The tendency these days is for physicians to recommend surgical procedures before any other kind of approach to muscular/skeletal injury or deformity, particularly in spinal cases. This sort of recommendation is not always a bad one; surgical practice, technology, and facilities have made routine surgery nearly flawless, almost futuristic. However, there are always risks, especially with patients that are morbidly obese or heavy smokers, not to mention the ever present fear of infection. Researchers have found that in many cases, multidisciplinary evaluation can reduce the need for operative procedures, with physical therapy being one of the leading methods of rehabilitation and healing. Here’s an excerpt from the PT in Motion article on the issue:
Multidisciplinary evaluation and direct communication among providers may offer patients with spine problems “more diverse nonoperative treatment options” and result in fewer unnecessary surgeries, leading to lower costs, experts say. In a pilot study e-published ahead of print in Spine (abstract only available for free), a team of providers from diverse fields recommended nonoperative treatment for 58% of patients who previously had been advised by a surgeon to undergo spinal fusion.
Researchers were hoping to learn what effect multidisciplinary decision making could have on what they termed the “inappropriate overutilization of spine surgery” for people with spinal disorders. They put together a group of physiatrists, anesthesiologists, pain specialists, neurosurgeons, orthopedic spine surgeons, physical therapists, social workers, physician assistants, and nurse practitioners to evaluate patients who had previously been recommended for spinal fusion by a surgeon not involved in the study.
In weekly group conferences, the clinicians assessed each patient’s level of disability, prior treatment, comorbidities, surgical and anesthesia risks, and potential for positive outcomes, as well as any imaging. Out of 137 patients, 100 had been recommended for spinal fusion. After evaluation, the group advised 58 of those patients to pursue a nonoperative plan of care. While some were advised against surgery due to obesity or smoking, the group identified physical therapy as potentially more beneficial for 22 patients and recommended others for steroid injection or vertebroplasty. “Multidisciplinary evaluation can alter the treatment recommendations” for this population, say authors.
The multidisciplinary decision making had other positive effects as well. Four patients who had been misdiagnosed with lumbar radiculopathy were referred to joint specialists for degenerative hip arthritis. And 16 of the 58 patients who did undergo surgery had a different type of operation due to consultation with the team. None of the operative patients had complications or readmissions at 90 days. While researchers do not yet know long-term outcomes for the patients who received nonoperative care, they are following the cohort.
“As clinicians, we bring our own biases into the treatment plan for patients … that drive us towards particular interventions,” authors note. In the case of lumbar spinal pathology, they assert, “Isolated surgical decision making may result in suboptimal treatment recommendations.” Instead, they urge clinicians to collaborate to “develop the infrastructure necessary to support multidisciplinary approaches to spine care.”
For more information on how physical therapy can help with spinal injuries or degenerative diseases, you can visit http://apta.org or talk with one of our physical therapists by contacting us via our CONTACT FORM!