Priority 6 from the Degenerative Cervical Myelopathy PSP

UNCERTAINTY: What is the role of rehabilitation following surgery for DCM? Can a structured postoperative rehabilitation improve outcome following surgery for DCM? What are the most effective strategies? (JLA PSP Priority 6)
Overall ranking	6
JLA question ID	0097/6
Explanatory note	A systematic review by Badran et al (2018) was conducted to evaluate the role of postoperative physiotherapy in patients with DCM. This review identified one small, retrospective study that met inclusion criteria. Yap et al (1993) concluded that patients can improve their postoperative functional status through rehabilitation. Furthermore, there are two registered randomized controlled trials that aim to investigate the efficacy of postoperative rehabilitation (physiotherapy and occupational therapy) in DCM (NCT02842775 and NCT03320759). There is no current standard for postoperative care in DCM or guidelines as to the approprate frequency, content and duration of rehabilitation.
Evidence	A systematic review on the role of postoperative physiotherapy concluded there was insufficient evidence to make any recommendations. No other systematic reviews, scoping reviews or guidelines were identified. Badran A, Davies BM, Bailey HM, Kalsi-Ryan S, Kotter MR. Is there a role for postoperative physiotherapy in degenerative cervical myelopathy? A systematic review. Clin Rehabil. 2018 Sep;32(9):1169-1174.
Health Research Classification System category	Neurological

Extra information provided by this PSP
Original uncertainty examples	Can physiotherapy improve function after surgical intervention? ~ Does a structured post surgical rehabilitation plan improve outcomes? ~ What are the most effective physical modalities ad exercise programs in management of DCM after surgical treatment? ~ Which patients benefit from postoperative rehabilitation? ~ What is the optimum rehabilitation programme (frequency and length) for patients with DCM post operatively?
Submitted by	Spinal Surgeons x 13 ~ Other healthcare professionals x 10 ~ People with DCM and their supporters x 4

Extra information provided by this PSP

Original uncertainty examples

Can physiotherapy improve function after surgical intervention? ~ Does a structured post surgical rehabilitation plan improve outcomes? ~ What are the most effective physical modalities ad exercise programs in management of DCM after surgical treatment? ~ Which patients benefit from postoperative rehabilitation? ~ What is the optimum rehabilitation programme (frequency and length) for patients with DCM post operatively?

Submitted by

Spinal Surgeons x 13 ~ Other healthcare professionals x 10 ~ People with DCM and their supporters x 4

PSP information
PSP unique ID	0097
PSP name	Degenerative Cervical Myelopathy
Total number of uncertainties identified by this PSP.	76 (To see a full list of all uncertainties identified, please see the detailed spreadsheet held on the JLA website)
Date of priority setting workshop	20 November 2019