Survey of postoperative practices for lumbar spinal stenosis surgery among canadian spinal surgeons and rehabilitation professionals
Bibliographic record
Abstract
Background: Postoperative rehabilitation for lumbar spine stenosis (LSS) surgery has been shown to improve functional status postoperatively. However, there is a lack of clinical guidelines on postsurgical recommendations, movement restrictions and rehabilitation practices, which can lead to variations in care. The purpose of this study was to describe current postoperative LSS surgery practices of spine surgeons, physiotherapists, and chiropractors in Canada related to movement restrictions, exercise recommendations and rehabilitation. Methods: The cross-sectional online survey was distributed to spine surgeons, physiotherapists and chiropractors through newsletters and emails from professional colleges and associations. The surveys involved 3 clinical vignettes of patients with LSS, each with a different type of surgical intervention. Participants were asked to reflect on the cases and provide information on their postoperative practices. Results: Twenty-six spine surgeons and 151 rehabilitation professionals responded to the survey. Many of the spine surgeons in this study do not (35%) or occasionally refer (27%) their post-LSS surgery patients to outpatient postoperative rehabilitation and do not believe such programs are necessary for all patients (65.4%). There was significant variation on which restrictions should be applied and the length of time that restrictions should be used across all movements and conditions. Rehabilitation professionals observed movement restrictions that aligned with surgeons' recommendations in Cases 1 (decompression) and 3 (long fusion). However, in Case 2 (laminectomy with 1-3 level fusion), they noted more restrictions (eg, pushing, pulling, lifting) than those prescribed by surgeons. The range of exercise recommendations and treatment modalities rehabilitation professionals prescribe vary widely. Conclusions: There is currently wide variation in care, demonstrating the need to build consensus among spine surgeons and rehabilitation professionals regarding the most optimal postoperative management. In addition, the reasoning behind imposed restrictions should be considered along with surgery-specific factors in refining current postoperative care pathways for the studied patient population.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.007 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.002 | 0.003 |
| Science and technology studies | 0.003 | 0.001 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".