Evidence-based rehabilitation after artificial disk replacement?

The following advertisement in the latest issue of JMMT caught my attention. Is it possible to have evidence-based rehabilitation when the surgey itself is more analagous to medical prostitution than a medical procedure. A picture is worth a thousand words.

I have nothing against any of the authors and have not flipped through a single page of the text. However, the reference lists in the text must be mostly empty because the following Pubmed search turned up a whopping 0 articles of any kind, even a single case report. See below for the search string and another picture worth a thousand words.

(artificial disc back rehabilitation) AND ((clinical[Title/Abstract] AND trial[Title/Abstract]) OR clinical trials[MeSH Terms] OR clinical trial[Publication Type] OR random*[Title/Abstract] OR random allocation[MeSH Terms] OR therapeutic use[MeSH Subheading])

 

Perhaps a certified physical therapist will come up with a DIY video on best practice artificial disc rehabilitation.

If you sense any cynicism about my perceptions of the state of our health care system, you could not be more right. We should be marching in the streets over it, but consumers have been duped into a false reality by the cunning marketing of surgeons, device manufacturers, and a culture of quick fixes for back pain as if the human spine is an automobile that can be mechanically diagnosed in the first place.

It's a sad time when patients are viewed as revenue streams and vulnerable to such gross exploitation. I don't blame anyone necessarily for writing a text to help consumers unfortunate to have this procedure done on them to accecss quality rehabilitation so long as the first thing we say to them is "I'm sorry". However, does publishing books like this indirectly attest to the legitimacy of the procedure itself? Will be interested to hear your thoughts.

John

Comments

[Carina Lowry]

Hmm...

Interesting John. You know I have looked more than once for EBP management of disc replacement patients since I see quite a few of them here in Chicago. The fortunate thing is that Medicare and most insurances are NOT covering this procedure here in Chi-town so that means only the very wealthy or the few with specific insurances can afford such surgery. I do think there is a time and place for this surgery (when absolutely EVERYTHING has failed) but unfortunately you will see that this becomes more common as the money is there to reimburse for it. Funny how that works huh.

So in regards to your question about clinical trials for EBM for disc replacements, well you won't find it with rehab or rehab recommendations, especially in peer reviewed journals. Believe me, I have looked. You will find it in non-peer reviewed professional lit such as Bone and Joint 2006, Ortho Today 2005, and other clinical trials in Spine to determine FAILURE of the artificial disc. Interesting that these trials are cohort trials that are funded by the disc maker such as Bryan.

So...I am not sure what evidence they are basing these EBM guidelines on. I have come up with my own protocols because I have only seen case studies out there--no RCT's or higher level evidence than that. Maybe the authors are working on that as we speak?

Always the optimist,

Carina

[Cameron MacDonald]

Carina,

Perhaps a case report/series is worth writing.......

"'Recovery' following artficial disc replacement. Designing a rehab protocol in PT following an investigational procedure."

- or something like that.

Cameron