Patient-reported Outcomes After Surgery for Lumbar Disc Herniation, a Randomized Controlled Trial Comparing the Effects of Referral to Municipal Physical Rehabilitation Versus No Referral.

Abstract

Randomized controlled trial. The aim of this study was to investigate the effect of referring patients to municipal physical rehabilitation compared to no referral on patient-reported outcomes (PROs) after surgery for lumbar disc herniation. In surgical spine practice, lumbar discectomy is one of the most frequent interventions. Postoperatively, patients are typically referred to physical rehabilitation at the time of hospital discharge, and in Denmark all patients are legally entitled to a personal rehabilitation plan and referral for free rehabilitation at the municipal facilities. However, whether postoperative rehabilitation is effective in this group of patients remains controversial. This single-center single blinded study randomized subjects into 2 groups. Patients in the REHAB group received municipal rehabilitation starting 4 to 6 weeks postoperative, whereas patients in the HOME group were discharged after surgery without any planned rehabilitation course. Primary outcome was Oswestry Disability Index after 6 months, whereas secondary outcomes included EuroQoL-5D and Visual Analogue Scale for leg and back pain. All PROs were obtained before surgery and at 1, 3 to 6, 12, and 24 months postoperative. A total of 146 patients were enrolled in the study: 73 allocated to the REHAB-group and 73 to the HOME-group. The groups were similar at baseline and the follow-up rate at 12 and 24 months was 78%. PROs in both groups improved significantly after surgery, but no statistically significant differences were observed between the groups at any follow-up time point in either the intent-to-treat, as-treated, and per-protocol analyses. Revision surgeries during the follow-up period were equally divided between the groups. Surgery for lumbar disc herniation is effective in relieving pain, improving function, and quality of life. The postoperative outcome is not altered significantly by referring patients to municipal physical rehabilitation compared to no referral. 1.