A comparison of clinical outcomes between early physical therapy intervention and usual care in individuals following anterior cervical fusion

Early physical therapy (PT) intervention with emphasis on spinal stabilization has been shown to benefit individuals undergoing lumbar spinal surgery. Further, training cervical spine stabilizers (deep cervical flexors and cervical multifidus) has been shown to be effective in reducing neck pain, restoring cervical spinal function and mobility in many types of cervical spine dysfunction. However, the training of stabilizers has not been studied in individuals undergoing cervical spinal surgery, even though these individuals often have problems with residual pain and weakness after the surgery. The purpose of this study was to compare clinical outcomes between an early physical therapy intervention including training of stabilizers and usual care in patients who have undergone Anterior Cervical Fusion (ACF) surgery. The clinical outcomes included: 1) pain level using the numeric pain rating scale (NPRS), 2) patient's perceived disability associated with neck pain as determined by Neck Disability Index (NDI), 3) Deep cervical flexor (DCF) strength, and 4) DCF endurance. This study was a double-blinded randomized clinical trial with a two-factor (2x2) research design. The four clinical outcomes measurements were collected before surgery for baseline, then at 6-week postoperative visits with the surgeon. In addition, at 6 weeks after surgery, the Global Rate ofChange (GROC) was a fifth outcome measure to determine the patient's perception of overall improvement as a result of surgery. The study also examined the relationships among the patient's perceived disability due to pain, DCF strength, and DCF endurance. Additionally, test-retest reliability of the craniocervical flexion (CCF) test of DCFs in surgical patients was determined in the post operative condition. A 2x2 MANOV A was performed to identify interactions between group and time frame. Thirty participants were randomly assigned to early PT intervention or usual care groups, and 29 of these completed 6 week post-operative testing. There were no significant interactions with group by time frame. Results showed significant improvements of all outcome measures by time frame only. Concordance correlation coefficient (pc) calculations on eight participants who completed between day testing showed excellent reliability for CCF-S (0.82) and good reliability for CCF-E (0.70). Pearson correlations showed significant relationships between DCF strength and DCF endurance in all cases, and between NDI and DCF strength and endurance before surgery and with overall data. This study showed that over a 6 week period there is no difference between an early PT intervention and usual care in improving pain and function after ACF surgery. However both groups showed significant improvement from before ACF surgery to 6 weeks post.