Abstract
Background and objectives: Lumbar spine surgery may be considered if pharmacologic, rehabilitation and interventional approaches cannot provide sufficient recovery from low back-related pain. Postoperative physiotherapy treatment in England is often accompanied by patient information leaflets, which contain important rehabilitation advice. However, in order to be an effective instrument for patients, the information provided in these leaflets must be up to date and based on the best available evidence and clinical practice. This study aims to critically analyse the current postoperative aspects of rehabilitation (exercise prescription and return to normal activity) that are provided in patient information leaflets in England as part of an evaluation of current practice following lumbar spine surgery. Materials and Methods: Patient information leaflets from English National Health Service (NHS) hospitals performing lumbar spine surgery were sourced online. A content analysis was conducted to collect data on postoperative exercise prescription and return to normal activities. Results: Thirty-two patient information leaflets on lumbar surgery were sourced (fusion, n = 11; decompression, n = 15; all lumbar procedures, n = 6). Many of the exercises prescribed within the leaflets were not based on evidence of clinical best practice and lacked a relationship to functional activity. Return to normal activity advice was also wide ranging, with considerable variation in the recommendations and definitions provided. Conclusions: This study highlights a clear variation in the recommendations of exercise prescription, dosage and returning to normal activities following lumbar spine surgery. Future work should focus on providing a consistent and patient-centred approach to recovery.
Highlights
Low back pain continues to be ranked as the leading cause of years lived with disability in the world [1] and radicular leg pain has been reported to have a lifetime incidence between 13 and 40% [2].The treatments for patients with low back pain and/or sciatica include pharmacologic, rehabilitation and interventional approaches
This study highlights a clear variation in the recommendations of exercise prescription, dosage and returning to normal activities following lumbar spine surgery
Thirty-two patient information leaflets were sourced from English National Health Service (NHS) hospitals or trusts (Supplementary Materials Table S1)
Summary
Low back pain continues to be ranked as the leading cause of years lived with disability in the world [1] and radicular leg pain has been reported to have a lifetime incidence between 13 and 40% [2].The treatments for patients with low back pain and/or sciatica include pharmacologic, rehabilitation and interventional (injection therapy) approaches. Perioperative physiotherapy has been reported as inconsistent [5], with no uniformity regarding advice on activities of daily living, and a lack of structured outcome evaluation [6] The reason for this inconsistency may be due to the complex multidimensional nature of low back-related pain that encompasses a bio-psychosocial context, and as such there is limited evidence to support the effectiveness of one particular rehabilitation intervention over another [7,8]. This study aims to critically analyse the current postoperative aspects of rehabilitation (exercise prescription and return to normal activity) that are provided in patient information leaflets in England as part of an evaluation of current practice following lumbar spine surgery. A content analysis was conducted to collect data on postoperative exercise prescription and return to normal activities
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