Characteristics of joint movement during the motion of rising from a supine position

Abstract

Purpose: To evaluate the effects of active rehabilitation for adults after first-time lumbar disc surgery. Methods:This is the second update of a Cochrane Review first published in 2002. CENTRAL, MEDLINE, EMBASE, CINAHL, PsycINFO and PEDrowere searched toMay 2013. Only randomised controlled trials (RCTs) 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:Twenty-two studieswere included, 10 low risk of bias. There is very low quality evidence (five RCTs,N= 272) that exercises are more effective than no treatment for pain at short-term follow-up (SMD−0.90; 95%CI−1.55 to−0.24), low quality evidence (four RCTs,N= 252) that they are more effective for functional status on short-term follow-up (SMD −0.67; 95% CI-1.22 to −0.04) and that there is no difference in functional status on long-term follow-up (threeRCTs, N= 226). There is very low quality evidence (two RCTs, N= 103) that high intensity exercises are more effective than low intensity exercises for pain in the short term (WMD −10.67; 95% CI−17.04 to−4.30) and low quality 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 very low quality evidence (four RCTs, N= 154) that there were no significant differences between supervised and home exercises for short-term pain relief or functional status. Conclusion(s): Considerable variation was noted in the content, duration and intensity of the rehabilitation programs included in this review. Despite the fact that we found no strong evidence for any of the comparisons, we were still able to reach some conclusions. Exercise programs starting 4-6 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 slightly faster decrease in pain and disability than low-intensity programs. There were no significant differences between supervised and home exercises for pain relief or disability. Implications: Exercise programs starting 4-6 weeks post-surgery may be used to decrease pain and disability. High-intensity exercise programsmay lead to a slightly faster decrease in pain and disability than low-intensity programs.