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

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:

• Spinal fusion
• surgical decompression
• neck pain
• Radiculopathy
• exercise therapy
• feasibility studies

Acknowledgments

The authors acknowledge Shea Sabin, BA and Crystal Coolbaugh, PhD for consultation on accelerometry data analysis.

Declaration of interest

The authors declare that there is no conflict of interest.

Additional information

Funding

This study was supported by a Cervical Spine Research Society research grant and a Vanderbilt Clinical and Translational Science Award (UL1 TR000445) from the National Center for Advancing Translational Sciences/National Institutes of Health.