Development of a person specific post-surgical rehabilitation program

1. 1 Development of a person specific post-surgical rehabilitation program �

2. 2 A micro-topography of interventions in a randomized clinical trial.�

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8. 8 Success Rate, Failure Rate following a Lumbar Microdiscectomy

9. 9 Reported Functional Outcomes following a Lumbar Microdiscectomy

10. 10 Research reports on Post Microdiscectomy Rehabilitation 5 studies between 1993 and 2005 number of subjects ranged from 20 to 96 details of intervention sparsely described length of intervention 4 to 12 weeks follow-up 12 months or less

11. 11 Question �.

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16. 16 Development of a person specific post-surgical rehabilitation program

17. 17 Wanted: Clinical Research Protocol Amenable to: Patients who become Study Participants .. Clinicians .. Surgeons .. Researchers

18. 18 Where did the protocol come from?

19. 19 Components and Characteristics of the Clinical Intervention Education Exercise: Back Extensor Endurance & Strength Mat & Upright Exercises Individualized, Performance based Three sessions per week for 12 weeks

20. 20 Interventions Education: Surgery-specific, brochure guided, individualized educational session Follow-up quiz and feedback All subjects receive this intervention

21. 21 Interventions Exercise: Trunk Extensors Endurance and Strengthening Symptom, Performance, and Perceived Exertion guided Progression

22. 22 Interventions Exercise (Mat & Upright): Abdominal, Back, and Lower Extremity Control and Endurance Symptom, Performance, and Perceived Exertion guided Progression

23. 23 Inception Protocol Training Standardization Implementation Training Sessions for Interventional Therapists (N = 52)

24. 24 Standardization of the Interventional Therapists (N = 27) Inception Protocol Training Standardization Implementation

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27. 27 A person specific post-surgical rehabilitation program within a clinical trial�

28. 28 Interventions Exercise: Trunk Extensors Endurance and Strengthening Symptom, Performance, and Perceived Exertion guided Progression

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33. 33 Interventions Exercise (Mat & Upright): Abdominal, Back, and Lower Extremity Control and Endurance Symptom, Performance, and Perceived Exertion guided Progression

34. 34 Rehabilitation Progression Through Squat and Lunge Exercises Post Microdiscectomy (subject C-03-012)

35. 35 Level One

36. 36 Level Two

37. 37 Level Three

38. 38 Level Four

39. 39 Level Five

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42. 42 STUDY DESIGN Exploratory Clinical Trial (Phase II) Describe the constant and variable components of a replicable intervention AND a feasible protocol for comparing the intervention to an appropriate alternative

43. 43 STUDY DESIGN Exercise to No Exercise �Exercise� is under the guidance of a PT in a clinical setting for 12 weeks �No Exercise� is one session of back care education and no restriction to activity

44. 44 STUDY DESIGN N = 100; age 18 � 60, single level lumbar microdiscectomy

45. 45 62/100 enrolled Data collection ongoing until December 2005 Participant satisfaction is high Preliminary muscle morphology findings favorable Current Status

46. 46 Acknowledgements: Orthopaedic Clinics participating in MUSSEL The Orthopaedic Clinical Faculty of the University of Southern California Developers of the Standardized Intervention Program Sean Flanagan, PhD, ATC Andrea Lee, DPT Ndidimaka D. Matthews, DPT Elizabeth Poppert, MS, PT, OCS Vera Rakic, DPT Thomas Sutton, DPT The Research Team George Beneck, MS, PT, OSC Robin Beauregard, BS Wendy Burke, PT, DPT,MS, OCS Allison Lamberty Bursch, DPT Raul Lona, DPT John Popovich, DPT, ATC Jason Villareal, BS, ATC Kimi Yamada, BS, ATC

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