Safety and feasibility of an early telephone-supported home exercise program after anterior cervical discectomy and fusion: a case series

Rogelio A Coronado, Clinton J Devin, Jacquelyn S Pennings, Oran S Aaronson, Christine M Haug, Erin E Van Hoy, Susan W Vanston, Kristin R Archer, Rogelio A Coronado, Clinton J Devin, Jacquelyn S Pennings, Oran S Aaronson, Christine M Haug, Erin E Van Hoy, Susan W Vanston, Kristin R Archer

Abstract

Objective: To describe the safety, feasibility, and preliminary outcomes of an early telephone-supported home exercise program (HEP) performed within the first 6 weeks after anterior cervical discectomy and fusion (ACDF) surgery.Methods: Eight patients (mean ± SD age = 53.4 ± 14.9 years, 5 females) were enrolled in this case series. Immediately after surgery, patients began a 6-week HEP including daily walking, deep breathing, distraction techniques, and cervical and upper body exercises. The HEP was supported by weekly telephone calls by a physical therapist. Safety for performing early exercise was examined with radiographic imaging at 6 months. Adverse events were assessed through weekly calls with a physical therapist. HEP adherence and acceptability data were obtained by patient self-report. Clinical measures were assessed preoperatively, at 6 weeks and at 6 months, and included the Neck Disability Index, Numeric Rating Scale for pain, Tampa Scale of Kinesiophobia, Pain Catastrophizing Scale, Pain Self-Efficacy Questionnaire, and accelerometry for physical activity.Results: Early radiographic imaging showed no signs of nonunion at 6 months. There were no reports of serious adverse events. At 6 months, all patients reported clinically significant changes in pain catastrophizing. Seven (88%) patients had clinically significant changes in disability and arm pain, six (75%) patients for neck pain and pain self-efficacy, and five (53%) patients for fear of movement. Only three (43%) of seven patients showed increased physical activity at 6 months.Conclusion: Based on this small case series, an early telephone-supported HEP appears safe for patients, feasible to implement, and promising for clinical benefits.

Keywords: Radiculopathy; Spinal fusion; exercise therapy; feasibility studies; neck pain; surgical decompression.

Conflict of interest statement

Declaration of Interest

The authors declare that there is no conflict of interest.

Figures

Figure 1.
Figure 1.
Timeline of home exercises.
Figure 2.
Figure 2.
Changes over time in disability (A: Neck Disability Index) and neck and arm pain intensity (B and C: Numeric Rating Scale)
Figure 2.
Figure 2.
Changes over time in disability (A: Neck Disability Index) and neck and arm pain intensity (B and C: Numeric Rating Scale)
Figure 2.
Figure 2.
Changes over time in disability (A: Neck Disability Index) and neck and arm pain intensity (B and C: Numeric Rating Scale)
Figure 3.
Figure 3.
Changes over time in objective physical activity (average steps per day)

References

    1. Alosh H, Li D, Riley LH, Skolasky RL 2015Health care burden of anterior cervical spine surgery: National trends in hospital charges and length of stay, 2000–2009. Journal of Spinal Disorders and Techniques 28: 5–11.
    1. Archer KR, Wegener ST, Seebach C, Song Y, Skolasky RL, Thornton C, Khanna AJ, Riley LH 2011The effect of fear of movement beliefs on pain and disability after surgery for lumbar and cervical degenerative conditions. Spine 36: 1554–1562.
    1. Badran A, Davies BM, Bailey HM, Kalsi-Ryan S, Kotter MR 2018Is there a role for postoperative physiotherapy in degenerative cervical myelopathy? A systematic review. Clinical Rehabilitation 32: 1169–1174.
    1. Bravata DM, Smith-Spangler C, Sundaram V, Gienger AL, Lin N, Lewis R, Stave CD, Olkin I, Sirard JR 2007Using pedometers to increase physical activity and improve health: A systematic review. JAMA 298: 2296–2304.
    1. Camara R, Ajayi OO, Asgarzadie F 2016Are external cervical orthoses necessary after anterior cervical discectomy and fusion: A review of the literature. Cureus 8: e688.
    1. Campbell MJ, Carreon LY, Traynelis V, Anderson PA 2009Use of cervical collar after single-level anterior cervical fusion with plate: Is it necessary? Spine 34: 43–48.
    1. Cannada LK, Scherping SC, Yoo JU, Jones PK, Emery SE 2003Pseudoarthrosis of the cervical spine: A comparison of radiographic diagnostic measures. Spine 28: 46–51.
    1. Carreon LY, Glassman SD, Campbell MJ and Anderson PA 2010. Neck Disability Index, short form-36 physical component summary, and pain scales for neck and arm pain: The minimum clinically important difference and substantial clinical benefit after cervical spine fusion. Spine Journal 10: 469–474.
    1. Chotai S, Parker SL, Sielatycki JA, Sivaganesan A, Kay HF, Wick JB, McGirt MJ, Devin CJ 2017Impact of old age on patient-report outcomes and cost utility for anterior cervical discectomy and fusion surgery for degenerative spine disease. European Spine Journal 26: 1236–1245.
    1. Coronado RA, George SZ, Devin CJ, Wegener ST, Archer KR 2015Pain sensitivity and pain catastrophizing are associated with persistent pain and disability after lumbar spine surgery. Archives of Physical Medicine and Rehabilitation 96: 1763–1770.
    1. De la Garza-Ramos R, Xu R, Ramhmdani S, Kosztowski T, Bydon M, Sciubba DM, Wolinsky JP, Witham TF, Gokaslan ZL, Bydon A 2016Long-term clinical outcomes following 3- and 4-level anterior cervical discectomy and fusion. Journal of Neurosurgery Spine 24: 885–891.
    1. French DJ, France CR, Vigneau F, French JA, Evans RT 2007Fear of movement/ (re)injury in chronic pain: A psychometric assessment of the original English version of the Tampa Scale for Kinesiophobia (TSK). Pain 127: 42–51.
    1. Goubert L, Crombez G, Van Damme S, Vlaeyen JW, Bijttebier P, Roelofs J 2004Confirmatory factor analysis of the Tampa Scale for Kinesiophobia: Invariant two-factor model across low back pain patients and fibromyalgia patients. Clinical Journal of Pain 20: 103–110.
    1. Groll DL, To T, Bombardier C, Wright JG 2005The development of a comorbidity index with physical function as the outcome. Journal of Clinical Epidemiology 58: 595–602.
    1. Hammett T, Simonian A, Austin M, Butler R, Allen KD, Ledbetter L, Goode AP 2018Changes in physical activity after total hip or knee arthroplasty: A systematic review and meta-analysis of six- and twelve-month outcomes. Arthritis Care and Research 70: 892–901.
    1. Harding P, Holland AE, Delany C, Hinman RS 2014Do activity levels increase after total hip and knee arthroplasty? Clinical Orthopaedics and Related Research 472: 1502–1511.
    1. Herr KA, Spratt K, Mobily PR, Richardson G 2004Pain intensity assessment in older adults: use of experimental pain to compare psychometric properties and usability of selected pain scales with younger adults. Clinical Journal of Pain 20: 207–219.
    1. Higuchi D 2015Prognostic value of preoperative coping strategies for pain in patients with residual neuropathic pain after laminoplasty for compressive cervical myelopathy. Asian Spine Journal 9: 675–682.
    1. Howlett N, Trivedi D, Troop NA, Chater AM 2019Are physical activity interventions for healthy inactive adults effective in promoting behavior change and maintenance, and which behavior change techniques are effective? A systematic review and meta-analysis. Translational Behavioral Medicine 9: 147–157.
    1. Jensen MP, McFarland CA 1993Increasing the reliability and validity of pain intensity measurement in chronic pain patients. Pain 55: 195–203.
    1. Jensen MP, Turner JA and Romano JM 1994. What is the maximum number of levels needed in pain intensity measurement? Pain 58: 387–392.
    1. Lame IE, Peters ML, Kessels AG, Van Kleef M, Patijn J 2008Test-retest stability of the Pain Catastrophizing Scale and the Tampa Scale for Kinesiophobia in chronic pain over a longer period of time. Journal of Health Psychology 13: 820–826.
    1. Leeuw M, Goossens ME, Linton SJ, Crombez G, Boersma K, Vlaeyen JW 2007The fear-avoidance model of musculoskeletal pain: Current state of scientific evidence. Journal of Behavioral Medicine 30: 77–94.
    1. Lord EL, Cohen JR, Buser Z, Meisel HJ, Brodke DS, Yoon ST, Youssef JA, Wang JC, Park JB 2017Trends, costs, and complications of anterior cervical discectomy and fusion with and without bone morphogenetic protein in the United States Medicare population. Global Spine Journal 7: 603–608.
    1. Lunardini DJ, Mauser NS, Krag MH, Lee JY, Donaldson WH, Kang JD 2018Cervical bracing practices after degenerative cervical surgery: A survey of Cervical Spine Research Society members. Spine Journal 18: 1950–1955.
    1. Machino M, Yukawa Y, Hida T, Ito K, Nakashima H, Kanbara S, Morita D, Kato F 2012Cervical alignment and range of motion after laminoplasty: Radiographical data from more than 500 cases with cervical spondylotic myelopathy and a review of the literature. Spine 37: E1243–1250.
    1. Marawar S, Girardi FP, Sama AA, Ma Y, Gaber-Baylis LK, Besculides MC, Memtsoudis SG 2010National trends in anterior cervical fusion procedures. Spine 35: 1454–1459.
    1. Marquez-Lara A, Nandyala SV, Fineberg SJ, Singh K 2014Current trends in demographics, practice, and in-hospital outcomes in cervical spine surgery: A national database analysis between 2002 and 2011. Spine 39: 476–481.
    1. Massel DH, Mayo BC, Bohl DD, Narain AS, Hijji FY, Fineberg SJ, Louie PK, Basques BA, Long WW, Modi KD, Singh K 2017Improvements in neck and arm pain following an anterior cervical discectomy and fusion. Spine 42: E825–E832.
    1. Maughan EF, Lewis JS 2010Outcome measures in chronic low back pain. European Spine Journal 19: 1484–1494.
    1. McClain JJ, Sisson SB, Tudor-Locke C 2007Actigraph accelerometer interinstrument reliability during free-living in adults. Medicine and Science in Sports and Exercise 39: 1509–1514.
    1. McEwan D, Harden SM, Zumbo BD, Sylvester BD, Kaulius M, Ruissen GR, Dowd AJ, Beauchamp MR 2016The effectiveness of multi-component goal setting interventions for changing physical activity behaviour: A systematic review and meta-analysis. Health Psychology Review 10: 67–88.
    1. Miles CL, Pincus T, Carnes D, Taylor SJ, Underwood M 2011Measuring pain self-efficacy. Clinical Journal of Pain 27: 461–470.
    1. Mudge S, Taylor D, Chang O, Wong R 2010Test-retest reliability of the StepWatch Activity Monitor outputs in healthy adults. Journal of Physical Activity and Health 7: 671–676.
    1. Munoz-Garcia D, Gil-Martinez A, Lopez-Lopez A, Lopez-de-Uralde-Villanueva I, La Touche R, Fernandez-Carnero J 2016Chronic neck pain and cervico-craniofacial pain patients express similar levels of neck pain-related disability, pain catastrophizing, and cervical range of motion. Pain Research and Treatment 2016: 7296032.
    1. Neblett R, Hartzell MM, Mayer TG, Bradford EM, Gatchel RJ 2016Establishing clinically meaningful severity levels for the Tampa Scale for Kinesiophobia (TSK-13). European Journal of Pain 20: 701–710.
    1. Ng E, Johnston V, Wibault J, Lofgren H, Dedering A, Oberg B, Zsigmond P, Peolsson A 2015Factors associated with work ability in patients undergoing surgery for cervical radiculopathy. Spine 40: 1270–1276.
    1. Nicholas MK 2007The pain self-efficacy questionnaire: Taking pain into account. European Journal of Pain 11: 153–163.
    1. Nicolson PJ, Hinman RS, Wrigley TV, Stratford PW, Bennell KL 2018Self-reported home exercise adherence: A validity and reliability study using concealed accelerometers. Journal of Orthopaedic Sports and Physical Therapy 48: 943–950.
    1. Oglesby M, Fineberg SJ, Patel AA, Pelton MA, Singh K 2013Epidemiological trends in cervical spine surgery for degenerative diseases between 2002 and 2009. Spine 38: 1226–1232.
    1. Osman A, Barrios FX, Gutierrez PM, Kopper BA, Merrifield T, Grittmann L 2000The Pain Catastrophizing Scale: Further psychometric evaluation with adult samples. Journal of Behavioral Medicine 23: 351–365.
    1. Overley SC, Merrill RK, Baird EO, Meaike JJ, Cho SK, Hecht AC, Qureshi SA 2017Is cervical bracing necessary after one- and two-level instrumented anterior cervical discectomy and fusion? A prospective randomized study. Global Spine Journal 8: 40–46.
    1. Ozemek C, Kirschner MM, Wilkerson BS, Byun W, Kaminsky LA 2014Intermonitor reliability of the GT3X+ accelerometer at hip, wrist and ankle sites during activities of daily living. Physiological Measurement 35: 129–138.
    1. Peolsson A, Vavruch L, Oberg B 2006Can the results 6 months after anterior cervical decompression and fusion identify patients who will have remaining deficit at long-term? Disability and Rehabilitation 28: 117–124.
    1. Prince SA, Adamo KB, Hamel ME, Hardt J, Connor Gorber S, Tremblay M 2008A comparison of direct versus self-report measures for assessing physical activity in adults: A systematic review. International Journal of Behavioral Nutrition and Physical Activity 5: 56.
    1. Roelofs J, Goubert L, Peters ML, Vlaeyen JW, Crombez G 2004The Tampa Scale for Kinesiophobia: Further examination of psychometric properties in patients with chronic low back pain and fibromyalgia. European Journal of Pain 8: 495–502.
    1. Scheer JK, Bakhsheshian J, Keefe MK, Lafage V, Bess S, Protopsaltis TS, Burton DC, Hart RA, Shaffrey CI, Schwab F, et al.2017Initial experience with real-time continuous physical activity monitoring in patients undergoing spine surgery. Clinical Spine Surgery 30: E1434–E1443.
    1. Schulte TL, Schubert T, Winter C, Brandes M, Hackenberg L, Wassmann H, Liem D, Rosenbaum D, Bullmann V 2010Step activity monitoring in lumbar stenosis patients undergoing decompressive surgery. European Spine Journal 19: 1855–1864.
    1. Scott W, Wideman TH, Sullivan MJ 2014Clinically meaningful scores on pain catastrophizing before and after multidisciplinary rehabilitation: A prospective study of individuals with subacute pain after whiplash injury. Clinical Journal of Pain 30: 183–190.
    1. Sirard JR, Melanson EL, Li L, Freedson PS 2000Field evaluation of the Computer Science and Applications, Inc. physical activity monitor. Medicine and Science in Sports and Exercise 32: 695–700.
    1. Sloman R, Wruble AW, Rosen G, Rom M 2006Determination of clinically meaningful levels of pain reduction in patients experiencing acute postoperative pain. Pain Management Nursing 7: 153–158.
    1. Smuck M, Muaremi A, Zheng P, Norden J, Sinha A, Hu R, Tomkins-Lane C 2018Objective measurement of function following lumbar spinal stenosis decompression reveals improved functional capacity with stagnant real-life physical activity. Spine Journal 18: 15–21.
    1. Sullivan MJ 2009The Pain Catastrophizing Scale - user manual. Montreal, Quebec, McGill University.
    1. Sullivan MJ, Bishop SR, Pivik J 1995The Pain Catastrophizing Scale: Development and validation. Psychological Assessment 7: 524–532.
    1. Swanson BT, Leger RR 2015Physical therapy following anterior cervical discectomy and fusion: A study of current clinical practice and therapist beliefs. International Journal of Physiotherapy 2: 399–406.
    1. Tederko P, Krasuski M, Tarnacka B 2019Effectiveness of rehabilitation after cervical disk surgery: A systematic review of controlled studies. Clinical Rehabilitation 33: 370–380
    1. Troiano RP, Berrigan D, Dodd KW, Masse LC, Tilert T, McDowell M 2008Physical activity in the United States measured by accelerometer. Medicine and Science in Sports and Exercise 40: 181–188.
    1. Trost SG, McIver KL, Pate RR 2005Conducting accelerometer-based activity assessments in field-based research. Medicine and Science in Sports and Exercise 37: S531–543.
    1. Vernon H, Mior S 1991The Neck Disability Index: A study of reliability and validity. Journal of Manipulative and Physiological Therapeutics 14: 409–415.
    1. Vlaeyen JW, Linton SJ 2000Fear-avoidance and its consequences in chronic musculoskeletal pain: A state of the art. Pain 85: 317–332.
    1. Wang MC, Kreuter W, Wolfla CE, Maiman DJ. Deyo RA 2009 Trends and variations in cervical spine surgery in the United States: Medicare beneficiaries, 1992 to 2005. Spine 34: 955–962.
    1. Wibault J, Oberg B, Dedering A, Lofgren H, Zsigmond P, Peolsson A 2018Structured postoperative physiotherapy in patients with cervical radiculopathy: 6-month outcomes of a randomized clinical trial. Journal of Neurosurgery Spine 28: 1–9
    1. Wibault J, Oberg B, Dedering A, Lofgren H, Zsigmond P, Persson L, Andell M, Jonsson R, Peolsson A 2017Neck-related physical function, self-efficacy, and coping strategies in patients with cervical radiculopathy: A randomized clinical trial of postoperative physiotherapy. Journal of Manipulative and Physiological Therapeutics 40: 330–339
    1. Woby SR, Roach NK, Urmston M, Watson PJ 2005Psychometric properties of the TSK-11: A shortened version of the Tampa Scale for Kinesiophobia. Pain 117: 137–144
    1. Woo A, Lechner B, Fu T, Wong CS, Chiu N, Lam H, Pulenzas N, Soliman H, DeAngelis C, Chow E 2015Cut points for mild, moderate, and severe pain among cancer and non-cancer patients: A literature review. Annals of Palliative Medicine 4: 176–183

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