J. Zadro1, A. Lewin2, P. Kharel1, C. Maher1, I. Harris1,2
1The University of Sydney, Institute for Musculoskeletal Health, Sydney School of Public Health, Faculty of Medicine and Health, Camperdown, Australia, 2University of New South Wales, Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, Sydney, Australia

Background: The efficacy of lumbar spine surgery – including fusion and decompression – remains unknown as there are no placebo-controlled trials. In terms of rehabilitation following lumbar spine surgery, low- to very low-certainty evidence suggests there are small, short-term benefits of exercise therapy if it commences 4-6 weeks following lumbar disc surgery for a disc prolapse.
Despite a lack of evidence supporting rehabilitation following lumbar spine surgery, post-operative physiotherapy appears widely utilised across Europe and there is variation in how much physiotherapy is provided. No study has investigated variation in the number of physiotherapy sessions patients receive following lumbar spine surgery in a workers’ compensation setting, or in Australia. Filling this evidence gap will provide information on how patients in this setting are managed following lumbar fusion or lumbar decompression surgery, facilitating comparison to other healthcare settings.

Purpose: To investigate physiotherapy utilization, costs, and return to work status in patients following lumbar spine surgery under a workers’ compensation claim.

Methods: Using data from the New South Wales (NSW) State Insurance Regulatory Authority (Australia), we audited physiotherapy billing codes for patients who received lumbar spine surgery from 2010-2017. We summarised the number of physiotherapy sessions patients received to 12 months post-surgery, total cost of physiotherapy and time to initiation of post-operative physiotherapy. We assessed the association between number of physiotherapy sessions or physiotherapy utilization at 12 months and return to work at 12 months. Analyses were stratified by type of surgery (fusion vs. decompression).

Results: We included 3,524 patients (1,220 had fusion; 2,304 decompression). On average, patients had 22 (standard deviation, SD = 22; range = 0 to 160) physiotherapy sessions in the 12 months post-operatively (mean cost = $1,768, interquartile range, IQR $405 to $2,557); 24% were still having physiotherapy at 12 months. Most patients had 9-24 (31%) or 25-50 sessions (25%); 11% had >50 sessions, whereas 11% had no physiotherapy. Patients who had fusion (vs. decompression) had more physiotherapy (mean: 25 vs. 20 sessions) and incurred higher physiotherapy costs (mean: $2,016 vs. $1,637). Although the number of post-operative physiotherapy sessions per patient remained stable from 2010-2017, time to initiate physiotherapy increased. Number of physiotherapy sessions was not associated with return to work status.

Conclusion(s): There is variation in physiotherapy utilization and costs following lumbar spine surgery for patients funded by NSW Workers’ Compensation. The amount of physiotherapy received was not associated with return to work status.

Implications: Effective rehabilitation programs following lumbar spine surgery typically involve 8-24 sessions, and in our sample 35% of cases had 25 sessions or more and one in ten had >50 sessions in the 12 months following surgery. This suggests many patients who have lumbar spine surgery funded by NSW Workers’ Compensation are receiving physiotherapy treatment above what may be necessary.

Funding, acknowledgements: This study did not receive funding. 

Keywords: rehabilitation, physical therapy, lumbar spine surgery

Topic: Musculoskeletal: spine

Did this work require ethics approval? Yes
Institution: South Western Sydney Local Health District
Committee: Research Ethics Office
Ethics number: HREC/16/LPOOL/189

All authors, affiliations and abstracts have been published as submitted.

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