Does adding case management to standard rehabilitation affect functional ability, pain, or the rate of return to work after lumbar spinal fusion? A randomized controlled trial with two-year follow-up

Objective

To examine the effect of a case manager–assisted rehabilitation programme as an add-on to usual physical rehabilitation in patients undergoing lumbar spinal fusion.

Design

A randomized controlled trial with a two-year follow-up.

Settings

Outpatient clinics of a university hospital and a general hospital.

Subjects

In total, 82 patients undergoing lumbar spinal fusion.

Interventions

The patients were randomized one-to-one to case manager–assisted rehabilitation (case manager group) or no case manager–assisted rehabilitation (control group). Both groups received usual physical rehabilitation. The case manager–assisted rehabilitation programme included a preoperative meeting with a case manager to determine a rehabilitation plan, postsurgical meetings, phone meetings, and voluntary workplace visits or roundtable meetings.

Main measures

Primary outcome was the Oswestry Disability Index. Secondary outcomes were back pain, leg pain, and return to work.

Results

Of the 41 patients in the case manager group, 49% were men, with the mean age of 46.1 (±8.7 years). In the control group, 51% were male, with the mean age of 47.4 (±8.9 years). No statistically significant between-group differences were found regarding any outcomes. An overall group effect of 4.1 points (95% confidence interval (CI): –1.8; 9.9) was found on the Oswestry Disability Index, favouring the control group. After two years, the relative risk of return to work was 1.18 (95% CI: 0.8; 1.7), favouring the case manager group.

Conclusion

The case manager–assisted rehabilitation programme had no effect on the patients’ functional disability or back and leg pain compared to usual physical rehabilitation. The study lacked power to evaluate the impact on return to work.