Postoperative Physical Therapy Utilization for Anterior Cervical Discectomy and Fusion: An Analysis of Practice Patterns in the United States.

Study design/setting: Retrospective Cohort Study.

Objective: To describe postoperative physical therapy (PostopPT) utilization patterns and evaluate predictors of utilization after anterior cervical discectomy and fusion (ACDF).

Background context: ACDF is the most common cervical spine procedure. PostopPT may improve outcomes, but current usage and program characteristics are unknown.

Methods: PearlDiver Database identified patients who underwent ACDF between 2010-April 2023. PostopPT utilization was assessed 7-365 days postoperatively. Demographics, comorbidities, and procedural characteristics were analyzed. Univariate and multivariate logistic regression identified predictors of PostopPT utilization.

Results: Of 309,230 ACDF patients, 17.16% utilized PostopPT within one year. Among users, the average number of visits was 7.4, with mean initiation at 88 days (median: 61 d). PostopPT users were younger, had higher comorbidity burden, higher income, were more often female, and more likely to present with combined radiculopathy and myelopathy (P<0.001).Demographic predictors included commercial insurance (OR: 1.37), residence in the Northeast (OR: 1.35) or Midwest (OR: 1.31), income >$75,000 (OR: 1.17), female gender (OR: 1.14), and age <50 (OR: 1.10) (all P<0.001). Comorbidity predictors included fibromyalgia (OR: 1.37), osteoarthritis (OR: 1.30), obesity (OR: 1.29), depression (OR: 1.26), osteoporosis (OR: 1.19), ECI ≥4 (OR: 1.13), diabetes (OR: 1.08), and tobacco use (OR: 1.07) (all P<0.001). Procedural predictors included mixed myelopathy/radiculopathy (OR: 1.29), fusion ≥3 levels (OR: 1.22), orthopedic surgeon as provider (OR: 1.10), inpatient surgery (OR: 1.09), and two-level fusion (OR: 1.08) (all P<0.001).Patients with myelopathy alone were more likely to receive gait training, aquatic therapy, and group training, but less likely to receive manual therapy, electrical stimulation, hot/cold therapy, or ultrasound (all P<0.001).

Conclusions: PostopPT usage following ACDF is limited. Distinct demographic, comorbidity, and procedural factors predicted usage. PostopPT programs varied in timing, frequency, and intervention type.