Application of early intensive rehabilitation in enhanced recovery after surgery protocol after laminoplasty:a mixed methods research
Objective To explore the effect of early postoperative intensive rehabilitation within the Enhanced Recovery After Sur-gery(ERAS)protocol for posterior cervical spine surgery using a mixed-methods approach.Methods For the quantitative study,the inpatients with cervical spondylotic myelopathy undergoing decompression sur-gery from January,2018 to January,2019,were divided into intensive rehabilitation group(n = 41)and orthope-dic treatment group(n = 33).Two groups accepted ERAS protocol.The intensive rehabilitation group received seven days of intensive rehabilitation under the guidance of a professional team post-surgery,whereas the ortho-pedic treatment group received routine education by orthopedic surgeons and nurses and then exercised at home.Before and(90±14)days after surgery,both groups were assessed with Visual Analog Scale(VAS)for pain,modi-fied Japanese Orthopedic Association(mJOA),Neck Disability Index(NDI)and Short Form-36 Health Survey(SF-36).For qualitative study,other twelve patients from each group who underwent surgery from May,2019 to November,2019 were interviewed with a semi-structured questionnaire(7±2)days after surgery.The results from the quantitative and qualitative studies were compared and integrated for analysis.Results The quantitative study revealed that for patients without C5 palsy,there were no significant differences in the VAS score,mJOA score,and NDI score at 90 days after surgery between the two groups(U>0.140,P>0.05).However,there was a significant difference in the physical function score of the SF-36(U = 2.031,P<0.05).The VAS score(ρ1 =-0.522,ρ2 =-0.334,P<0.05)and NDI score(ρ1 =-0.681,ρ2 =-0.590,P<0.05)90 days after surgery were negatively correlated with the body health and mental health scores of SF-36,while the mJOA score(ρ1 = 0.408,ρ2 = 0.304,P<0.05)was positively correlated with the body health and mental health scores of SF-36.In qualitative study,the intensive rehabilitation group showed better improvement than the orthopedic treat-ment group in terms of pain,cervical spine function,neurological function and quality of life at seven days after surgery.Conclusion Early intensive rehabilitation after laminoplasty is effective on early postoperative function.For patients without C5 palsy,early intensive rehabilitation can improve the quality of life three months after surgery.
cervical spondylotic myelopathylaminoplastyenhanced recovery after surgeryintensive rehabilitation
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