The Effect of Exercise Interventions After Lumbar Decompression Surgery: A Systematic Review and Meta-Analysis

Abstract

The purpose of the present systematic review was to evaluate the effectiveness of exercise after lumbar decompression surgery on pain, function, motor-sensory symptoms, and psychosocial parameters. A literature search was conducted with PubMed, Web of Science, Scopus, ScienceDirect, and Cochrane databases. Quality analysis and bias risk assessment were performed with "Physiotherapy Evidence Database" and "Revised Cochrane risk-of-bias tool randomized trials", respectively. A total of 1219 articles were accessed from the relevant databases (PubMed = 97, Cochrane = 61, Web of Science = 97, Scopus = 104, ScienceDirect = 860). Fourteen studies were included in the systematic review. Systematic review results were presented with narrative synthesis due to heterogeneous data. Homogeneous data were given with meta-analysis. The results demonstrated that strengthening, stabilization, and aerobic exercises provide additional advantages after lumbar decompression than education or clinical advice alone. Studies also emphasized the importance of relaxation, stretching, and mobilization training. The exercise training provided an additional advantage in terms of disability score at 6-12 weeks (short- to moderate-term) follow-up (effect size [ES]: -0.87, 95% confidence interval [CI]: -1.30; -0.45) with high-degree evidence. However, results in the identical pooling for pain scores showed low efficacy (ES: -0.35, 95% CI: -0.76; 0.05). Short Form-36 pooling in the 12-week follow-up demonstrated that exercise training had moderate-degree evidence effectiveness on physical function (ES: 0.51, 95% CI: 0.12; 0.91), bodily pain (ES: 0.52, 95% CI: 0.13; 0.91), and social function (ES: 0.53, 95% CI: 0.13; 0.93). The results highlighted the importance of exercise training, particularly strengthening. Meta-analysis results also proved the effectiveness of exercise on disability in the short to medium term.