Object:

Currently, patient satisfaction ratings play a critical role in pay-for-performance initiatives. To achieve further improvement in satisfaction, modifiable factors should be identified according to the type of surgery. This study aimed to compare the overall treatment satisfaction after microendoscopic lumbar decompression between the patients treated with a postoperative physical therapy (PT) program focused on low back pain (LBP) improvement and those treated with a conventional physical therapy program. 

Methods:

This is a prospective cohort study including 200 consecutive patients who undergoing microendoscopic lumbar decompression for disc herniation or spinal stenosis. Initially, 100 consecutive patients were enrolled into the control cohort, and were treated with a conventional physical therapy (PT) program postoperatively. Subsequently, 100 consecutive patients undergoing surgery under the same indications as the control cohort were enrolled into the test cohort, and were treated with a PT program focused on LBP improvement. Both PT programs included 40-min outpatient sessions, once per week for 3 months postoperatively. Background factors, clinical scores, and treatment satisfaction at three months postoperatively were compared between the groups. The primary outcome was set as overall treatment satisfaction at 3 months postoperatively. Secondly outcomes were set as patient characteristics (age at surgery, sex, height, weight, body mass index, comorbidities, surgical levels and diagnosis), Japanese Orthopaedic Association score, Oswestry Disability Index, EuroQoL-5 dimensions 5 levels.

Results:

Adequate compliance was achieved in 92 and 84 patients in the control and test cohorts, respectively. There were no significant differences in background factors; however, the postoperative patient-reported pain score was significantly better, and the treatment satisfaction was significantly higher, in the test cohort than in the control cohort (p=0.029 and 0.045, respectively). On multivariate logistic regression analysis, patients treated with the LBP program tended to be more satisfied than those treated with the conventional program, independent of age, sex, and diagnosis (adjusted odds ratio=2.34, p=0.012).   　

Conclusions

Patients treated with a physical therapy focused on LBP improvement showed significantly better pain scores and higher overall satisfaction than those treated with a conventional physical therapy program at three months postoperatively. Current results suggest options for postoperative management that could reduce pain more effectively and achieve higher overall satisfaction after minimally invasive lumbar decompression without additional pharmacological therapy including perioperative opioid. These results could guide spine surgeons in achieving higher short-term satisfaction after minimally invasive lumbar decompression.