Abstract
The aim of this study was to compare two physiotherapy interventions following lumber disc surgery regarding effect on pain, functioning and fear of movement. This study is a prospective randomized controlled study. When admitted to hospital for first time lumbar disc surgery, the participants were randomized to one of two post-operative intervention groups: one group received information only and the other exercise in combination with information. Outcomes were collected at baseline, 6-8 weeks and 12-months post-surgery. The primary outcome was to record changes in back/hip pain and leg pain. Secondary outcomes were evaluation of changes in function, fear-avoidance beliefs and kinesiophobia. Seventy patients completed the study and were included in the analysis, of which 37 were randomized to the group receiving information only and the remaining 33 receiving both exercise and information. For primary outcomes, at 12 months postoperatively, the group receiving both exercise and information had significantly lower leg pain compared with those receiving only information (p < .033). For secondary outcomes, at 12 months postoperatively, a significant difference (p < .027) was detected for function, which favoured those that received both exercise and information. There was no significant difference in the results for the other secondary outcomes. Both groups showed clinically important changes in relation to pain and function from baseline to 12 months. The effect of treatment showed a statistically significant difference in favour of exercise and information, but the difference was not clinically relevant. Exercise in combination with information reduced leg pain and improved function, which was statistically more evident over a period of time. Postoperative physiotherapy after lumbar disc surgery could include exercises in addition to information, but perhaps not for all patients, as both groups improved, and the difference between the two groups was not clinically relevant.
Highlights
Physiotherapy has traditionally been part of postoperative rehabilitation after lumbar disc surgery
The results indicate that exercise in combination with information gave significantly less pain and improved functioning, compared with those who got information alone; both groups improved
A review by Snowdon and Peiris concluded that early comprehensive physiotherapy, starting 1–15 days after surgery in patients diagnosed with lumbar disc herniation, led to less pain both at 12 weeks and at 12 to 18 months follow-up compared with the control groups
Summary
Physiotherapy has traditionally been part of postoperative rehabilitation after lumbar disc surgery. Kjellby-Wendt et al found that patients who did early active training after lumbar disc surgery had less intense pain 6 and 12 weeks after surgery, compared with the control group who had traditional, less active, training. Trials included in the review were comprehensive with education forming a vital component, and the exercise programmes had a defined intensity. This may lead to the assumption that in order to reduce disability and improve pain postsurgery, education, early comprehensive physiotherapy, and intensity of treatment plays a role
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