The Effectiveness of Physical Exercise After Lumbar Fusion Surgery: A Systematic Review and Meta-Analysis

Abstract

The aim of the study was to review the effect of exercise interventions in patients after lumbar fusion surgery. It was sought to reveal the effect of exercise protocols on various clinical parameters. PubMed, Web of Science, Scopus, and ScienceDirect databases were searched. "Revised Cochrane risk-of-bias tool for randomized trials (ROB 2)" and "The Tool for the assEssment of Study qualiTy and reporting in EXercise (TESTEX)" were used to evaluate the bias risk and quality assessment, respectively. A literature search yielded 1595 studies. After the procedures, eight and three studies were included in the systematic review and meta-analysis, respectively. TESTEX scores of the studies ranged from 4 to 10 (median: 7.50). The majority (n = 5) of the studies' bias risk was classified as "some concerns" in ROB 2. The superiority of trunk-stabilization training was controlled in two studies. The most focused (n = 3) intervention was cognitive therapy plus exercise. Evidence proved that cognitive therapy plus exercise intervention was not superior to only exercise therapy on long-term pain (effect size [ES]: 0.48, 95% confidence interval [CI]: -0.44 to 1.47) and quality-of-life (ES: 1.34, 95% CI: -4.12 to 1.13) level. On the other hand, low-quality evidence demonstrated that cognitive therapy plus exercise yielded better results on long-term disability (ES: 0.78, 95% CI: -0.27 to 2.78) and kinesiophobia (ES: 0.14, 95% CI: 1.10 to 1.67). The systematic review results demonstrated that cognitive therapy or consultation during the exercise program provides better outcomes in lumbar fusion surgery over exercise alone. Positive effects of core stabilization training on muscle strength and endurance were observed in the short term; however, this superiority was not the case in long-term studies. Meta-analysis results proved the positive effect of additional cognitive therapy to exercise on disability and kinesiophobia.