Rehabilitation following lumbar disc surgery
Projectomschrijving
De REALISE studie heeft onderzocht wat de meest (kosten)effectieve manier is om te revalideren na een lumbale hernia operatie. De twee gangbare vormen in Nederland zijn onderzocht:
1) Na de operatie komt de patiënt direct onder behandeling van een fysiotherapeut. Tijdens de controleafspraak bij de neurochirurg, 6 weken na de operatie, wordt beslist of deze behandeling wordt voortgezet.
Of 2) Er wordt een afwachtend beleid gevoerd en pas 6 weken na de operatie, tijdens de controleafspraak bij de neurochirurg, beoordeeld of een verwijzing naar de fysiotherapeut noodzakelijk is. De resultaten lieten zien dat er geen relevante verschillen waren tussen deze beide vormen op een aantal belangrijke klinische effectmaten zoals pijn en functioneren. Ook waren er geen relevante verschillen in kosten. Het onmiddellijk verwijzen naar de fysiotherapie na de operatie heeft dus geen toegevoegde waarde.
Producten
Auteur: Oosterrhuis T, Ostelo R, Tulder MW,
Auteur: Oosterhuis T, Ostelo R, Tulder MW
Auteur: T Oosterhuis. Proefschrift wordt momenteel afgerond en wordt aangeboden aan leescie begin 2016
Auteur: Teddy Oosterhuis, Maurits van Tulder, Wilco Peul, Judith Bosmans, Carmen Vleggeert-Lankamp, Lidwien Smakman, Mark Arts and Raymond Ostelo
Magazine: BMC Musculoskelet Disord. 2013 Apr 5;14
Link: https://doi.org/10.1186/1471-2474-14-124
Auteur: Teddy Oosterhuis, Raymond Ostelo, Johanna M van Dongen, Wilco C Peul , Michiel R de Boer, Judith E Bosmans, Carmen L Vleggeert-Lankamp, Mark P Arts, Maurits W van Tulder
Magazine: Journal of Physiotherapy 2017 Jul;63(3)
Link: https://doi.org/10.1016/j.jphys.2017.05.016.
Auteur: Oosterhuis, Teddy, van Tulder, Maurits, Peul, Wilco, Bosmans, Judith, Vleggeert-Lankamp, Carmen, Smakman, Lidwien, Arts, Mark, Ostelo, Raymond
Magazine: BMC Musculoskeletal Disorders 2013 Apr 5;14
Link: https://doi.org/10.1186/1471-2474-14-124.
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Samenvatting van de aanvraag
Background In The Netherlands there are two strategies for rehabilitation of patients following lumbar disc surgery. In some hospitals rehabilitation is restricted to the hospital phase and after discharge there is no more supervised rehabilitation. If complaints persist at the 6 weeks consultation of the neurosurgeon, a patient is referred for physiotherapy (PT). However, there are also hospitals that continue rehabilitation directly after discharge, during the first 6 weeks after surgery. This rehabilitation is mainly delivered by PTs in a primary care setting. Since January 1st, 2006, patients can also directly access PT without a referral (DTF). Then the PT has to decide after initial assessment if rehabilitation is indicated and some PTs opt for continuation of the rehabilitation while others don’t. So, regardless of the specific procedure (referral by neurosurgeon or DTF) there is wide variation in care. Evidence shows that continuation of rehabilitation within the first 6 weeks is effective and leads to faster recovery but a head-to-head comparison of the cost-effectiveness is lacking. Aim and design To assess if a continued rehabilitation program in the first six weeks post-surgery for patients following a first time is more cost-effective as compared to no further treatment after discharge from the hospital an economic evaluation alongside a randomized controlled trial will be conducted. Treatment groups Patients are randomised into 2 groups: In the continued rehabilitation group patients will receive treatment according to the Dutch Physiotherapy (KNGF) guideline. Patients in the control group receive no further treatment after hospital discharge. Measurements Primary outcomes are: global perceived recovery (7-point scale), functional status (Oswestry Disability Index (ODI)), and pain intensity (leg and back) (11-point NRS). Also general health (SF-36) return to work and quality of life (EuroQol) are measured. Costs will be recorded in cost diaries. Timing of measurement: baseline (in addition to outcomes at baseline also demographics and most important prognostic factors are measured), 3, 6 and 26 weeks. Sample size Anticipating a 15% drop out, a total of 200 patients are necessary (power 0.9; alpha 0.05) to detect a clinical relevant mean difference between the continued rehabilitation group and the no treatment group of 8 points on the ODI (SD 15), a 2 points difference (SD 3) for pain (11-point NRS) and a 20% difference on the dichotomized global perceived recovery (recovered vs not recovered). Data analysis includes an intention-to-treat analysis and a per-protocol analysis, and a multi-level analysis, incorporating practice, patient and time of measurement as level. Time schedule Months: (0-8) preparation (project leader and researcher): final recruitment of participating hospitals and primary care physiotherapy practices; development of research infrastructure (general: administration, data management; and per hospital: patient inclusion system, randomisation, referral to physiotherapy. (9-34) patient inclusion. (9-42) treatment, follow up measures. (24-43) data entry and cleaning. (38-48) analysis, economic evaluation, writing report and publications