Spinal decompression rehabilitation (reviewed)

Running head: SPINAL DECOMPRESSION REHABILITATION 1

Reduction of Pain Frequency in Rehabilitation Patients Post-Spinal Decompression

Aaron Peterson

Becker College

SPINAL DECOMPRESSION REHABILITATION 2

Introduction

This research will investigate the patient and how they respond to treatment of spinal

injuries over a specified amount of time and how their pain level was affected depending on the

form of rehabilitation used. This will be analyzed based on patient report. Lowered patient pain

level is expected with all rehabilitation techniques used, but there will be a differing factor based

upon which rehabilitation method is chosen. This differing factor is one that this research seeks

out and it will emerge from the evidence. Many people suffer every day from lower back pain

and need a solution to their deteriorating condition. Surgery offers relief from symptoms of pain,

whether or not that is completely relieved over time remains to be seen, but hopefully, this

research will bring new information on what efforts do lower the pain score post-surgery for

spinal decompression.

The Problem

The problem being addressed is how well post-surgical patients recover from spinal

decompression surgery through certain types of rehabilitation.

PICOT

In patients who underwent spinal decompression surgery how does self-management

rehab compared to physical therapy affect recovery and pain frequency within the first two years.


Background to the Problem

The problem presented offers a unique insight into a certain set of procedures. Research

suggests that more than 400,000 back surgeries are performed per year, with that number

increasing steadily (Rajaee, 2012). Not only do these patients look for relief of pain, but they

look for a better lifestyle in coordination with reduction of this symptom. This makes the

problem being addressed important because the question identifies the manner in which pain is

most reduced through differing rehabilitation techniques. Many people and organizations work

on this problem every day. Hospitals looks for best practice post-surgery and organizations,

including sports teams, try to find the best rehabilitation measures possible to get their

employees back in action. Methods being used include, physical therapy, home therapy and

medication therapy. The results provided by the sources used blind trials that only included

patients who had previously had spinal decompression surgery. Each source used a follow up

period that ended anywhere from a 12 month period to two years. The results of the sources

mentioned that there was a bit of variation when it came to the outcome of each type of therapy.

Surprisingly, the data really was not skewed in one direction (Mannion, Denzler, Dvorak,

Müntener & Grob, 2007). All patients were experiencing lifestyle changes for the worse because

of their back pain before the surgery took place. The care remedies chosen for the trial groups

included some sort of home therapy, partial physical therapy and full physical therapy (Mannion,

Denzler, Dvorak, Müntener & Grob, 2007). One included some sort of home regimen with little

intervention, while the other two did involve intervention from a medical professional. The

results not only took a look at what the treatment did to the pain level of the patients, but it also

took into account how the patient felt about the health care provider in question. The patients

involved in the studies seemed to fair better under a full physical therapy regimen, while the


patients who took care of themselves at home found that their condition got better, but not at the

pace of the other patients. As previously mentioned above, the pain scores of the patients did not

differ as much as previously thought, but this will not deter future research.

Integrative Review of the Literature

The literature used for the analysis mainly consisted of scholarly articles published

through the ProQuest search engine. These articles delivered important and relevant information

for this research proposal. The methodologies were not very sound at the beginning of the

allotted time for research. The search began with research based on laminectomy recovery times,

but stumbled on many spinal decompression rehabilitation articles. This changed the PICOT

question to a broader subject, but in the end it helped the overall method become much sounder.

Articles were found by combining the words “spine”, “surgery” and “rehabilitation”. This

literature provided not only statistics, but methods of practice, and authors who are advocating

for patients. These authors are advocating for patients around the globe because finding the best

type of rehabilitation after spinal decompression surgery will set the stage for many years to

come and help many patients on the road to a quick recovery. There were limitations in the

literature, as there are when researching any topic, but the limitations were few and far between.

Information on the previous PICOT question was few and far between when reviewing the

literature for the first time, this suggested a change of method and search criteria. Searching for a

broader subject really helped with the amount of information found and the type of information

that was presented. Because of the nature of my PICOT question, a decent amount of quantitative

literature presented itself, which led to the belief that the topic in question garnered more of a

quantitative answer rather than a set of qualitative answers. The evidence ended up suggesting

just what was previously discussed, but in a more lax presentation. The information did not


further solidify what had already been presented, it actually bolstered the idea that home therapy

may be effective if used correctly with a certain regimen.

Research Design

The theory that most complies with the proposed PICOT question, is Sister Callista Roy’s

adaptation model. This framework is built off of the human changing themselves to suit their

environment. Sister Callista Roy’s adaptation model describes itself by showing that each

individual strives to adapt and cope with life in their own unique way. This rehabilitation project

each of these patients endure is helping the human cope with their painEvery human who had

this surgery encountered some sort of circumstance that changed their lifestyle, they adapt by

getting surgery and changing their environment to suit their now changing living situation. Each

person creates their own stimulus and when you are rehabilitating and injury, those stimuli create

stressors that impact your recovery negatively or positively. The human has to adapt to those

stimuli and create an environment that they can grow in. Roy also describes health as more of an

outcome of the adaptation one has made to those stimuli, and that is completely in line with what

a rehabilitation patient goes through. Throughout this study lines do need to be drawn

somewhere while still being able to find meaning. So, the limit has to be where the information

is no longer necessary. Information that describes a rehabilitation technique, rather than sharing

how it helps the patient is of no use, so the limits in searching for my topic have to be sound. As

far as data goes, the data found shows a path which the patients took towards bettering their

condition. A study that does not compare one group to another, or one that does not give

sufficient information on whether or not correct measures were made to obtain a healthier

lifestyle is a study that is not a vital source. The use of Becker College’s library resources will be

used to maintain a high level of scholarly writing to create the framework. This set of


information taken from Becker College’s resources will be justified by scholarly use of these

papers and by the number of scholarly sources used to create the papers themselves. These

scholarly articles and sets of data are also justified in their reliability, the explanations of trials

being used and how recently the articles were written.

Gaining knowledge over a two year period will garner the evidence necessary to draw

knowledge about whether or not a certain rehabilitation measure was more effective than

another. The study does need to be blind, which will be unknown to the patients involved in the

treatment cycles. This is to maintain the integrity of the study and of the rehabilitation groups. Of

course, there has to be a set of surveys conducted throughout the two year regimen. Each group

will be presented with questions asking about how the rehabilitation treatment has either helped

or discouraged their lifestyle, how well they are able to perform activities of daily life and what

the patients’ pain score is. This will help in determining which pain management sequences

benefitted post-surgical patients the most. The surveys will be given one month, two months, six

months, one year, and two years post-surgery to not only check-in, but watch for growth or

deterioration in the population. A test will be performed with the patient before the procedure to

establish a baseline of how well the activities of daily life are performed, this same test will be

performed at one year and two years post-operation.

Expected Results

After maintaining a regimen in the three sets of patients described, the pain score on the

pain scale should decrease throughout the treatment. This will vary depending on the group

chosen by the patient. Patients in each group will be given information on the therapies offered.

Each group will have 50 participants, which brings the total to 150 participants. At the beginning

of the treatment the provider will gain knowledge on each patient set and their condition. The


patients will also have the opportunity to ask any questions necessary for the proposed treatment

regimen. After making sure the provider and patients are informed and have inquired about the

process ahead, then treatment will begin. While maintaining the survey frequency, the provider

will find that the group using physical therapy as their main treatment will experience a lower

pain score and excel in performing activities of daily living. Home therapy will follow with a

slightly higher pain score. Medication therapy will follow home therapy, but the pain score will

be differentiated in two instances. The medication therapy will help with pain at rest, but the

patient will find that the pain score increases while trying to perform activities of daily living.

The method that most prepares the patient for life after surgery, is physical therapy. After two

years post-surgery, participants will be given information for physical therapy and what positives

it provides. A large portion of information comes from patient report through surveys. These are

given in the time-frame previously mentioned. Pain scores during the test pre-procedure will be

varied depending on the area and type of spinal compression occurring, this will impact the post-

test results at one and two years respectively. Though, with 150 participants, it will not affect the

overall expected result


Works Cited

Archer, K. R., Coronado, R. A., Haug, C. M., Vanston, S. W., Devin, C. J., Fonnesbeck, C. J., . . .

Wegener, S. T. (2014). A comparative effectiveness trial of postoperative management for

lumbar spine surgery: Changing behavior through physical therapy (CBPT) study

protocol. BMC Musculoskeletal Disorders, 15, 325.

Mannion, A. F., Denzler, R., Dvorak, J., Müntener, M., & Grob, D. (2007). A randomised

controlled trial of post-operative rehabilitation after surgical decompression of the lumbar

spine. European Spine Journal, 16(8), 1101-17.

O'Day, K.,E. (2008). Athletes get their game back after lumbar spine

surgery.Biomechanics, 15(5), 37-38,40-42.

Soegaard, R., Christensen, F. B., Lauersen, I., & Bünger, C.,E. (2006). Lumbar spinal fusion

patients' demands to the primary health sector: Evaluation of three rehabilitation

protocols. A prospective randomized study. European Spine Journal, 15(5), 648-56.

Rajaee, S. (n.d.). Result Filters. Retrieved March 26, 2016, from

http://www.ncbi.nlm.nih.gov/pubmed/21311399

O'Day, K.,E. (2008). Athletes get their game back after lumbar spine

surgery.Biomechanics, 15(5), 37-38,40-42.

Rajaee, S. (n.d.). Result Filters. Retrieved March 26, 2016, from

http://www.ncbi.nlm.nih.gov/pubmed/21311399

Healthcare

Spinal decompression rehabilitation (reviewed)