الفهرس 
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Abstract
Cervical degenerative disc disease (DDD) is a common cause of pain and disability, affecting approximately two thirds of the U.S adult population. It must be recognized early and managed either medically or surgically. Delayed management may make recovery less likely. If the condition progresses rapidly and causes loss of function, early treatment should be considered.
Treatment may vary greatly depending on correlation of diagnostic findings with the clinical findings. Referral for surgery depends on the degree of the patient‟s neurologic dysfunction.
While most patients with degenerative cervical disorders may be effectively treated conservatively, some might not respond to conservative treatment or have symptoms that necessitate surgery. After 4 to 6 weeks of conservative therapy, if the symptoms worsen or did not improve surgery may be recommended. The goal of surgery is to arrest symptom progression and if possible, restore lost function.
Nurses in neurosurgery practice settings encounter patients with pain due to cervical spine disorders and they struggle to manage it. Nurses play a pivotal role in assessing and implementing interventions that promote effective pain relief. Neurosurgical nurse serves as an integral member of the multidisciplinary pain team as she/he in, is a unique position to provide patients with effective management strategy to alleviate their persistent pain and suffering.
The nurse plays a key role in dispensing accurate information about the proper use of body mechanics how to properly lift heavy objects, how to maintain good posture while working and during activities of daily living , and how to perform certain exercises to treat and prevent recurrence of symptoms
The aim of this study was: -
To determine the impact of nursing physical training program on the clinical outcomes of patients undergoing cervical spine surgery.
Materials and method:-
Materials:
This study was conducted at the Neurosurgery Department at Alexandria Main University Hospital the affiliated Outpatient Clinic. Subjects of this study were a convenient sample of 40 adult patients diagnosed with cervical spondylosis, canal stenosis and cervical disc prolapse undergoing cervical spine surgery. They were sequentially divided into two equal groups; the first was the control group which comprised 20 patients exposed to routine care only, the second was the study group and comprised 20 patients who received the nursing physical training program.
Two tools were used to determine the impact of nursing physical training program on the clinical outcomes of patients undergoing cervical spine surgery.
Tool I: Cervical Spine Surgery Patients’ Assessment:
This tool was developed by the researcher after reviewing relevant literature and it was used to assess patients with cervical degenerative disc disease before and after implementation of nursing physical training program. It consisted of four parts:
Part I: Patient’s Sociodemographic characteristics: This part included data such as; age, sex, educational level, marital status, occupation.
Part II: Patients’ Clinical Data: This part included data such as; medical history, surgical history, operation name, duration of disease, names and dosages of all prescribed and over the counter medications, level of cervical disc affected, patients complaints and previous neck –or back surgery.
Part III: Cervical Spine Surgery Patients’ Pain Assessment, this part included two sections to assess pain characteristics and pain intensity.
Part IV: Physical Assessment:
This part encompassed five sections to assess motor and sensory status of patients undergoing cervical spine surgery.
1. Section one: assessment of gait
2. Section two :assessment of posture
3. Section three :assessment of muscle strength
4. Section four: sensory assessment
5. Section five: assessment of reflexes.
Tool II: Neck Disability Index (NDI)
This tool was developed by Vernon to assess patients level of disability .It is an instrument for measuring self-rated disability due to neck pain caused by cervical spine disorders. The NDI consists of 10 items: pain intensity, personal care, lifting, reading, headaches, concentration, work, driving, sleeping, and recreation. Each item was evaluated on a rating scale ranging from 0 to 5, for a total score of 50. The lower the score, the less self-rated the disability.
Method:
• A written approval was obtained from the hospital administrator and head of neurosurgery department, after explanation of the study aim.
• Tool I cervical spine surgery patients‟ assessment was developed by the researcher after reviewing of related literature. Tools and booklet were tested for content validity, completeness and clarity of items by five Faculty Staff of Medical –Surgical Nursing and five Neurosurgeons in Alexandria University.
• Reliability of the study tools was estimated using Cronbach’s Alpha test ranged from (0.89 to 0.98). A pilot study was done on four patients for testing, clarity, feasibility and applicability of the developed tool.
Initial assessment of all patients (study and control group) was done preoperatively using tool (I and II) to collect a baseline data.
• The developed program was implemented on patients of the study group individually in the in-patients departments. It included 3 sessions of patient‟s teaching during preoperative, 3 days post-operative and pre-discharge periods.
• After program application ,every patient in the study and control group were evaluated two times after two weeks, and one month post discharge using tool I and II at the affiliated out-patient clinic.
The main results of the study were:
1. About two thirds of studied and control groups were aged from 40 to less than 50 years. Around one-quarter of both study and control groups were aged from 50 to 60 years old.
2. Males were more prevalent in the studied sample, and the majority of the studied patients in the study and control group were married.
3. The highest percentage of patients in the study and control groups (half of each group), was illiterate.
4. More than two- thirds of the control group (35.0%) and one-fifth of the study group (20.0%) were manual workers, and one-third of study and control groups (30.0% and 35.0% respectively) were housewives.
5. The single most common affected intervertebral discs were C5-C6 followed by C6 - C7.
6. All patients in both groups were complaining of neck stiffness and numbness. More than two- thirds of study group (70.0%) and more than four fifths of control group (85.0%) complained from muscle weakness.
7. All patients of study and control groups were receiving muscle relaxants and analgesics. Also, the majority of patients in study group (70.0%) and more than half the control group (55.0%) were receiving non-steroidal anti-inflammatory drugs.
8. The majority of study and control group, 80.0% and 85.0%, respectively experienced severe pain preoperatively.
9. There were high statistically significant differences between study and control group regarding pain intensity one month after surgery.
10. There was a statistically significant improvement in the patients‟ gait between preoperative, 14 days postoperatively and 30 days postoperatively in the study group. While in the control group, these changes were statistically insignificant.
11. The mean score of all assessed muscle strength was increased from preoperative day to two weeks postoperative to one month after surgery. This increase within the study group was statistically significant.
12. There was a statistically significant improvement in sensory function in the postoperative period in both study and control group.
13. The mean scores of all deep tendon reflexes assessed increased significantly from the preoperative assessment to two weeks after surgery to one month postoperative. Also, the mean scores of all reflexes among study group were 2.0± 0.00 one month
postoperative which denotes the improvement to normal response. In addition among the control group, in the majority of tendon reflexes assessed, there was also a significant increase in the mean scores all over the periods of assessment although the mean score did not reach 2.0± 0.00 but it was around 1.8± 0.41.
14. One month postoperatively, the degree of disability of 60.0% of study group improved to moderate disability compared to only 10.0% among the control group. Moreover, half of the patients in control group were remained suffering from complete disability compared to none from the study group. Moreover, 10.0% of study group experienced more improvement and reached mild disability degree compared to none from control group. These differences were highly statistically significant (P= <0.001).
Conclusion:
• It can be concluded that applying nursing physical training program significantly improved the studied patients‟ pain intensity, gait, muscle strength, sensory function, reflexes, and neck disability index postoperatively than their controls.
Recommendations:
• The developed booklet has to be distributed to patients, undergoing cervical spine surgery in the study setting, other departments and outpatient clinics.
• The patients or a family member should be taught postoperative information about home care, dangerous symptoms after discharge and exercises, in order to improve patient health outcomes postoperatively.
• Nurses should attend update conferences and in-service training program/or workshops, related to the recent advances in treatment modalities for perioperative patients undergoing cervical spine surgery.
• Further research is needed to investigate the long term effect of such program on the health status for patient undergoing cervical spine surgery.