Timing of Rehabilitation Following Cervical Spinal Surgery in Degenerative Myelopathy

• Physical Therapy (Behavioral): Active, task-specific physical therapy to enhance balance, walking, and strength

Primary outcomes

• Change from Baseline in the Ten Metre Walk Test [Baseline and End Rehabilitation (8 weeks following Baseline)]: Time to walk ten metres; lower times indicate faster walking speed

Secondary outcomes

• Change from Baseline in the Six Minute Walk Test [Baseline and End Rehabilitation (8 weeks following Baseline)]: Distance walked in six minutes; longer distances indicate greater walking endurance
• Change from Baseline in the Timed Up and Go [Baseline and End Rehabilitation (8 weeks following Baseline)]: Time taken to stand, walk 3 metres and return to sitting position; longer time indicates balance and mobility impairments
• Change from Baseline in the Berg Balance Scale [Baseline and End Rehabilitation (8 weeks following Baseline)]: Standardized test that includes 14 balance tasks, with scores ranging from 0 to 56; lower scores indicate balance impairment
• Change from Baseline on the 36-item Short Form Survey [Baseline and End Rehabilitation (8 weeks following Baseline)]: Survey measuring health-related quality of life, with scores ranging from 0 to 100; higher scores indicate better health status
• Change from Admission to Study on the modified Japanese Orthopaedic Association Scale [Study Admission and End of Study (12 weeks)]: Score to evaluate the severity of degenerative cervical myelopathy, with scores ranging from 0 to 18; higher scores indicate more mild myelopathy
• Change from Baseline in Motor-Evoked Potentials [Baseline and End Rehabilitation (8 weeks following Baseline)]: Transcranial Magnetic Stimulation (TMS) will be used and electromyography (EMG) will be recorded in lower extremity muscles; size of motor-evoked potentials will be measured
• Change from Baseline in Hoffman Reflexes [Baseline and End Rehabilitation (8 weeks following Baseline)]: Hoffman reflexes will be elicited in the soleus muscle and electromyography (EMG) will be recorded; H:M ratios and rate-dependent depression will be measured.

Other outcomes

• Feasibility (Participant Recruitment and Retention) [From Study Admission to the End of Study (12 weeks)]: The recruitment and drop out rates will be recorded
• Acceptability [Immediately following rehabilitation (Week 8 for Intervention Group, Week 12 for Usual Care Control)]: Participants will describe their satisfaction with the intervention (including content and timing) through a custom survey following the intervention
• Safety (Adverse Events) [From Study Admission to the End of Study (12 weeks)]: Details and timing of any adverse events will be documented for all participants
• Change from Baseline in Daily Activity [Baseline and End Rehabilitation (8 weeks following Baseline)]: Activity monitors will be used to measure daily activity levels (including step counts). Average activity over 4-7 days of monitoring will be calculated.

Sex: All, ages: 18 Years to any

Inclusion Criteria:

* adult (>18 years of age) with diagnosis of degenerative cervical myelopathy, within 2 weeks of spinal decompression surgery
* plan to be discharged home from acute care (i.e., not admitted to another facility for post-operative rehabilitation)
* able to stand with a maximum of one-person assist (+/- use of gait aid)
* persistent functional impairment in lower extremity strength, balance, coordination, and/or gait
* ability to attend an 8-week in-person rehabilitation program in Edmonton, Alberta

Exclusion Criteria:

* discharge from acute care facility > 2 weeks post-operative
* intra-operative or early post-operative complication delaying discharge or precluding participation in early rehabilitation