Priority 25 from the Degenerative Cervical Myelopathy PSP

UNCERTAINTY: What treatments should be implemented following surgery and continued in the long-term? Is there a role for extended rehabilitation and exercise programs? What should be its frequency, content and duration, and whom should it be coordinated by? (JLA PSP Priority 25)
Overall ranking	25
JLA question ID	0097/25
Explanatory note	Surgery is often recommended as the preferred management strategy for patients with DCM as it can halt neurological deterioration and improve functional impairment, disability and quality of life. Following surgery, patients are typically motivated to participate in rehabilitation in order to maximize their outcomes. 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). Unfortunately, there is no current standard for postoperative care in DCM and no recommendations as to the frequency, content and duration of rehabilitation.
Evidence	No systematic reviews, scoping reviews or guidelines identified
Health Research Classification System category	Neurological

Extra information provided by this PSP
Original uncertainty examples	What treatments are recommended after surgery for DCM? How well are Physiotherapists trained to deal with post surgery issues? ~ What is the role of exercise programs in long term? ~ ~ What physiotherapy and GP management is required? ~ What role does inflammation control, active and passive therapy have in the long term management of DCM? ~ What is the Long term effects of rehabilitation? Clinical prediction rule for physical therapy? ~ What is the best way to regain strength after surgery?
Submitted by	Spinal Surgeons x 19, Other healthcare professionals x 12, People with DCM and their supporters x 15

Extra information provided by this PSP

Original uncertainty examples

What treatments are recommended after surgery for DCM? How well are Physiotherapists trained to deal with post surgery issues? ~ What is the role of exercise programs in long term? ~ ~ What physiotherapy and GP management is required? ~ What role does inflammation control, active and passive therapy have in the long term management of DCM? ~ What is the Long term effects of rehabilitation? Clinical prediction rule for physical therapy? ~ What is the best way to regain strength after surgery?

Submitted by

Spinal Surgeons x 19, Other healthcare professionals x 12, People with DCM and their supporters x 15

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