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Selective Dorsal Rhizotomy: Patient Demographics and Postoperative Physical Therapy
Kristen Blatt1, Jessica Lewis1, Rachel Bican2
1Division of Clinical Therapies, Department of Physical Therapy, Nationwide Children's Hospital, Columbus, Ohio.
Insights
Children with public insurance, Black or African American children, and those in large metro areas are less likely to receive selective dorsal rhizotomy (SDR). Postoperative physical therapy (PT) doses are also below recommendations after SDR for cerebral palsy (CP).
Area of Science:
- Neurosurgery
- Pediatric Rehabilitation
- Orthopedic Surgery
Background:
- Selective dorsal rhizotomy (SDR) is a surgical intervention for spastic cerebral palsy (CP) that permanently reduces lower extremity spasticity.
- Intensive postoperative physical therapy (PT) is crucial for optimizing outcomes after SDR in children with CP.
- Disparities in access to SDR and adherence to recommended PT regimens may impact long-term functional gains.
Purpose of the Study:
- To compare demographic characteristics of children undergoing SDR with the broader CP population at a single institution.
- To evaluate the adherence to prescribed postoperative physical therapy (PT) doses among ambulatory children who received SDR.
- To identify potential barriers to equitable access to SDR and adequate PT post-intervention.
Main Methods:
- Retrospective analysis of electronic medical records for 60 children with spastic CP who underwent SDR.
- Inclusion of a subset of 12 ambulatory children to assess postoperative PT dose.
- Data collection included patient demographics, SDR details, and PT encounter codes and locations.
Main Results:
- Children identifying as Black or African American, those residing in large central metropolitan areas, and those with public insurance were significantly less likely to undergo SDR.
- Ambulatory children who underwent SDR did not achieve the recommended dose of postoperative PT following hospital discharge.
- Statistical significance was observed for race (P = 0.002), habitancy (P = 0.033), and insurance type (P ≤ 0.001).
Conclusions:
- Access to SDR is inequitable across different patient populations, indicating potential systemic disparities.
- The frequency of prescribed postoperative PT following SDR falls short of recommended guidelines, potentially compromising rehabilitation.
- Further research is warranted to elucidate the reasons behind these access and adherence disparities and to develop targeted interventions.
Background:
Selective dorsal rhizotomy (SDR) is a surgical procedure that permanently alters lower extremity spasticity, common in children with spastic cerebral palsy (CP). Intensive postoperative physical therapy (PT) is recommended following SDR. The first purpose of this study is to describe and compare patient demographics between children who received SDR and the population of children with CP at one institution. The second purpose of this study is to compare the completed dose of postoperative PT with the clinically recommended dose for a subset of ambulatory children who underwent SDR.
Methods:
This retrospective, observational study included 60 children with spastic CP following SDR. A subset (n = 12 ambulatory children) was included to describe the dose of postoperative PT. Information gathered from electronic medical records included age at the time of SDR, sex, Gross Motor Function Classification System level, anatomic distribution, race, county-level habitancy, health insurance provider, timed current procedural terminology codes, and location for postoperative PT encounters within a single institution.
Results:
Black or African American children (P = 0.002), children living in large central metro areas (P = 0.033), and children with public insurance (P ≤ 0.001) were significantly less likely to receive SDR. Children undergoing SDR do not achieve the recommended dose of PT after hospital discharge.
Conclusion:
SDR is not equally accessed by patient populations, and postoperative PT frequency is below current recommendations throughout the rehabilitation process. Future studies need to investigate why these disparities exist and what prevents children from meeting the clinically recommended dose of postoperative PT after SDR.
