Survey of current physiotherapy practice for patients undergoing lumbar spinal fusion in the United kingdom

Descriptive survey methodology employed a SurveyMonkey online questionnaire to evaluate UK National Health Service physiotherapy practice for lumbar spinal fusion surgery. A rising rate of surgery and high level of patient dis-satisfaction focus attention to rehabilitation of patients undergoing lumbar spinal fusion. Inconclusive, very low-quality evidence for the effectiveness of physiotherapy management after lumbar spinal fusion exists. Best practice, therefore, is still not unclear. Limited comparability of outcomes and retrieval of only 2 trials reflected a lack of research and considerable heterogeneity. An evaluation of current practice is needed to inform a future trial to evaluate a best practice physiotherapy intervention. Eligible participants were all physiotherapists working with patients undergoing spinal fusion. A previous survey and recent systematic review informed questions. Statistical analyses included responder characteristics and preplanned descriptive analyses. Thematic analysis was conducted on open-ended question data. The 83.5% response rate was good. Findings illustrated varied provision relating to assessment and management of patients pre- and postoperatively. Physiotherapists employed limited use of protocols or guidelines, attributal in part to the poor evidence base for this surgery. Scope of practice included exercise, advice, listing for surgery, and ordering investigations. Patient education played an significant role. Patient-centered practice was important, although constraints owing to limited resources (staffing, poor evidence, base/lack of protocols) were evident.

Current UK pre- and postoperative physiotherapy practice for lumbar spinal fusion is described. It is unclear whether patients who are seen by physiotherapists have improved outcomes, owing to variability of practice, physiotherapy being delivered in a range of locations at a range of times postoperatively, and limited use of outcome measures. The findings support the necessity for a randomized clinical trial evaluating effectiveness of a best practice physiotherapy management intervention.