Postoperative Physical Therapy Utilization for Anterior Cervical Discectomy and Fusion: An Analysis of Practice Patterns in the United States.

Abstract

Retrospective Cohort Study. To describe postoperative physical therapy (PostopPT) utilization patterns and evaluate predictors of utilization after anterior cervical discectomy and fusion (ACDF). ACDF is the most common cervical spine procedure. PostopPT may improve outcomes, but current usage and program characteristics are unknown. PearlDiver Database identified patients who underwent ACDF between 2010-April 2023. PostopPT utilization was assessed 7-365 days postoperatively. Demographics, comorbidities, and procedural characteristics were analyzed. Univariate and multivariate logistic regression identified predictors of PostopPT utilization. Of 309,230 ACDF patients, 17.16% utilized PostopPT within one year. Among users, the average number of visits was 7.4, with mean initiation at 88 days (median: 61 d). PostopPT users were younger, had higher comorbidity burden, higher income, were more often female, and more likely to present with combined radiculopathy and myelopathy (P<0.001).Demographic predictors included commercial insurance (OR: 1.37), residence in the Northeast (OR: 1.35) or Midwest (OR: 1.31), income >$75,000 (OR: 1.17), female gender (OR: 1.14), and age <50 (OR: 1.10) (all P<0.001). Comorbidity predictors included fibromyalgia (OR: 1.37), osteoarthritis (OR: 1.30), obesity (OR: 1.29), depression (OR: 1.26), osteoporosis (OR: 1.19), ECI ≥4 (OR: 1.13), diabetes (OR: 1.08), and tobacco use (OR: 1.07) (all P<0.001). Procedural predictors included mixed myelopathy/radiculopathy (OR: 1.29), fusion ≥3 levels (OR: 1.22), orthopedic surgeon as provider (OR: 1.10), inpatient surgery (OR: 1.09), and two-level fusion (OR: 1.08) (all P<0.001).Patients with myelopathy alone were more likely to receive gait training, aquatic therapy, and group training, but less likely to receive manual therapy, electrical stimulation, hot/cold therapy, or ultrasound (all P<0.001). PostopPT usage following ACDF is limited. Distinct demographic, comorbidity, and procedural factors predicted usage. PostopPT programs varied in timing, frequency, and intervention type.