s00586-016-4433-4 ORIGINAL ARTICLE Determining clinical practice of expert physiotherapy for patients undergoing lumbar spinal fusion: a cross-sectional survey study Esther R. C. Janssen1 • Elle E. M. Scheijen1 • Nico L. U. van Meeteren2,3 • Rob A. de Bie2 • Anton F. Lenssen1,4 • Paul C. Willems5 • Thomas J. Hoogeboom6 Received: 16 March 2015 / Revised: 5 January 2016 / Accepted: 28 January 2016 Ó The Author(s) 2016. This article is published with open access at Springerlink.com Abstract Purpose To determine the content of current Dutch expert hospital physiotherapy practice for patients undergoing lumbar spinal fusion (LSF), to gain insight into expert-based clinical practice. Methods At each hospital where LSF is performed, one expert physiotherapist received an e-mailed questionnaire, about pre- and postoperative physiotherapy and discharge after LSF. The level of uniformity in goals and interventions was graded on a scale from no uniformity (50–60 %) to very strong uniformity (91–100 %). Results LSF was performed at 34 of the 67 contacted hospitals. From those 34 hospitals, 28 (82 %) expert physiotherapists completed the survey. Twenty-one percent of the respondents saw patients preoperatively, generally to provide information. Stated postoperative goals and administered interventions focused mainly on performing transfers safely and keeping the patient informed. Outcome measures were scarcely used. There was no uniformity regarding advice on the activities of daily living. Conclusion Dutch perioperative expert physiotherapy for patients undergoing LSF is variable and lacks structural outcome assessment. Studies evaluating the effectiveness of best-practice physiotherapy are warranted. E. R. C. Janssen and E. E. M. Scheijen contributed equally to this work. Keywords Physical therapy modalities
Rehabilitation
Health surveys Electronic supplementary material The online version of this article (doi:10.1007/s00586-016-4433-4) contains supplementary material, which is available to authorized users. & Thomas J. Hoogeboom 1 Physiotherapy Program, Health Faculty, Zuyd University of Applied Sciences, Heerlen, The Netherlands 2 Department of Epidemiology and Research School Caphri, Maastricht University Medical Centre?, Maastricht, The Netherlands 3 Healthy Living, TNO, Leiden, The Netherlands 4 Department of Physiotherapy, Maastricht University Medical Centre?, Maastricht, The Netherlands 5 Department of Orthopaedics and Research School Caphri, Maastricht University Medical Centre?, Maastricht, The Netherlands 6 Radboud University Medical Centre, Radboud Institute for Health Sciences, IQ Healthcare, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands Introduction In the past decades surgical interventions, especially lumbar spinal fusion (LSF), have gained popularity [1]. In the United States the number of LSFs increased between 1998 and 2007 by 237 % (from 174,223 to 413,171 procedures) [2]. LSF is a procedure in which two or more vertebrae are fixated to restrict painful spinal motion. Regaining function after LSF is very important for the patient. Clinical rehabilitation, in particular physiotherapy, may be an important factor in regaining functional independence. There is little knowledge on the optimal physiotherapy practice in patients undergoing LSF. In a systematic review of the literature, Rushton et al. [3] demonstrated that studies on the effectiveness of physiotherapy after LSF are of low quality and too heterogeneous to pool. Consequently, physiotherapists have to depend on 123 Eur Spine J their own competence and experience in their day-to-day practice. This results in highly variable clinical care with unknown effectiveness, as demonstrated by Rushton et al. [4] in the UK. Thus, best clinical physiotherapy practice in LSF remains to be elucidated [3, 5]. We hypothesised that studying clinical practice for patients undergoing LSF provided by expert physiotherapists would establish a better understanding of the current best practice. These data could serve as temporary guidelines for hospital physiotherapists working with people undergoing LSF and as a usual care arm in future randomised studies. Therefore, the purpose of this study is to describe the content of Dutch inpatient expert physiotherapy before and after LSF. Methods Design and population In this cross-sectional survey study, we asked expert physiotherapists who perform inpatient treatment before and after LSF to complete a survey on their practice routines. To select the expert physiotherapists, we contacted all heads of physiotherapy departments who were registered with the Dutch Association for Physiotherapy in Hospitals (NVZF) by e-mail (02/06/2014). The NVZF represents 67 general hospitals, academic hospitals and specialised care centres in the Netherlands [6]. Hospitals where LSF was not performed were excluded. Department heads were informed about the content of the study and were asked to forward the survey to their expert physiotherapist concerning LSF (i.e. the physiotherapist they would want to be treated by if they underwent LSF). Return of the questionnaire was considered as informed consent. A reminder was sent after 1 month. This manuscript is reported according to the STROBE guideline for crosssectional studies [7] and the CHERRIES checklist for reporting the results of internet E-surveys [8]. Assessment by a medical ethics review board was not necessary. Survey The survey comprised 46 questions (nine open and 37 multiple-choice) on four domains: (1) demographic data (nine questions), (2) preoperative diagnostics and treatment (seven questions), (3) postoperative diagnostics and treatment (26 questions), and (4) information for discharge (four questions). The questions in the survey were based on a similar study in the UK by Rushton et al. [4]. However, we adapted the survey to the Dutch healthcare context. Moreover, we based the answer options for the questions on diagnostic procedures on the ICF core set for LBP [9]. 123 Finally, we added 17 questions in order to obtain information regarding multidisciplinary cooperation, discharge criteria and referral information after discharge. The survey (translated into English; i.e., not an official cross-cultural adaptation) is available as an appendix to this manuscript. Data collection To collect the data, we used Qualtrics (http://www.qual trics.com), a commonly used internet-based program for administering surveys [10]. To minimise the chance of incomplete responses due to skipped and/or forgotten questions, the function ‘‘Force Response’’ was used. ‘‘Skip Logic’’ was added to increase the efficiency of the questionnaire (completion time was approximately 15 min). Respondents were able to review and change their given answers using a back button. To prevent multiple answers from the same individual we checked from which hospital the questionnaire originated and their IP-address. In th (...truncated)