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Are Exercise and Physical Therapy Common Forms of Conservative Management in the Year Before Lumbar Spine Surgery?
Jessica A Carrignan1, Richard Tyler Simmet1, Matthew Coddington1
1United States Army-Baylor Doctoral Program in Physical Therapy, Joint Base San Antonio-Fort Sam, Houston, Texas.
Objective:
To quantify and compare utilization of opioids, exercise therapy, and physical therapy in the year before spine surgery.
Design:
A retrospective cohort of surgical and claims data.
Setting:
Beneficiaries of the Military Health System seen at Brooke Army Medical Center PARTICIPANTS: Patients (N=411) undergoing surgery between January 1, 2014, and December 31, 2015, identified retrospectively through the Surgical Scheduling System (S3) based on procedure type (fusion, laminectomy, arthroplasty, vertebroplasty, and diskectomy).
Interventions:
Elective lumbar spine surgery.
Main Outcome Measures:
Health care utilization variables present during the full 12 months before surgery, which included physical therapy services and visits for exercise therapy or manual therapy procedures and opioid prescriptions.
Results:
The mean age of participants was 44.8±11.7 years and 32.4% were female. In the year before surgery, 143 (34.8%) patients had a physical therapy plan of care, 140 (34.1%) had at least 1 visit that included exercise therapy, and only 60 (14.6%) had a minimum of 6 exercise therapy visits. However, 347 (84.4%) patients received at least 1 opioid prescription fill (mean of 6.1 unique fills).
Conclusions:
Before elective lumbar spine surgery, opioid prescriptions were common but physical therapy services and exercise therapy utilization occurred infrequently.
