Does Postoperative Physical Therapy Impact Pain, Opioid Consumption, and Clinical Outcomes after Single-Level Lumbar Fusion?

Abstract

Study design: Retrospective Cohort.

Objective: To determine the impact of physical therapy (PT) on opioid consumption, surgical outcomes, and patient-reported outcome measures (PROMs) following single-level lumbar fusion.

Summary of background data: Physical therapy following lumbar fusion surgery is variably prescribed, with the goals of pain relief and return to activity. However, existing evidence on the efficacy of postoperative PT after spine surgery is heterogeneous and generally low-quality. Furthermore, the impact of PT on opioid use following lumbar fusion has been minimally studied.

Methods: All patients underwent single-level lumbar fusion surgery at a single tertiary academic institution. Insurance claims data was reviewed to determine which patients utilized outpatient PT in the 180 days postoperatively. Patient demographics, surgical variables, surgical outcomes, and PROMs were compared between patients with postoperative PT and those without. The state prescription drug monitoring program (PDMP) database was utilized to record prescription opioid use in the 1-year preoperative and 1-year postoperative periods. Multivariate regression analyses were created to examine the impact of PT on postoperative opioid use.

Results: A total of 365 patients were included; 187 patients received postoperative PT while 178 did not. There were no differences in demographics/surgical variables, surgical outcomes, or PROMs between groups. There was no difference in preoperative or postoperative opioid use, total morphine milligram equivalents (MMEs), or total opioid prescriptions between groups. Multivariate regression analyses revealed that the use of PT was not a significant predictor of MME consumption at any time point after surgery.

Conclusion: PT does not appear to increase complications after single-level lumbar fusion, and thus is likely a safe consideration during recovery. However, it may not significantly improve outcomes or reduce opioid consumption when implemented routinely for all patients. Surgeons should consider individual patient risk factors when deciding on optimal postoperative management.