• A Rushton, C Wright, A Heap, L White, G Eveleigh, and N Heneghan.
• *School of Sport, Exercise, and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom; and †Department of Spinal Surgery/Physiotherapy, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Queen Elizabeth Medical Centre, Birmingham, United Kingdom.
• Spine. 2014 Nov 1;39(23):E1380-7.

Study DesignDescriptive survey methodology employed a SurveyMonkey online questionnaire.ObjectiveTo evaluate UK National Health Service physiotherapy practice for lumbar spinal fusion surgery.Summary Of Background DataAn increasing 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, remains 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 required, to inform a future trial to evaluate a best practice physiotherapy intervention.MethodsEligible 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.ResultsThe 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, partly attributed to the poor evidence base for this surgery. Scope of practice included exercise, advice, listing for surgery, and ordering investigations. Patient education played an important role. Patient-centered practice was important, although constraints owing to limited resources (staffing, poor evidence, base/lack of protocols) were evident.ConclusionCurrent UK pre- and postoperative physiotherapy practice for lumbar spinal fusion is described. It is not clear 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 need for a randomized clinical trial evaluating effectiveness of a best practice physiotherapy management intervention.Level Of Evidence3.

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