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Yu H, Cancelliere C, Mior S, Pereira P, Nordin M, Brunton G, Wong JJ, Shearer HM, Connell G, Ead L, Verville L, Rezai M, Myrtos D, Wang D, Marchand AA, Romanelli A, Germann D, To D, Young JJ, Southerst D, Candelaria H, Hogg-Johnson S, Côté P. Effectiveness of postsurgical rehabilitation following lumbar disc herniation surgery: A systematic review. BRAIN & SPINE 2024; 4:102806. [PMID: 38690091 PMCID: PMC11059472 DOI: 10.1016/j.bas.2024.102806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 03/08/2024] [Accepted: 04/04/2024] [Indexed: 05/02/2024]
Abstract
Introduction The effectiveness of post-surgical rehabilitation following lumbar disc herniation (LDH) surgery is unclear. Research question To investigate the effectiveness and safety of rehabilitation interventions initiated within three months post-surgery for adults treated surgically for LDH. Material and methods This systematic review searched seven databases from inception to November 2023. Independent reviewers screened studies, assessed and extracted data, and rated the certainty of the evidence using the GRADE approach. Results This systematic review retrieved 20,531 citations and included 25 randomized controlled trials. The high certainty evidence suggests that adding Pilates exercise to routine care and cognitive behavioral therapy may improve function immediately post-intervention (1 RCT), and that adding whole-body magnetic therapy to exercise, pharmacological and aquatic therapy may reduce low back pain intensity (1 RCT) immediately post-intervention. Compared to placebo, pregabalin did not reduce low back pain or leg pain intensity (1 RCT) (moderate to high certainty evidence). We found no differences between: 1) behavioral graded activity vs. physiotherapy (1 RCT); 2) exercise and education vs. neck massage or watchful waiting (1 RCT); 3) exercise, education, and in-hospital usual care vs. in-hospital usual care (1 RCT); 4) functional or staged exercise vs. usual post-surgical care including exercise (2 RCTs); and 5) supervised exercise with education vs. education (1 RCT). No studies assessed adverse events. Discussion and conclusion Evidence on effective and safe post-surgical rehabilitation interventions is sparse. This review identified two interventions with potential short-term benefits (Pilates exercises, whole-body magnetic therapy) but safety is unclear, and one with an iatrogenic effect (pregabalin).
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Affiliation(s)
- Hainan Yu
- Faculty of Health Sciences, Ontario Tech University, Canada
- Institute for Disability and Rehabilitation Research, Faculty of Health Sciences, Ontario Tech University and Canadian Memorial Chiropractic College, Canada
- Undergraduate Education, Canadian Memorial Chiropractic College, Canada
| | - Carol Cancelliere
- Faculty of Health Sciences, Ontario Tech University, Canada
- Institute for Disability and Rehabilitation Research, Faculty of Health Sciences, Ontario Tech University and Canadian Memorial Chiropractic College, Canada
| | - Silvano Mior
- Faculty of Health Sciences, Ontario Tech University, Canada
- Institute for Disability and Rehabilitation Research, Faculty of Health Sciences, Ontario Tech University and Canadian Memorial Chiropractic College, Canada
- Research and Innovation, Canadian Memorial Chiropractic College, Canada
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Paulo Pereira
- Faculty of Medicine, University of Porto, Portugal
- Department of Neurosurgery - Centro Hospitalar Universitário S. João, Porto, Portugal
| | - Margareta Nordin
- Departments of Orthopedic Surgery and Environmental Medicine, Occupational and Industrial Orthopedic Center, NYU School of Medicine, New York University, New York, NY, USA
| | - Ginny Brunton
- Faculty of Health Sciences, Ontario Tech University, Canada
- Institute for Disability and Rehabilitation Research, Faculty of Health Sciences, Ontario Tech University and Canadian Memorial Chiropractic College, Canada
| | - Jessica J. Wong
- Faculty of Health Sciences, Ontario Tech University, Canada
- Institute for Disability and Rehabilitation Research, Faculty of Health Sciences, Ontario Tech University and Canadian Memorial Chiropractic College, Canada
- Division of Graduate Studies, Canadian Memorial Chiropractic College, Canada
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Heather M. Shearer
- Faculty of Health Sciences, Ontario Tech University, Canada
- Institute for Disability and Rehabilitation Research, Faculty of Health Sciences, Ontario Tech University and Canadian Memorial Chiropractic College, Canada
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Canada
| | - Gaelan Connell
- Faculty of Health Sciences, Ontario Tech University, Canada
- Institute for Disability and Rehabilitation Research, Faculty of Health Sciences, Ontario Tech University and Canadian Memorial Chiropractic College, Canada
| | - Lauren Ead
- Institute for Disability and Rehabilitation Research, Faculty of Health Sciences, Ontario Tech University and Canadian Memorial Chiropractic College, Canada
- Division of Graduate Studies, Canadian Memorial Chiropractic College, Canada
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Leslie Verville
- Faculty of Health Sciences, Ontario Tech University, Canada
- Institute for Disability and Rehabilitation Research, Faculty of Health Sciences, Ontario Tech University and Canadian Memorial Chiropractic College, Canada
| | - Mana Rezai
- Faculty of Health Sciences, Ontario Tech University, Canada
- Institute for Disability and Rehabilitation Research, Faculty of Health Sciences, Ontario Tech University and Canadian Memorial Chiropractic College, Canada
| | - Danny Myrtos
- Department of Clinical Education and Diagnosis, Canadian Memorial Chiropractic College, Canada
| | - Dan Wang
- Faculty of Health Sciences, Ontario Tech University, Canada
- Institute for Disability and Rehabilitation Research, Faculty of Health Sciences, Ontario Tech University and Canadian Memorial Chiropractic College, Canada
| | | | - Andrew Romanelli
- Department of Clinical Education and Diagnosis, Canadian Memorial Chiropractic College, Canada
| | - Darrin Germann
- Department of Clinical Education and Diagnosis, Canadian Memorial Chiropractic College, Canada
| | - Daphne To
- Department of Clinical Education and Diagnosis, Canadian Memorial Chiropractic College, Canada
| | - James J. Young
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Canada
- Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Denmark
| | - Danielle Southerst
- Faculty of Health Sciences, Ontario Tech University, Canada
- Institute for Disability and Rehabilitation Research, Faculty of Health Sciences, Ontario Tech University and Canadian Memorial Chiropractic College, Canada
| | - Henry Candelaria
- Rapid Access Clinic for Low Back Pain, Trillium Health Partners, Mississauga, Ontario, Canada
| | - Sheilah Hogg-Johnson
- Institute for Disability and Rehabilitation Research, Faculty of Health Sciences, Ontario Tech University and Canadian Memorial Chiropractic College, Canada
- Research and Innovation, Canadian Memorial Chiropractic College, Canada
- Epidemiology Division, Dalla Lana School of Public Health, University of Toronto, Canada
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Pierre Côté
- Faculty of Health Sciences, Ontario Tech University, Canada
- Institute for Disability and Rehabilitation Research, Faculty of Health Sciences, Ontario Tech University and Canadian Memorial Chiropractic College, Canada
- Epidemiology Division, Dalla Lana School of Public Health, University of Toronto, Canada
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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Manni T, Ferri N, Vanti C, Ferrari S, Cuoghi I, Gaeta C, Sgaravatti I, Pillastrini P. Rehabilitation after lumbar spine surgery in adults: a systematic review with meta-analysis. Arch Physiother 2023; 13:21. [PMID: 37845718 PMCID: PMC10578022 DOI: 10.1186/s40945-023-00175-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 09/19/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND The role of rehabilitation after surgery in patients with low back pain is well recognized. The aim of this systematic review is to summarize and update the existing evidence according to the type of clinical condition and rehabilitation approach. METHODS This systematic review included RCTs on the effectiveness of rehabilitation after surgery for lumbar disc herniation, spinal stenosis, and spondylolisthesis. We searched the literature for randomized controlled trials indexed in MEDLINE, Embase, CINHAL, CENTRAL, Scopus, PEDro, and Web of Science databases, up to April 15, 2023. We used Cochrane Risk of Bias 2.0 tool to assess each study. We conducted a quantitative synthesis when population, intervention, control, and outcome were sufficiently homogeneous; otherwise, we conducted a qualitative analysis. RESULTS Forty-five studies (3.036 subjects) were included and analyzed according to the population considered: lumbar stenosis (1 trial), spondylolisthesis (3 trials), and disc herniation (41 trials). Regarding lumbar stenosis, a supervised active exercise program appears to improve outcomes related to pain, disability, and quality of life both in the short- and mid-term (1 study, n = 60). Concerning spondylolisthesis, kinesiophobia is reduced in the home exercises group compared to usual care, at 3-months follow-up (3 studies, n = 98). For disk herniation, supervised exercises are better than non-supervised exercises to reduce pain (MD -1.14; 95% CIs -1.65, -0.62; 5 trials, n = 250) and disability (SMD -0.70; 95% CIs -1.14, -0.26; 4 trials, n = 175). Supervised exercises are better than advice in reducing pain (SMD -0.91; 95% CIs -1.61, -0.21; 5 trials, n = 341) and disability (SMD -0.80; 95% CIs -1.59, -0.01; 4 trials, n = 261), in the short-term. Supervised exercises are equal to no treatment in reducing pain and disability, at 3 and 6 months after intervention (2 trials, n = 166). These results are supported by a very low to low quality of evidence. CONCLUSIONS Our research suggests that supervised exercise may be effective in improving patient's pain and disability after lumbar surgery, but RCTs regarding lumbar spinal stenosis and lumbar spondylolisthesis are still scarce, with significant heterogeneity of proposed interventions.
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Affiliation(s)
- Tiziana Manni
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum, University of Bologna, 40138, Bologna, Italy.
| | - Nicola Ferri
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum, University of Bologna, 40138, Bologna, Italy
| | - Carla Vanti
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum, University of Bologna, 40138, Bologna, Italy
| | - Silvano Ferrari
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum, University of Bologna, 40138, Bologna, Italy
| | - Ilaria Cuoghi
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum, University of Bologna, 40138, Bologna, Italy
| | - Claudia Gaeta
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum, University of Bologna, 40138, Bologna, Italy
| | - Isabella Sgaravatti
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum, University of Bologna, 40138, Bologna, Italy
| | - Paolo Pillastrini
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum, University of Bologna, 40138, Bologna, Italy
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Impact of Active Physiotherapy Rehabilitation on Pain and Global and Functional Improvement 1-2 Months after Lumbar Disk Surgery: A Systematic Review and Meta-Analysis. Healthcare (Basel) 2022; 10:healthcare10101943. [PMID: 36292390 PMCID: PMC9601491 DOI: 10.3390/healthcare10101943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 09/09/2022] [Accepted: 09/28/2022] [Indexed: 11/04/2022] Open
Abstract
Introduction: Lumbar disc surgery is a common procedure for patients with lower back pain associated with lumbar disc herniation. This study aims to evaluate the impact of active physiotherapeutic rehabilitation on global/functional improvement and subjective pain score reduction among patients 1–2 months following lumbar disc surgery. The outcomes of this study are to assess the impact of active physiotherapeutic rehabilitation on functional improvement and subjective improvement in pain behavior post active rehabilitation. The outcomes are measured as pain assessed using the visual analog scale, global measurement of improvement, back pain functional status, and return to work. Methods: Databases, including MEDLINE/PubMed (10 June 1996, 2022), Web of Science (10 June 1997, 2022), Scopus (15 March, 10 June 2004, 2022), CINAHL Plus (10 June 1961, 2022), and Cochrane (10 June 1993, 2022) were reviewed without any language restrictions. All studies were systematically screened; however, only randomized controlled trials were eligible against the inclusion/exclusion criteria. All statistical tests were conducted in Review Manager (RevMan) 5.4. The quality of studies was appraised using the grading of recommendations assessment, development, and evaluation (GRADE) approach and the risk-of-bias 2 (RoB 2) tool. Results: Fifteen articles were identified, enrolling a total of 2188 patients, where the majority of active rehabilitation interventions continued for 3 months. All these interventions began 1–2 months postoperatively, and quantitative findings were presented as mean scores. The subjective pain scores were significantly lower in the interventional group, with a mean difference (MD) of −7.01 (p = 0.004). The pain disability score was considerably lower in the interventional group, with an MD of −3.94 (p = 0.002). Global improvement was higher in the interventional group (OR = 1.94, p = 0.0001). Conclusions: This study presents significant improvement in all parameters concerning pain and functionality. Postoperative rehabilitation requires optimization concerning timing, duration, intensity, and associated components to benefit patients post lumbar disc surgery.
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Sharaf MA, Rezkallah SS, Fouda KZ, Gharib NM. Effects of adding neural mobilization to traditional physical therapy on pain, functional disability, and H-reflex in patients after lumbar laminectomy: A randomized controlled trial. Clin Rehabil 2021; 36:51-58. [PMID: 34296639 DOI: 10.1177/02692155211034154] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To investigate whether adding neural mobilization to a standard postoperative physical therapy program could improve the outcomes of patients after lumbar laminectomy. DESIGN A single blinded randomized controlled trial. SETTING Outpatient setting. PARTICIPANTS Sixty participants of both sexes who had undergone lumbar laminectomy. INTERVENTIONS Participants were allocated randomly to two groups; study and control groups. All patients received a standard postoperative physical therapy program. Those in the study group received additional neural mobilization in the form of straight leg raising and dorsiflexion with two-ended slider. Treatment was administered three times/week for six successive weeks. OUTCOME MEASURES Visual analog scale (VAS), Oswestry disability index (ODI), and H-reflex latency were measured pre and post-treatment. RESULTS The mean age of participants was 44.23 ± 4.64 and 45.3 ± 5.3 in study and control groups respectively (P > 0.05). There were statistically significant differences in VAS, ODI, and H-reflex latency in favor of the study group (P < 0.05). The mean ± SD for VAS, ODI, and H-reflex latency pre vs post treatment was 6.13 ± 1.22 vs 1.40 ± 0.77, 64.46 ± 4.05 vs 16.86 ± 2.55, and 32.07 ± 2.76 vs 27.46 ±1.79 in study group and 5.86 ± 1.07 vs 2.46 ± 0.73, 63.93 ± 3.91 vs 23.40 ± 2.93, and 31.76 ± 2.69 vs 29.4 ± 1.94 in control group, respectively. CONCLUSIONS Neural mobilization combined with traditional physical therapy program achieved better improvement in pain, functional disability and H-reflex in patients who underwent decompressive laminectomy than traditional physical therapy program only.
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Affiliation(s)
- Moussa A Sharaf
- Department of Physical Therapy for Neuromuscular Disorders and its Surgery, Faculty of Physical Therapy, Cairo University, Giza, Egypt.,Department of Physical Therapy, College of Applied Medical Sciences, Taif University, Taif, Saudi Arabia
| | - Soheir S Rezkallah
- Department of Physical Therapy for Basic Sciences, Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | - Khalid Z Fouda
- Department of Physical Therapy for Basic Sciences, Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | - Nevein Mm Gharib
- Department of Physical Therapy for Neuromuscular Disorders and its Surgery, Faculty of Physical Therapy, Cairo University, Giza, Egypt.,Department of Physical Therapy, College of Applied Medical Sciences, Taif University, Taif, Saudi Arabia
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Dupeyron A, Ribinik P, Rannou F, Kabani S, Demoulin C, Dufour X, Foltz V, Godard J, Huppert J, Nizard J, Petit A, Silvestre C, Kouyoumdjian P, Coudeyre E. Rehabilitation and lumbar surgery: the French recommendations for clinical practice. Ann Phys Rehabil Med 2021; 64:101548. [PMID: 34192564 DOI: 10.1016/j.rehab.2021.101548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 05/24/2021] [Accepted: 06/01/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Indications and techniques of rehabilitation differ widely across types of lumbar surgery, including timing (before or after surgery) and prescriptions (surgeons but also medical or paramedical professionals). OBJECTIVES This project aimed to build consensual recommendations for practice in this context. METHODS The SOFMER methodology was used to establish recommendations for physical medicine and rehabilitation: a steering committee defined the types of lumbar surgery involved and developed the main questions to be addressed; a scientific committee performed a literature review for grading evidence and proposed the first version of recommendations, which were discussed during a dedicated session at the national Physical and Rehabilitation Medicine congress; then an e-Delphi method with cross-professional experts was used to finalise recommendations and reach a multidisciplinary consensus. RESULTS The main questions developed were the value of rehabilitation before and after surgery, timing and type of rehabilitation, benefit of supervision and instrumental rehabilitation, value of patient education, and complementary interventions concerning rehabilitation for discectomy, fusion, and disc prosthesis (excluding decompression for spinal stenosis). The literature review identified 60 articles, but for several of the questions, no article in the literature addressed the issue. The multidisciplinary scientific committee analysed the literature and addressed the questions to propose the first version of a set of 23 recommendations. The congress session failed to answer all questions or to reach consensus for all items. After a three-step e-Delphi, 20 recommendations were retained, for which consensus among experts was reached. The recommendations are applicable only to patients without a neurological lesion. CONCLUSIONS These recommendations provide important and consensual knowledge to assist clinicians in decision-making for rehabilitation in lumbar surgery. Despite many of the recommendations relying exclusively on expert opinion rather than published evidence, this approach is an important advance to improve concordance among healthcare professionals.
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Affiliation(s)
- Arnaud Dupeyron
- Service de Médecine Physique et de Réadaptation, CHU Nîmes, Univ Montpellier, Nîmes, France.
| | - Patricia Ribinik
- Service de Médecine Physique et de Réadaptation, CH de Gonesse, Gonesse, France
| | - François Rannou
- Service de Rééducation et de Réadaptation de l'appareil locomoteur et des pathologies du Rachis, hôpitaux universitaires Paris centre-groupe hospitalier Cochin, AP-HP, Paris, France
| | - Sarah Kabani
- Service de Biostatistique, Epidémiologie, Santé Publique, Innovation Méthodologique (BESPIM), CHU Nîmes, Univ Montpellier, Nîmes, France
| | - Christophe Demoulin
- Department of Sport and Rehabilitation Sciences, University of Liege, Liege, Belgium
| | | | - Violaine Foltz
- Service de Rhumatologie, Hôpitaux universitaires Paris centre-groupe hospitalier Pitié-Salpétrière, AP-HP, Paris, France
| | - Joel Godard
- Service de Neurochirurgie et de chirurgie de la douleur et du rachis, CHRU Besançon, Université de Franche Comté, Besançon, France
| | - Jean Huppert
- Service de Neurochirurgie, Clinique du Parc, Saint-Priest-en-Jarez, France
| | - Julien Nizard
- Centre fédératif douleur soins de support, UIC 22, équipe mobile de soins palliatifs et de support, CHU Nantes, Nantes, France
| | - Audrey Petit
- Centre de consultation de pathologie professionnelle, CHU d'Angers, Angers, France
| | - Clement Silvestre
- Département de Chirurgie Orthopédique, Clinique Médico-Chirurgicale des Massues, Lyon, France
| | - Pascal Kouyoumdjian
- Service de Chirurgie Orthopédique, CHU Nîmes, Univ Montpellier, Nîmes, France
| | - Emmanuel Coudeyre
- Service de Médecine Physique et de Réadaptation, CHU Clermont-Ferrand, Université Clermont Auvergne, INRAE, UNH, F-63000 Clermont-Ferrand, France
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Kaçar Ş, Alptekin K, Atilla Alkan ŞN, Öncü J. Comparison of daily living return efficiency of patients with pressure biofeedback and normal exercise program after lumbar disc herniation surgery. GAZZETTA MEDICA ITALIANA ARCHIVIO PER LE SCIENZE MEDICHE 2020. [DOI: 10.23736/s0393-3660.19.04154-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Mancuso CA, Rigaud MC, Wellington B, Duculan R, Cammisa FP, Sama AA, Hughes AP, Girardi FP. Qualitative assessment of patients' perspectives and willingness to improve healthy lifestyle physical activity after lumbar surgery. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2020; 30:200-207. [PMID: 32562080 DOI: 10.1007/s00586-020-06508-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 06/02/2020] [Accepted: 06/13/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE Many patients retain sedentary lifestyles after lumbar surgery and incur increased risks of adverse health outcomes. The goal of this study was to assess patients' perspectives about postoperative physical activity. METHODS During routine post-lumbar surgery visits in a tertiary care center, 260 patients were asked open-ended questions about their spine and physical activity. Three investigators reviewed responses and determined themed categories. Patients also completed surveys measuring disability, depressive symptoms, anxiety, and fear-avoidance of physical activity. Surgical complexity was assigned based on operative features. RESULTS Mean age was 63, and 53% were men. Thirty-nine percent thought walking was good for the spine, particularly among those with less fear-avoidance, less disability, and less complex surgery. Spine benefits were cited (42%) for the short-term ("faster recovery") and long-term ("decreases chances of another surgery"), particularly by younger patients. To increase activity, patients suggested spine-specific techniques (35%, "use railings") and advised caution (24%, "pace yourself"). The major deterrent was persistent back pain (36%) particularly for those with worse disability, and more depressive symptoms, anxiety, complex surgery, and fear-avoidance. Our findings consistently fit with the Social Cognitive Theory of health behavior which posits a dynamic three-way interaction of personal factors, environmental influences, and behavior. CONCLUSIONS Patients acknowledge short- and long-term benefits of physical activity for their spine and overall health; however, many are deterred from increasing activity by spine-related concerns. Interventions to improve physical activity should foster self-efficacy and self-direction and should be reinforced by members of the spine care team who are knowledgeable about prudent activities.
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Affiliation(s)
- Carol A Mancuso
- Research Division, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA. .,Department of Medicine, Weill Cornell Medical College, New York, NY, USA.
| | - Manuela C Rigaud
- Rory Meyers College of Nursing, New York University, New York, NY, USA
| | - Bay Wellington
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Roland Duculan
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Frank P Cammisa
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Andrew A Sama
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Alexander P Hughes
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Federico P Girardi
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
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Taulaniemi A, Kankaanpää M, Rinne M, Tokola K, Parkkari J, Suni JH. Fear-avoidance beliefs are associated with exercise adherence: secondary analysis of a randomised controlled trial (RCT) among female healthcare workers with recurrent low back pain. BMC Sports Sci Med Rehabil 2020; 12:28. [PMID: 32391158 PMCID: PMC7197113 DOI: 10.1186/s13102-020-00177-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 04/20/2020] [Indexed: 12/19/2022]
Abstract
Background Exercise is recommended for the treatment and management of low back pain (LBP) and the prevention of chronicity. Exercise adherence has been only modest in intervention studies among people with musculoskeletal pain. Fear-avoidance beliefs (FABs) are known to affect exercise adherence. The purpose was twofold: to examine which bio-psycho-social factors contributed to exercise adherence during a 6-month neuromuscular exercise intervention among female healthcare workers with recurrent LBP, and to investigate how exercising affects FABs at 6 and 12 months’ follow-up. Methods Some 219 healthcare workers aged 30–55 years with mild-to-moderate re-current non-specific LBP were originally allocated into: 1) exercise, 2) counselling, 3) combined exercise and counselling, and 4) control groups. In the present secondary analysis, groups 1 and 3 (exercise only and exercise+counselling) were merged to be exercisers and groups 2 and 4 were merged to be non-exercisers. Baseline variables of the exercise compliers (≥24 times over 24 weeks; n = 58) were compared to those of the non-compliers (< 1 time/week, 0–23 times; n = 52). The effects of the exercise programme on FABs were analysed by a generalised linear mixed model according to the intention-to-treat principle (exercisers; n = 110 vs non-exercisers; n = 109) at three measurement points (baseline, 6, and 12 months). A per-protocol analysis compared the more exercised to the less exercised and non-exercisers. Results A low education level (p = 0.026), shift work (p = 0.023), low aerobic (p = 0.048) and musculoskeletal (p = 0.043) fitness, and high baseline physical activity-related FABs (p = 0.019) were related to low exercise adherence. The exercise programme reduced levels of both physical activity- and work-related FABs, and there was a dose response: FABs reduced more in persons who exercised ≥24 times compared to those who exercised 0–23 times. Conclusion Healthcare workers who had lower education and fitness levels, worked shifts, and had high physical activity-related FABs had a lower adherence to the 6-month neuromuscular exercise programme. Exercising with good adherence reduced levels of FABs, which have been shown to be linked with prolonged LBP. Motivational strategies should be targeted at persons with low education and fitness levels and high FABs in order to achieve better exercise adherence.
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Affiliation(s)
| | - Markku Kankaanpää
- 2Department of Physical and Rehabilitation Medicine, Tampere University Hospital, Tampere, Finland
| | - Marjo Rinne
- 1UKK Institute for Health Promotion Research, Tampere, Finland
| | - Kari Tokola
- 1UKK Institute for Health Promotion Research, Tampere, Finland
| | - Jari Parkkari
- 1UKK Institute for Health Promotion Research, Tampere, Finland
| | - Jaana H Suni
- 1UKK Institute for Health Promotion Research, Tampere, Finland
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10
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Madera M, Brady J, Deily S, McGinty T, Moroz L, Singh D, Tipton G, Truumees E. The role of physical therapy and rehabilitation after lumbar fusion surgery for degenerative disease: a systematic review. J Neurosurg Spine 2017; 26:694-704. [PMID: 28291412 DOI: 10.3171/2016.10.spine16627] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE The purpose of this study was to provide a systematic and comprehensive review of the existing literature regarding postfusion rehabilitation. METHODS Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, the authors conducted an exhaustive review of multiple electronic databases. Potential articles were screened using inclusion/exclusion criteria. Two authors independently analyzed these studies using predefined data fields, including study quality indicators such as level of evidence and availability of accepted patient-reported outcomes measures. These findings were synthesized in a narrative format. A third author resolved disagreements regarding the inclusion of a study. RESULTS Twenty-one articles with I or II levels of evidence were included in the review. The authors divided the findings of the literature review into several groups: rehabilitation terminology, timing and duration of postfusion rehabilitation, the need for rehabilitation relative to surgery-related morbidity, rehabilitation's relationship to outcomes, and cognitive and psychosocial aspects of postsurgical rehabilitation. Current evidence generally supports formal rehabilitation after lumbar fusion surgery. Starting physical therapy at the 12-week postoperative mark results in better outcomes at lower cost than an earlier, 6-week start. Where available, psychosocial support improves outcomes. However, a number of the questions could not be answered with high-grade evidence. In these cases, the authors used "best evidence available" to make recommendations. There are many cases in which different types of caregivers use clinical terminology differently. The data supporting an optimal protocol for postfusion rehabilitation remains elusive but, using the data available, the authors have crafted recommendations and a model protocol, which is currently undergoing prospective study. CONCLUSIONS Rehabilitation has long been a common feature in the postoperative management of patients undergoing spinal fusion. Although caregivers from multiple disciplines agree that the majority of their patients will benefit from this effort, the supporting data remain sparse. In creating a model protocol for postlumbar fusion rehabilitation, the authors hope to share a starting point for future postoperative lumbar fusion rehabilitation research.
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Affiliation(s)
- Marcella Madera
- Department of Surgery and Perioperative Care, The University of Texas Dell Medical School
| | | | | | | | - Lee Moroz
- Physical Medicine & Rehabilitation and
| | | | - George Tipton
- Orthopaedic Spine Surgery, Seton Spine & Rehabilitation; and
| | - Eeric Truumees
- Department of Surgery and Perioperative Care, The University of Texas Dell Medical School
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Marchand AA, O’Shaughnessy J, Châtillon CÉ, Sorra K, Descarreaux M. Current Practices in Lumbar Surgery Perioperative Rehabilitation: A Scoping Review. J Manipulative Physiol Ther 2016; 39:668-692. [DOI: 10.1016/j.jmpt.2016.08.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 07/14/2016] [Accepted: 08/11/2016] [Indexed: 10/20/2022]
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Kim BJ, Ahn J, Cho H, Kim D, Kim T, Yoon B. Rehabilitation with osteopathic manipulative treatment after lumbar disc surgery: A randomised, controlled pilot study. INT J OSTEOPATH MED 2015. [DOI: 10.1016/j.ijosm.2014.11.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Repositioning suture of the erector spinae muscle for lumbar spine surgery via the posterior approach: a prospective randomized study. Cell Biochem Biophys 2014; 69:75-80. [PMID: 25453117 DOI: 10.1007/s12013-013-9770-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
We prospectively studied the effectiveness of the repositioning suture of the erector spinae muscle for lumbar spine surgery using the posterior approach. 393 patients undergoing lumbar spine surgery were randomized to receive the repositioning or conventional suture of the erector spinae muscle. Time to stitch removal and drainage volume was recorded at 24 and 48 h after operation. Hemoglobin loss rate was determined at 48 h post operation and the rate of malunion (redness, swelling and effusion at stitch removal and would disruption after stitch removal) was recorded. Low back pain was evaluated using the visual analog scale (VAS) preoperatively and 6 and 12 months after operation. Time to stitch removal was comparable in lumbar spine surgery patients receiving the repositioning or conventional suture of the erector spinae muscle (P > 0.05). Compared with the conventional suture, the repositioning suture was associated with significantly reduced drainage volume both at 24 (P < 0.01) and 48 h after operation (P < 0.05). Hemoglobin loss rate at 48 h post operation was also markedly lower in lumbar spine surgery patients receiving the repositioning suture than in those receiving the conventional suture (P < 0.01 or 0.05). Furthermore, the malunion rate in lumbar spine surgery patients using the repositioning suture was markedly lower than that in the conventional group (P < 0.05 or 0.001). There was no difference in preoperative VAS scores in both the groups (P > 0.05). Compared with the conventional suture, the repositioning suture was associated with significantly reduced VAS scores both at 24 and 48 h after operation (P < 0.01 in both). The repositioning suture of the erector spinae muscle is superior to the conventional suture in posterior lumbar spine surgery with marked lessened pain and reduced drainage volume.
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Hall AM, Kamper SJ, Hernon M, Hughes K, Kelly G, Lonsdale C, Hurley DA, Ostelo R. Measurement tools for adherence to non-pharmacologic self-management treatment for chronic musculoskeletal conditions: a systematic review. Arch Phys Med Rehabil 2014; 96:552-62. [PMID: 25108098 DOI: 10.1016/j.apmr.2014.07.405] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Revised: 07/14/2014] [Accepted: 07/15/2014] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To identify measures of adherence to nonpharmacologic self-management treatments for chronic musculoskeletal (MSK) populations; and to report on the measurement properties of identified measures. DATA SOURCES Five databases were searched for all study types that included a chronic MSK population, unsupervised intervention, and measure of adherence. STUDY SELECTION Two independent researchers reviewed all titles for inclusion using the following criteria: adult (>18y) participants with a chronic MSK condition; intervention, including an unsupervised self-management component; and measure of adherence to the unsupervised self-management component. DATA EXTRACTION Descriptive data regarding populations, unsupervised components, and measures of unsupervised adherence (items, response options) were collected from each study by 1 researcher and checked by a second for accuracy. DATA SYNTHESIS No named or referenced adherence measurement tools were found, but a total of 47 self-invented measures were identified. No measure was used in more than a single study. Methods could be grouped into the following: home diaries (n=31), multi-item questionnaires (n=11), and single-item questionnaires (n=7). All measures varied in type of information requested and scoring method. The lack of established tools precluded quality assessment of the measurement properties using COnsensus-based Standards for the selection of health Measurement INstruments methodology. CONCLUSIONS Despite the importance of adherence to self-management interventions, measurement appears to be conducted on an ad hoc basis. It is clear that there is no consistency among adherence measurement tools and that the construct is ill-defined. This study alerts the research community to the gap in measuring adherence to self-care in a rigorous and reproducible manner. Therefore, we need to address this gap by using credible methods (eg, COnsensus-based Standards for the selection of health Measurement INstruments guidelines) to develop and evaluate an appropriate measure of adherence for self-management.
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Affiliation(s)
- Amanda M Hall
- School of Public Health, Physiotherapy and Population Science, University College Dublin, Dublin, Ireland.
| | - Steven J Kamper
- Musculoskeletal Division, George Institute for Global Health, Sydney, NSW, Australia; EMGO+ Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Marian Hernon
- School of Public Health, Physiotherapy and Population Science, University College Dublin, Dublin, Ireland
| | - Katie Hughes
- School of Public Health, Physiotherapy and Population Science, University College Dublin, Dublin, Ireland; Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
| | - Gráinne Kelly
- Department of Clinical Therapies, University of Limerick, Limerick, Ireland
| | - Chris Lonsdale
- Faculty of Health Sciences, Australian Catholic University, Sydney, NSW, Australia
| | - Deirdre A Hurley
- Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
| | - Raymond Ostelo
- EMGO+ Institute, VU University Medical Center, Amsterdam, The Netherlands
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Ten-year follow-up of strengthening versus flexibility exercises with or without abdominal bracing in recurrent low back pain. Spine (Phila Pa 1976) 2014; 39:997-1003. [PMID: 24732860 DOI: 10.1097/brs.0000000000000338] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Randomized prevention trial. OBJECTIVE To compare the long-term effect of strengthening versus flexibility exercises and to evaluate the additional effect of abdominal bracing in recurrent low back pain (LBP). SUMMARY OF BACKGROUND DATA No conclusions could be made regarding appropriate exercise types or parameters in recurrent LBP. Abdominal bracing increases trunk stiffness; however, its long-term effect has not been evaluated in recurrent LBP yet. METHODS Six hundred patients with recurrent LBP participated. They were randomized into 4 groups-150 patients (age: 42.5 ± 12.7) performed strengthening exercises; 150 patients (age: 41.3 ± 11.5) performed flexibility exercises; 150 patients (age: 41.0 ± 13.2) performed strengthening exercises and used abdominal bracing in daily activities/exercises; and 150 patients (age: 40.6 ± 12.3) performed flexibility exercises and used abdominal bracing in daily activities/exercises. At the beginning of the study and at the end of 10 consecutive years were recorded 6 outcomes-frequency, intensity, and duration of pain, as well as frequency, intensity, and duration of exercises. RESULTS Regarding the first 4 outcomes-all groups showed improvement from the beginning to the second year, but worsening from the second to the 10th year; there was no difference between strengthening and flexibility groups; bracing groups showed better results versus nonbracing groups. Intensity, frequency, and duration of the pain correlated with each other and with frequency of the exercises, but not with exercise duration or intensity. CONCLUSION The exercise frequency is more important than the type, duration, or intensity of the exercise. Abdominal bracing adds to the exercise effect. It could be considered as a "preliminary muscle back belt on demand" increasing the trunk stiffness and the frequency of the trunk muscle contractions/cocontractions without interruption of daily activities, which may remind/convince the patients to exercise more frequently. Frequent exercising and bracing seems effective long-term prevention advices in recurrent LBP. LEVEL OF EVIDENCE 2.
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Oosterhuis T, Costa LOP, Maher CG, de Vet HCW, van Tulder MW, Ostelo RWJG. Rehabilitation after lumbar disc surgery. Cochrane Database Syst Rev 2014; 2014:CD003007. [PMID: 24627325 PMCID: PMC7138272 DOI: 10.1002/14651858.cd003007.pub3] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Several rehabilitation programmes are available for individuals after lumbar disc surgery. OBJECTIVES To determine whether active rehabilitation after lumbar disc surgery is more effective than no treatment, and to describe which type of active rehabilitation is most effective. This is the second update of a Cochrane Review first published in 2002.First, we clustered treatments according to the start of treatment.1. Active rehabilitation that starts immediately postsurgery.2. Active rehabilitation that starts four to six weeks postsurgery.3. Active rehabilitation that starts longer than 12 months postsurgery.For every cluster, the following comparisons were investigated.A. Active rehabilitation versus no treatment, placebo or waiting list control.B. Active rehabilitation versus other kinds of active rehabilitation.C. Specific intervention in addition to active rehabilitation versus active rehabilitation alone. SEARCH METHODS We searched CENTRAL (2013, Issue 4) and MEDLINE, EMBASE, CINAHL, PEDro and PsycINFO to May 2013. SELECTION CRITERIA We included only randomised controlled trials (RCTs). DATA COLLECTION AND ANALYSIS Pairs of review authors independently assessed studies for eligibility and risk of bias. Meta-analyses were performed if studies were clinically homogeneous. The GRADE approach was used to determine the overall quality of evidence. MAIN RESULTS In this update, we identified eight new studies, thereby including a total of 22 trials (2503 participants), 10 of which had a low risk of bias. Most rehabilitation programmes were assessed in only one study. Both men and women were included, and overall mean age was 41.4 years. All participants had received standard discectomy, microdiscectomy and in one study standard laminectomy and (micro)discectomy. Mean duration of the rehabilitation intervention was 12 weeks; eight studies assessed six to eight-week exercise programmes, and eight studies assessed 12 to 13-week exercise programmes. Programmes were provided in primary and secondary care facilities and were started immediately after surgery (n = 4) or four to six weeks (n = 16) or one year after surgery (n = 2). In general, the overall quality of the evidence is low to very low. Rehabilitation programmes that started immediately after surgery were not more effective than their control interventions, which included exercise. Low- to very low-quality evidence suggests that there were no differences between specific rehabilitation programmes (multidisciplinary care, behavioural graded activity, strength and stretching) that started four to six weeks postsurgery and their comparators, which included some form of exercise. Low-quality evidence shows that physiotherapy from four to six weeks postsurgery onward led to better function than no treatment or education only, and that multidisciplinary rehabilitation co-ordinated by medical advisors led to faster return to work than usual care. Statistical pooling was performed only for three comparisons in which the rehabilitation programmes started four to six weeks postsurgery: exercise programmes versus no treatment, high- versus low-intensity exercise programmes and supervised versus home exercise programmes. Very low-quality evidence (five RCTs, N = 272) shows that exercises are more effective than no treatment for pain at short-term follow-up (standard mean difference (SMD) -0.90; 95% confidence interval (CI) -1.55 to -0.24), and low-quality evidence (four RCTs, N = 252) suggests that exercises are more effective for functional status on short-term follow-up (SMD -0.67; 95% CI -1.22 to -0.12) and that no difference in functional status was noted on long-term follow-up (three RCTs, N = 226; SMD -0.22; 95% CI -0.49 to 0.04). None of these studies reported that exercise increased the reoperation rate. Very low-quality evidence (two RCTs, N = 103) shows that high-intensity exercise programmes are more effective than low-intensity exercise programmes for pain in the short term (weighted mean difference (WMD) -10.67; 95% CI -17.04 to -4.30), and low-quality evidence (two RCTs, N = 103) shows that they are more effective for functional status in the short term (SMD -0.77; 95% CI -1.17 to -0.36). Very low-quality evidence (four RCTs, N = 154) suggests no significant differences between supervised and home exercise programmes for short-term pain relief (SMD -0.76; 95% CI -2.04 to 0.53) or functional status (four RCTs, N = 154; SMD -0.36; 95% CI -0.88 to 0.15). AUTHORS' CONCLUSIONS Considerable variation was noted in the content, duration and intensity of the rehabilitation programmes included in this review, and for none of them was high- or moderate-quality evidence identified. Exercise programmes starting four to six weeks postsurgery seem to lead to a faster decrease in pain and disability than no treatment, with small to medium effect sizes, and high-intensity exercise programmes seem to lead to a slightly faster decrease in pain and disability than is seen with low-intensity programmes, but the overall quality of the evidence is only low to very low. No significant differences were noted between supervised and home exercise programmes for pain relief, disability or global perceived effect. None of the trials reported an increase in reoperation rate after first-time lumbar surgery. High-quality randomised controlled trials are strongly needed.
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Affiliation(s)
- Teddy Oosterhuis
- VU UniversityDepartment of Health Sciences, Faculty of Earth and Life SciencesDe Boelelaan 1085AmsterdamNetherlands1081 HV
| | - Leonardo OP Costa
- Universidade Cidade de São PauloMasters in Physical TherapyRua Cesário Galeno 448São PauloBrazil03071‐000
| | - Christopher G Maher
- University of SydneyThe George Institute for Global HealthLevel 7, 341 George StSydneyNSWAustralia2000
| | - Henrica CW de Vet
- VU University Medical CenterDepartment of Epidemiology and Biostatistics, EMGO Institute for Health and Care ResearchPO Box 7057AmsterdamNetherlands1007 MB
| | - Maurits W van Tulder
- VU UniversityDepartment of Health Sciences, Faculty of Earth and Life SciencesDe Boelelaan 1085AmsterdamNetherlands1081 HV
| | - Raymond WJG Ostelo
- VU UniversityDepartment of Health Sciences, EMGO Institute for Health and Care ResearchPO Box 7057AmsterdamNetherlands1007 MB
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An evaluation of a postoperative rehabilitation program after spinal surgery and its impact on outcome. Spine (Phila Pa 1976) 2012; 37:E417-22. [PMID: 22024898 DOI: 10.1097/brs.0b013e31823b00b2] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN This study invited patients to evaluate the content and style of a rehabilitation program used as an intervention in a multicenter, factorial, randomized controlled trial of the postoperative management of spinal surgery patients. OBJECTIVE To determine the acceptability and content of the rehabilitation program. SUMMARY OF BACKGROUND DATA The use of rehabilitation after spinal surgery is sporadic, and the evidence for its benefit is mixed. A randomized controlled trial was conducted to determine whether functional outcome of spinal surgery could be improved by a postoperative rehabilitation program and/or an educational booklet provided at hospital discharge, each compared with usual care. METHODS Patients randomized to postoperative rehabilitation began the course 6 weeks after surgery. At the end of the course of 12 classes, patients completed an evaluation of content, style, and length using forced choice and open questions. Patients not attending the final class completed the evaluation at their 3-month review. RESULTS Compliance with rehabilitation was poor, with 41% of subjects failing to attend any classes and 16% attending less than half. Compliance with the evaluation was 100% for the 105 patients attending 1 or more classes. The length, content, and approach to the classes were rated positively, and patients gave the class a median rating of 9 of 10, range 5 to 10, with 91% rating the classes as 7 or above. CONCLUSION Compliance with a postoperative rehabilitation program was disappointing, but the program was assessed positively and of benefit by those who attended. Issues were raised in relation to timing and location of classes.
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Kim IH, Kim JH, Lee JU, Kim MY, Kim B, Kim J. The Effect of an Early Lumbar Exercise Program on Trunk Strength and the Oswestry Disability Index after Herniated Nucleus Pulposus Surgery. J Phys Ther Sci 2012. [DOI: 10.1589/jpts.24.165] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Il-Hyun Kim
- Graduate School of Rehabilitation & Health Science, Doctoral Course, Yongin University
| | - Ju-Hyun Kim
- Graduate School of Rehabilitation & Health Science, Doctoral Course, Yongin University
| | - Jeong-Uk Lee
- Graduate School of Rehabilitation & Health Science, Doctoral Course, Yongin University
| | - Mee-Young Kim
- Graduate School of Rehabilitation & Health Science, Doctoral Course, Yongin University
| | - Bokyung Kim
- Department of Physiology, Institute of Functional Genomics, School of Medicine, Konkuk University
| | - Junghwan Kim
- Department of Physical Therapy, College of Public Health & Welfare Yongin University
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ISSLS prize winner: Function After Spinal Treatment, Exercise, and Rehabilitation (FASTER): a factorial randomized trial to determine whether the functional outcome of spinal surgery can be improved. Spine (Phila Pa 1976) 2011; 36:1711-20. [PMID: 21378603 DOI: 10.1097/brs.0b013e318214e3e6] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN This was a multicenter, factorial, randomized, controlled trial on the postoperative management of spinal surgery patients, with randomization stratified by surgeon and operative procedure. OBJECTIVE This study sought to determine whether the functional outcome of two common spinal operations could be improved by a program of postoperative rehabilitation that combines professional support and advice with graded active exercise commencing 6 weeks after surgery and/or an educational booklet based on evidence-based messages and advice received at discharge from hospital, each compared with usual care. SUMMARY OF BACKGROUND DATA Surgical interventions on the spine are increasing, and while surgery for spinal stenosis and disc prolapse have been shown to be superior to conservative management, functional outcome, and patient satisfaction are not optimal. METHODS The study compared the effectiveness of a rehabilitation program and an education booklet for the postoperative management of patients undergoing discectomy or lateral nerve root decompression surgery, each compared with "usual care" using a 2 × 2 factorial design, randomizing patient to four groups; rehabilitation-only, booklet-only, rehabilitation-plus-booklet, and usual care only. The primary outcome measure was the Oswestry Disability Index (ODI) at 12 months, with secondary outcomes including visual analog scale measures of back and leg pain. RESULTS Three hundred thirty-eight patients were recruited into the study and measurements were obtained preoperatively and then repeated at 6 weeks, 3, 6, 9 and 12 months postoperatively. Twelve months postoperatively the observed effect of rehabilitation on ODI was -2.7 (95% CI: -6.8 to 1.5) and the effect of booklet was 2.7 (95% CI: -1.5 to 6.9). CONCLUSION This study found that neither intervention had a significant impact on long-term outcome.
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Physiotherapy rehabilitation post first lumbar discectomy: a systematic review and meta-analysis of randomized controlled trials. Spine (Phila Pa 1976) 2011; 36:E961-72. [PMID: 21224754 DOI: 10.1097/brs.0b013e3181f0e8f8] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
STUDY DESIGN Systematic review and meta-analysis. OBJECTIVE To evaluate effectiveness of physiotherapy intervention in patients post first lumbar discectomy on clinically relevant outcomes short (3 months) and longer term (12 months). SUMMARY OF BACKGROUND DATA Physiotherapy intervention is recommended post discectomy, although the most beneficial intervention and the effectiveness of physiotherapy management is unclear. METHODS Randomized Controlled Trials (RCTs) published in English before December 31, 2009 investigating physiotherapy outpatient management of patients (>16 years), post first single level lumbar discectomy were included. Measurements reported on ≥1 outcome of disability, function, and health were included. Two reviewers independently searched information sources, assessed studies for inclusion, and evaluated risk of bias. Quantitative synthesis was conducted on comparable outcomes across studies with similar interventions and no clearly identified overall risk of bias. RESULTS Sixteen RCTs (1336 participants) from 11 countries were included. Interventions were categorized as intervention versus control/sham, and less versus more intensive comparisons. Eight of 16 trials were evaluated as high risk of bias, 7 as unclear and 1 as low. Six hundred and thirty-five participants were incorporated in the meta-analysis on eight trials. Although evidence from two trials suggested that intervention might reduce disability short-term, and more intensive intervention may be more beneficial than less intensive, the pooled effects (-0.89, 95% CI -1.84 to 0.06 for intervention vs. control/sham; -0.27, 95% CI -0.80 to 0.25 for more vs. less intensive) did not show statistically significant effects. There was no evidence that intervention changes range of movement flexion (ROM) or overall impairment short term, or disability or back pain longer term. There was no evidence that intensity of intervention affects back pain short or longer term, ROM short term, or patients' satisfaction with outcome longer term. Substantial heterogeneity was evident. CONCLUSION Inconclusive evidence exists for the effectiveness of outpatient physiotherapy post first lumbar discectomy. Best practice remains unclear.
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Puppin MAFL, Marques AP, Silva AGD, Futuro Neto HDA. Alongamento muscular na dor lombar crônica inespecífica: uma estratégia do método GDS. FISIOTERAPIA E PESQUISA 2011. [DOI: 10.1590/s1809-29502011000200003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
O objetivo deste estudo foi verificar a eficácia do alongamento muscular, usando uma sequência proposta pelo Método Godelieve Denys-Struyf (GDS) na redução da dor, na incapacidade funcional, no aumento da flexibilidade global e na capacidade de contração do músculo transverso do abdome (TrA), em indivíduos com dor lombar crônica inespecífica. Participaram 55 pacientes, de 18 a 60 anos, divididos em dois grupos: Grupo Alongamento (n=30) submetido a exercícios de alongamento, duas vezes por semana, e Grupo Controle (n=25) que não realizou tratamento. A dor foi avaliada pela escala visual analógica; a incapacidade funcional, pelo Índice de Oswestry; a flexibilidade global, pelo terceiro dedo ao solo; e a capacidade de contração do TrA, pela unidade de biofeedback pressórico. Foram realizadas três avaliações, inicial, após 8 e 16 semanas da inicial. Foi considerado nível de significância de α<0,05. Os resultados mostram que o Grupo Alongamento apresentou diminuição na dor, incapacidade funcional e aumentou a flexibilidade global (p<0,001) após 8 e 16 semanas (p<0,05), porém não melhorou a capacidade de contração do TrA (p=0,13). A sequência de alongamentos usada no método GDS mostra-se eficaz na redução da dor, incapacidade funcional e melhora da flexibilidade global em pacientes com dor lombar crônica inespecífica.
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Postoperative rehabilitation following lumbar discectomy with quantification of trunk muscle morphology and function: a case report and review of the literature. J Orthop Sports Phys Ther 2010; 40:402-12. [PMID: 20592478 DOI: 10.2519/jospt.2010.3332] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN A case report and literature review. BACKGROUND Optimizing clinical outcomes following lumbar disc surgery is a research priority; however, relatively little attention has been paid to the postoperative management of this population. The transversus abdominis and lumbar multifidus (LM) muscles appear to play a unique role in lumbar spine stability, and may relate to clinical outcome following lumbar disc surgery. The purpose of this case report was to describe the preoperative LM morphology, clinical outcome, and change in transversus abdominis and LM muscle activation in a patient following lumbar disc surgery and motor control exercise initiated in the early postoperative period. CASE DESCRIPTION A 29-year-old female underwent an 8-week postoperative rehabilitation program emphasizing motor control exercises to restore trunk muscle function 10 days following lumbar disc surgery. OUTCOMES The patient experienced clinically important improvements in pain and disability following the postoperative rehabilitation program. Substantial improvements in muscle activation were observed of the transversus abdominis and the LM at the L4-5 level. Minimal change in LM activation and a higher proportion of intramuscular fat was observed at the L5-S1 level. DISCUSSION This case report represents limited evidence regarding the feasibility of instituting a rehabilitation program in the early postoperative period following lumbar disc surgery. Improvements in clinical status and muscle function were observed, and a differential change in muscle activation between the L4-5 and L5-S1 levels was noted. The literature regarding rehabilitation following lumbar disc surgery, as well as the neuromuscular changes observed in this population, was reviewed. Additionally, a novel method of examining LM morphology was described and suggestions were made for directions of future research. LEVEL OF EVIDENCE Therapy, level 4.
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McGregor AH, Doré CJ, Morris TP, Morris S, Jamrozik K. Function after spinal treatment, exercise and rehabilitation (FASTER): improving the functional outcome of spinal surgery. BMC Musculoskelet Disord 2010; 11:17. [PMID: 20102625 PMCID: PMC2823667 DOI: 10.1186/1471-2474-11-17] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2010] [Accepted: 01/26/2010] [Indexed: 11/21/2022] Open
Abstract
Background The life-time incidence of low back pain is high and diagnoses of spinal stenosis and disc prolapse are increasing. Consequently, there is a steady rise in surgical interventions for these conditions. Current evidence suggests that while the success of surgery is incomplete, it is superior to conservative interventions. A recent survey indicates that there are large differences in the type and intensity of rehabilitation, if any, provided after spinal surgery as well as in the restrictions and advice given to patients in the post-operative period. This trial will test the hypothesis that functional outcome following two common spinal operations can be improved by a programme of post-operative rehabilitation that combines professional support and advice with graded active exercise and/or an educational booklet based on evidence-based messages and advice. Methods/Design The study design is a multi-centre, factorial, randomised controlled trial with patients stratified by surgeon and operative procedure. The trial will compare the effectiveness and cost-effectiveness of a rehabilitation programme and an education booklet for the postoperative management of patients undergoing discectomy or lateral nerve root decompression, each compared with "usual care"using a 2 × 2 factorial design. The trial will create 4 sub-groups; rehabilitation-only, booklet-only, rehabilitation-plus-booklet, and usual care only. The trial aims to recruit 344 patients, which equates to 86 patients in each of the four sub-groups. All patients will be assessed for functional ability (through the Oswestry Disability Index - a disease specific functional questionnaire), pain (using visual analogue scales), and satisfaction pre-operatively and then at 6 weeks, 3, 6 and 9 months and 1 year post-operatively. This will be complemented by a formal analysis of cost-effectiveness. Discussion This trial will determine whether the outcome of spinal surgery can be enhanced by either a post-operative rehabilitation programme or an evidence-based advice booklet or a combination of the two and as such will contribute to our knowledge on how to manage spinal surgery patients in the post-operative period. Trial Registration Current controlled trials ISRCTN46782945 UK CRN ID: 2670
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Affiliation(s)
- A H McGregor
- Surgery & Cancer, Faculty of Medicine, Imperial College London, Charing Cross Hospital Campus, London W6 8RP, UK.
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Newsome RJ, May S, Chiverton N, Cole AA. A prospective, randomised trial of immediate exercise following lumbar microdiscectomy: a preliminary study. Physiotherapy 2009; 95:273-9. [PMID: 19892091 DOI: 10.1016/j.physio.2009.06.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2008] [Accepted: 06/16/2009] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To investigate whether immediate commencement of exercises after lumbar microdiscectomy enabled patients to become independently mobile more rapidly with no increase in risk of complications. STUDY DESIGN Randomised, single-blind, controlled trial. SETTING One secondary care teaching hospital in the UK. PARTICIPANTS Thirty patients were recruited. The follow-up rate was 28 (93%) at 4 weeks and 23 (77%) at 3 months. INTERVENTIONS Patients were randomised to an intervention group commencing exercises within 2 hours after surgery, or a control group commencing exercises on the first postoperative day. MAIN OUTCOME MEASURES Primary outcome measures included the time taken for the patient to become independently mobile and attain discharge criteria following surgery. Secondary outcome measures were disability and pain scores collected before surgery, and 4 weeks and 3 months after surgery; and return to work rates. RESULTS The two groups were similar at baseline. The results indicated significantly reduced time to independent mobility [median 7 vs 19 hours, median difference 9 hours, 95% confidence interval (CI) 1.25 to 14.5, P=0.009] and return to work (median 6 vs 8 weeks, median difference 2 weeks, 95% CI 0 to 6, P=0.002) in the intervention group compared with the control group. At 15 hours after surgery, independent mobility was attained in 80 and 40% of the intervention and control groups, respectively. There were no significant differences in disability and pain scores at 4 weeks and 3 months. CONCLUSIONS Immediate commencement of exercises following first-time single-level lumbar microdiscectomy enabled patients to become independently mobile more rapidly and return to work sooner. Immediate commencement of exercises may enable patients to be discharged earlier, with associated cost benefits to health care and no increase in the rate of revision surgery.
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Affiliation(s)
- R J Newsome
- Sheffield Teaching Hospitals, Physiotherapy Department, Sheffield, UK
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25
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Abstract
STUDY DESIGN Cochrane systematic review of randomized controlled trials. OBJECTIVE To evaluate the effects of active rehabilitation for adults after first-time lumbar disc surgery. SUMMARY OF BACKGROUND DATA Several rehabilitation programs are available for individuals after lumbar disc surgery, however, little is known about the efficacy of these treatments. METHODS Search strategies were performed on CENTRAL (The Cochrane Library 2007, Issue 2) and MEDLINE, EMBASE, CINAHL, and PsycINFO up to May 2007. All randomized controlled trials without language limitations were included. Pairs of review authors independently assessed studies for eligibility and risk of bias. A meta-analysis was performed with clinically homogeneous studies. The GRADE approach was used to determine the quality of evidence. RESULTS Fourteen studies were included, 7 of which had a low risk of bias. Most programs were only assessed in 1 study. Statistical pooling was only completed for 3 comparisons in which exercises started 4 to 6 weeks postsurgery: exercise programs versus no treatment, high versus low intensity exercise programs, and supervised versus home exercises. We found low quality evidence (3 randomized controlled trials [RCTs], N = 122) that exercises are more effective than no treatment for pain at short-term follow-up (weighted mean difference [WMD]:-11.13; 95% CI: -18.44 to -3.82) and moderate evidence (2 RCTs, N = 102) that exercises are more effective for functional status on short-term follow-up (WMD: -6.50; 95% CI: -9.26 to -3.74). None of the studies reported that exercises increased the reoperation rate. We also found low quality evidence (2 RCTs, N = 103) that high intensity exercises are slightly more effective than low intensity exercise programs for pain in the short-term (WMD: -10.67; 95% CI: -17.04 to -4.30) and moderate evidence (2 RCTs, N = 103) that they are more effective for functional status in the short-term (standardized mean difference [SMD] -0.77; 95% CI: -1.17 to -0.36). Finally, we found low quality evidence (3 RCTs, N = 95) that there were no significant differences between supervised and home exercises for short-term pain relief (SMD: -1.12; 95% CI: -2.77-0.53) or functional status (3 RCT, N = 95; SMD -1.17; 95% CI: -2.63-0.28). CONCLUSION Exercise programs starting 4 to 6 weeks postsurgery seem to lead to a faster decrease in pain and disability than no treatment. High intensity exercise programs seem to lead to a faster decrease in pain and disability than low intensity programs. There were no significant differences between supervised and home exercises for pain relief, disability, or global perceived effect. There is no evidence that active programs increase the reoperation rate after first-time lumbar surgery.
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Johansson AC, Linton SJ, Bergkvist L, Nilsson O, Cornefjord M. Clinic-based training in comparison to home-based training after first-time lumbar disc surgery: a randomised controlled trial. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2009; 18:398-409. [PMID: 19020904 PMCID: PMC2899417 DOI: 10.1007/s00586-008-0826-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2008] [Revised: 10/16/2008] [Accepted: 10/28/2008] [Indexed: 10/21/2022]
Abstract
The effectiveness of physiotherapy after first-time lumbar disc surgery is still largely unknown. Studies in this field are heterogeneous and behavioural treatment principles have only been evaluated in one earlier study. The aim of this randomised study was to compare clinic-based physiotherapy with a behavioural approach to a home-based training programme regarding back disability, activity level, behavioural aspects, pain and global health measures. A total of 59 lumbar disc patients without any previous spine surgery or comorbidity participated in the study. Clinic-based physiotherapy with a behavioural approach was compared to home-based training 3 and 12 months after surgery. Additionally, the home training group was followed up 3 months after surgery by a structured telephone interview evaluating adherence to the exercise programme. Outcome measures were: Oswestry Disability Index (ODI), physical activity level, kinesiophobia, coping, pain, quality of life and patient satisfaction. Treatment compliance was high in both groups. There were no differences between the two groups regarding back pain disability measured by ODI 3 and 12 months after surgery. However, back pain reduction and increase in quality of life were significantly higher in the home-based training group. The patients in the clinic-based training group had significantly higher activity levels 12 months after surgery and were significantly more satisfied with physiotherapy care 3 months after surgery compared to the home-based training group. Rehabilitation after first-time lumbar disc surgery can be based on home training as long as the patients receive both careful instructions from a physiotherapist and strategies for active pain coping, and have access to the physiotherapist if questions regarding training arise. This might be a convenient treatment arrangement for most patients.
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Affiliation(s)
- Ann-Christin Johansson
- Department of Orthopaedic Surgery, Center for Clinical Research, Central Hospital, Uppsala University, 721 89, Västerås, Sweden.
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27
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Abstract
BACKGROUND Several rehabilitation programs are available for individuals after lumbar disc surgery. OBJECTIVES To evaluate the effects of active rehabilitation for adults after first-time lumbar disc surgery. SEARCH STRATEGY We searched CENTRAL (The Cochrane Library 2007, Issue 2) and MEDLINE, EMBASE, CINAHL and PsycINFO to May 2007. SELECTION CRITERIA We only included randomised controlled trials (RCTs). DATA COLLECTION AND ANALYSIS Pairs of review authors independently assessed studies for eligibility and risk of bias. A meta-analysis was performed with clinically homogeneous studies. The GRADE approach was used to determine the quality of evidence. MAIN RESULTS Fourteen studies were included, seven of which had a low risk of bias. Most programs were only assessed in one study. Statistical pooling was only completed for three comparisons in which exercises were started four to six weeks post-surgery: exercise programs versus no treatment, high versus low intensity exercise programs, and supervised versus home exercises.There is low quality evidence (three RCTS, N = 156) that exercises are more effective than no treatment for pain at short-term follow-up (WMD -11.13; 95% CI -18.44 to -3.82) and moderate evidence (two RCTs, N = 136) that they are more effective for functional status on short-term follow-up (WMD -6.50; 95% CI -9.26 to -3.74). None of the studies reported that exercises increased the re-operation rate.There is low quality evidence (two RCTs, N =103) that high intensity are slightly more effective than low intensity exercise programs for pain in the short term (WMD -10.67; 95% CI -17.04 to -4.30) and moderate evidence (two RCTs, N = 103) that they are more effective for functional status in the short term (SMD -0.77; 95% CI -1.17 to -0.36).There is low quality evidence (three RCTS, N = 95) that there were no significant differences between supervised and home exercises for short-term pain relief (SMD -1.12; 95% CI -2.77 to 0.53) or functional status (three RCTs, N = 88; SMD -1.18; 95% CI -2.63 to 0.26). AUTHORS' CONCLUSIONS Exercise programs starting four to six weeks post-surgery seem to lead to a faster decrease in pain and disability than no treatment. High intensity exercise programs seem to lead to a faster decrease in pain and disability than low intensity programs. There were no significant differences between supervised and home exercises for pain relief, disability, or global perceived effect. There is no evidence that active programs increase the re-operation rate after first-time lumbar surgery.
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Affiliation(s)
- Raymond W J G Ostelo
- EMGO Institute - Institute for Health Sciences, Department of Health Sciences - VU University; VU University Medical Centre, Van der Boechorststraat 7, Amsterdam, Netherlands, 1081 BT.
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28
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Erdogmus CB, Resch KL, Sabitzer R, Müller H, Nuhr M, Schöggl A, Posch M, Osterode W, Ungersböck K, Ebenbichler GR. Physiotherapy-based rehabilitation following disc herniation operation: results of a randomized clinical trial. Spine (Phila Pa 1976) 2007; 32:2041-9. [PMID: 17762803 DOI: 10.1097/brs.0b013e318145a386] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Three-group, randomized, single blinded, controlled trial. OBJECTIVE To test the effectiveness of physiotherapy-based rehabilitation starting 1 week after lumbar disc surgery. In addition, we tried to estimate the contribution of specific effects to the observed outcome (efficacy). SUMMARY OF BACKGROUND DATA Physiotherapy-based rehabilitation is usually recommended for patients following lumbar disc surgery. Few and conflicting data exist for the relative effectiveness of this intervention. METHODS A total of 120 patients following first-time, uncomplicated lumbar disc surgery were randomly assigned to "comprehensive" physiotherapy, "sham" neck massage, or no therapy. Before enrollment, all subjects completed a minimal physiotherapeutic intervention. Physiotherapy was administered by experienced physiotherapists and consisted of 20 sessions per patient over 12 weeks. Masseurs administered "sham massage" to the neck. The amount of treatment time was equal to that of physiotherapy. The main outcome measure was the Low Back Pain Rating Score (LBPRS) at 6 and 12 weeks, and 1.5 years after randomization. Secondary parameters were patients' overall satisfaction with treatment outcome and socioeconomic and psychologic measures. RESULTS At the end of therapy (12 weeks), the LBPRS revealed a significantly better improvement in the physiotherapy group than in the untreated group. LBPRS outcome, however, did not significantly differ between physiotherapy and "sham" therapy. There was a tendency toward significance between the sham therapy and no therapy. Within the 1.5-year follow-up, LBP rating scales remained significantly improved compared with baseline, but there were no significant outcome differences. No statistically significant between-group differences were found for the secondary outcome parameters. CONCLUSION As compared with no therapy, physiotherapy following first-time disc herniation operation is effective in the short-term. Because of the limited benefits of physiotherapy relative to "sham" therapy, it is open to question whether this treatment acts primarily physiologically in patients following first-time lumbar disc surgery, but psychological factors may contribute substantially to the benefits observed.
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Affiliation(s)
- Celal B Erdogmus
- Department of Physical Medicine & Rehabilitation, Vienna Medical University, Vienna, Austria
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29
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Unloaded movement facilitation exercise compared to no exercise or alternative therapy on outcomes for people with nonspecific chronic low back pain: a systematic review. J Manipulative Physiol Ther 2007; 30:301-11. [PMID: 17509439 DOI: 10.1016/j.jmpt.2007.03.010] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2006] [Revised: 01/01/2007] [Accepted: 02/20/2007] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The purpose of this study was to determine the effect of unloaded movement facilitation exercises on outcomes for people with nonspecific chronic low back pain (NSCLBP). METHODS This systematic review was conducted according to Cochrane Back Review Group and Quality of Reporting of Meta-analyses (QUORUM) guidelines. Exercise effects were reported as standardized mean difference (SMD) with 95% confidence intervals (95% CI). RESULTS Six high-quality randomized controlled trials were included. For NSCLBP effects favored McKenzie therapy over intensive trunk strengthening for pain: SMD: short-term: 0.35 (0.10, 0.59); long-term 0.36 (0.12, 0.61) and short-term function: SMD: 0.45 (0.20, 0.70) and were comparable for medium-term function: SMD: 0.15 (-0.90, 0.40). Effects of favored McKenzie therapy were comparable to specific spinal stabilization exercises for short-term pain: SMD: 0.63 (-0.11, 1.38) and function: SMD: 0.47 (-0.27, 1.20). Pooled effects favored McKenzie therapy over other exercises for short-term pain (pooled SMD: 0.38 (0.14, 0.61)) and were comparable for short-term function: SMD: 0.10 (-0.20, 0.40). Yoga compared to trunk strengthening produced comparable effects for pain: (SMD: short-term: 0.13 (-0.46, 0.71); medium-term 0.51 (-0.08, 1.11)) and function SMD: short-term: 0.51 (-0.08, 1.10); medium-term 0.38 (-0.22, 0.97)). Compared to education, effects of yoga were large for medium-term pain and function (pooled SMDs: 0.92 (0.47, 1.37); 0.95 (0.50, 1.40)). Effects favored unloaded movement facilitation exercises of McKenzie compared to other or no exercise and were comparable for yoga. CONCLUSIONS For NSCLBP, there is strong evidence that unloaded movement facilitation exercise, compared to no exercise, improves pain and function. Compared to other types of exercise, including effort-intensive strengthening and time-intensive stabilization exercise, the effects are comparable. This challenges the role of strengthening for NSCLBP.
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McGregor AH, Burton AK, Sell P, Waddell G. The development of an evidence-based patient booklet for patients undergoing lumbar discectomy and un-instrumented decompression. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2007; 16:339-46. [PMID: 16688473 PMCID: PMC2200695 DOI: 10.1007/s00586-006-0141-9] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2005] [Revised: 03/14/2006] [Accepted: 04/23/2006] [Indexed: 10/24/2022]
Abstract
Post-operative management after lumbar surgery is inconsistent leading to uncertainty amongst surgeons and patients about post-operative restrictions, reactivation, and return to work. This study aimed to review the evidence on post-operative management, with a view to developing evidence-based messages for a patient booklet on post-operative management after lumbar discectomy or un-instrumented decompression. A systematic literature search produced a best-evidence synthesis of information and advice on post-operative restrictions, activation, rehabilitation, and expectations about outcomes. Evidence statements were extracted and developed into patient-centred messages for an educational booklet. The draft text was evaluated by peer and patient review. The literature review found little evidence for post-operative activity restrictions, and a strong case for an early active approach to post-operative management. The booklet was built around key messages derived from the literature review and aimed to reduce uncertainty, promote positive beliefs, encourage early reactivation, and provide practical advice on self-management. Feedback from the evaluations were favourable from both review groups, suggesting that this evidence-based approach to management is acceptable and it has clinical potential.
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Affiliation(s)
- A H McGregor
- Biosurgery and Surgical Technology, Faculty of Medicine, Imperial College London, Charing Cross Hospital Campus, London W6 8RF, UK.
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