Use the Back button in your browser to see the other results of your search or to select another record.
Detailed Search Results
| Early versus late initiation of rehabilitation after lumbar spinal fusion: economic evaluation alongside a randomized controlled trial [with consumer summary] |
| Oestergaard LG, Christensen FB, Nielsen CV, Bunger CE, Fruensgaard S, Sogaard R |
| Spine 2013 Nov 1;38(23):1979-1985 |
| clinical trial |
| 5/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: Yes; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: No; Adequate follow-up: No; Intention-to-treat analysis: No; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed* |
|
STUDY DESIGN: Economic evaluation conducted alongside a randomized controlled trial with 1-year follow-up. OBJECTIVE: To examine the cost-effectiveness of initiating rehabilitation 6 weeks after surgery as opposed to 12 weeks after surgery. SUMMARY OF BACKGROUND DATA: In a previously reported randomised controlled trial, we assessed the impact of timing of rehabilitation after a lumbar spinal fusion and found that a fast-track strategy led to poorer functional ability. Before making recommendations, the societal perspective including return to work, quality of life, and costs seems relevant to address. METHODS: A cost-effectiveness analysis and a cost-utility analysis were conducted. 82 patients undergoing instrumented lumbar spinal fusion due to degenerative disc disease or spondylolisthesis (grade I or II) were randomised to an identical protocol of four sessions of group-based rehabilitation and were instructed in home exercises focusing on active stability training. Outcome parameters included functional disability (Oswestry Disability Index) and quality-adjusted life years. Health care and productivity costs were estimated from national registries and reported in Euros (EUR). Costs and effects were transformed into net benefit. Bootstrapping was used to estimate 95% confidence intervals (95% CI). RESULTS: The fast-track strategy tended to be more costly by 6,869 EUR (95% CI -4,640 to 18,378) while at the same time leading to significantly poorer outcomes of functional disability by 9 points (95% CI 1 to 16) and a tendency for a reduced gain in quality-adjusted life years by -.04 (95% CI -0.11 to 0.03). The overall probability for the fast-track strategy being cost-effective does not reach 10% at conventional thresholds for cost-effectiveness. CONCLUSION: Initiating rehabilitation 6 weeks as opposed to 12 weeks after surgery is on average more costly and less effective. The uncertainty of this result did not seem to be sensitive to methodological issues, and clinical managements who have already adapted fast-track rehabilitation strategies have reason to reconsider their choice. LEVEL OF EVIDENCE: 2.
|
The database was last updated on 7 July 2025 (this includes records added or amended since 5 May 2025). The next update is planned for 4 August 2025. The total number of records on the database is 65,600.