title: Lumbar spinal fusion patients' demands to the primary health sector: evaluation of three rehabilitation protocols. A prospective randomized study.
abstract: Very few studies have investigated the effects or costs of rehabilitation regimens following lumbar spinal fusion. The effectiveness of in-hospital rehabilitation regimens has substantial impact on patients' demands in the primary health care sector. The aim of this study was to investigate patient-articulated demands to the primary health care sector following lumbar spinal fusion and three different in-hospital rehabilitation regimens in a prospective, randomized study with a 2-year follow-up. Ninety patients were randomized 3 months post lumbar spinal fusion to either a 'video' group (one-time oral instruction by a physiotherapist and patients were then issued a video for home exercise), or a 'café' group (video regimen with the addition of three café meetings with other fusion-operated patients) or a 'training' group (exercise therapy; physiotherapist-guided; two times a week for 8 weeks). Register data of service utilization in the primary health care sector were collected from the time of randomization through 24 months postsurgery. Costs of in-hospital protocols were estimated and the service utilization in the primary health care sector and its cost were analyzed. A significant difference (P=0.023) in number of contacts was found among groups at 2-year follow-up. Within the periods of 3-6 months and 7-12 months postoperatively, the experimental groups required less than half the amount of care within the primary health care sector as compared to the video group (P=0.001 and P=0.008). The incremental costs of the café regimen respectively, the training regimen were compensated by cost savings in the primary health care sector, at ratios of 4.70 (95% CI 4.64; 4.77) and 1.70 (95% CI 1.68; 1.72). This study concludes that a low-cost biopsychosocial rehabilitation regimen significantly reduces service utilization in the primary health care sector as compared to the usual regimen and a training exercise regimen. The results stress the importance of a cognitive element of coping in a rehabilitation program.
authors.affiliation: Orthopaedic Research Laboratory, University Hospital of Aarhus, Nørrebrogade 44, 8000 Aarhus C, Denmark. rikke.sogaard@ki.au.dk
authors.forename: Rikke
authors.initials: R
authors.lastname: Soegaard
authors.forename: Finn B
authors.initials: FB
authors.lastname: Christensen
authors.forename: Ida
authors.initials: I
authors.lastname: Lauerberg
authors.forename: Ida
authors.initials: I
authors.lastname: Lauersen
authors.forename: Cody E
authors.initials: CE
authors.lastname: Bünger
mesh_terms: D000203:Activities of Daily Living / Q000523:psychology; D000328:Adult; D003362:Cost-Benefit Analysis; D003718:Denmark; D005081:Exercise Therapy / Q000191:economics / Q000706:statistics & numerical data / Q000639:trends; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007403:Intervertebral Disc / Q000473:pathology / Q000601:surgery; D007405:Intervertebral Disc Displacement / Q000534:rehabilitation* / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D010809:Physical Fitness / Q000523:psychology; D026741:Physical Therapy Modalities / Q000191:economics / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000191:economics / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012047:Rehabilitation Centers / Q000191:economics / Q000706:statistics & numerical data*; D012944:Social Support; D013123:Spinal Fusion / Q000191:economics / Q000534:rehabilitation* / Q000706:statistics & numerical data; D016896:Treatment Outcome