Updated Recommendations for Adolescent Idiopathic Scoliosis (AIS) Following Posterior Spinal Fusion (PSF)

Purpose: Over the years, surgical approaches and recovery pathways for patients with AIS who undergo PSF have evolved.1,2 As part of the patient’s acute recovery, physical therapists serve an important role in educating patients and providing recommendations at the time of discharge. Unfortunately, as the medical aspects of a patient’s care have changed, post-operative precautions and physical therapy (PT) recommendations have not always been concurrently updated in practice. This abstract describes the process of updating post-operative recommendations that include precautions and exercise programs at discharge. This abstract will also provide information regarding the collaboration process between therapists and physicians. The barriers identified and steps taken to complete this process will be reviewed.

Description: Representatives from the acute care PT team at an academic children’s hospital identified a need to clarify and update post-operative precautions following PSF. Goals were to standardize practice and provide consistent recommendations for patients at time of discharge. Current patient educational handouts were reviewed and compared to a range of updated surgeon specific recommendations. The PT group came to consensus on updated exercises to be provided by each clinician as part of their typical practice. Information that required updates, including clarification of precautions and post operative recommendations, was presented to a group of orthopedic surgeons who regularly perform posterior spinal fusions at this institution. All confirmed updates were incorporated into a new patient and family educational handout. In addition, a standardized home exercise and activity program was developed and issued to patients prior to discharge.

Summary of Use: The updated patient and family education handouts and home exercise and activity program were submitted for review. Following review, all edits were completed and submitted for leadership approval. The completed handouts were presented by the PT group to the remainder of the leadership team. The full PT team was educated on the revisions made and how to incorporate the updated documents into patient care. The standardization of recommendations following surgery will result in positive changes in clinical practice and allow for better tracking of patient progress following discharge for future research opportunities.

Importance to Members: As surgical approaches and post operative precautions change, it is important for physical therapists to remain current with their post operative recommendations. With this review, it was determined that many of the recommendations that were being provided to patients following a PSF were more conservative than required. It is anticipated that the updated precautions and standardized PT recommendations will serve to minimize the patients’ movement limitations and encourage mobility during recovery following PSF.