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Purpose: To evaluate the effectiveness of an evidence-based pre-, peri- and postoperative rehabilitation pathway (i.e. the REACT rehabilitation pathway) on disability in patients undergoing lumbar fusion surgery (LFS), compared to usual care., Methods: A prospective, nonrandomized controlled trial included 72 patients scheduled for one- or two-level LFS for degenerative conditions or adult isthmic spondylolisthesis. Participants were allocated to usual care (N = 36) or the REACT rehabilitation pathway (N = 36). The REACT rehabilitation pathway includes prehabilitation, early mobilization and avoidance of unsubstantiated postoperative restrictions, early postoperative physiotherapy, patient empowerment, case manager guidance, and support towards an early return to activity. The primary outcome was disability; key secondary outcomes were back and leg pain intensity, and return-to-work rate. Additional secondary outcomes included fear of movement, pain catastrophizing, negative emotional states, sit-to-stand performance, analgesic use, length of stay, and adverse events. Data were collected preoperatively and at five time points up to one year postoperatively., Results: Participants in the REACT group demonstrated significantly greater improvements in disability (p = 0.003), back pain intensity (p = 0.007), and return-to-work rates (88% vs 56%, p = 0.34) compared to the control group. The REACT group also showed greater improvements in fear of movement (p = 0.038), pain catastrophizing (p < 0.001), combined negative emotional states (p = 0.007), sit-to-stand performance (p = 0.021), and reduced analgesic use (p = 0.001). No significant differences were observed in leg pain intensity (p = 0.042), length of hospital stay (p = 0.095) or adverse events (p = 1.00)., Conclusion: The REACT rehabilitation pathway significantly reduced disability in the first postoperative year after LFS compared to usual care. The most promising result is the significantly higher return-to-work rate in the REACT group., Competing Interests: Declarations. Conflict of interests: The authors declare no competing interests., (© 2025. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: A novel motion analysis (MA) protocol for patients with adult spinal deformity (ASD) was developed within University Hospitals Leuven, aiming for better functional outcomes by improved treatment planning and decision making., Research Question: Can insights into the costs of a research-focused MA (RMA) protocol support the transition to a concise clinical MA (CMA) protocol and facilitate its potential adoption as standard clinical care?, Methods: Time-driven activity-based costing (TD-ABC) was used to quantify the costs directly related to performing the MA protocol. Time durations were derived from observations and interviews and validated using time intervals retrospectively derived from previous motion analyses metadata. Costs were computed based on resource time usage and the per-minute cost of practical capacity. An expert panel then refined the RMA into a CMA protocol by excluding some trials, utilizing cost insights and insights in the potential clinical relevance of trials, including their discriminative abilities, their ability to highlight compensatory mechanisms and their standardization potential. The clinical costs of the CMA were then again calculated using the same methodology., Results: The average time to perform the RMA was 179.0 minutes and dropped to 130.9 minutes after the expert panel excluded 12 types of motion trials. The total cost of this new CMA was € 220.83. The largest cost component of the CMA was staff costs (68.1 %), followed by the cost of equipment (30.2 %)., Significance: This study demonstrates how cost insights complement insights on clinical relevance when defining a motion analysis protocol for integration in standard clinical care. Future value- improvements to the protocol should also integrate insights on its impact on treatment outcome., Competing Interests: Declaration of Competing Interest The authors declare that there are no competing interests, financial or otherwise, that could have appeared to influence the work reported in this paper., (Copyright © 2025. Published by Elsevier B.V.)