Clinic-based training in comparison to home-based training after first-time lumbar disc surgery: a randomised controlled trial

Abstract

The effectiveness of physiotherapy after firsttime lumbar disc surgery is still largely unknown. Studies in this field are heterogeneous and behavioural treatment principles have only been evaluated in one earlier study. The aim of this randomised study was to compare clinicbased physiotherapy with a behavioural approach to a home-based training programme regarding back disability, activity level, behavioural aspects, pain and global health measures. A total of 59 lumbar disc patients without any previous spine surgery or comorbidity participated in the study. Clinic-based physiotherapy with a behavioural approach was compared to home-based training 3 and 12 months after surgery. Additionally, the home training group was followed up 3 months after surgery by a structured telephone interview evaluating adherence to the exercise programme. Outcome measures were: Oswestry Disability Index (ODI), physical activity level, kinesiophobia, coping, pain, quality of life and patient satisfaction.Treatment compliance was high in both groups. There were no differences between the two groups regarding back pain disability measured by ODI 3 and 12 months after surgery. However, back pain reduction and increase in quality of life were significantly higher in the home-based training group. The patients in the clinic-based training group had significantly higher activity levels 12 months after surgery and were significantly more satisfied with physiotherapy care 3 months after surgery compared to the home-based training group. Rehabilitation after first-time lumbar disc surgery can be based on home training as long as the patients receive both careful instructions from a physiotherapist and strategies for active pain coping, and have access to the physiotherapist if questions regarding training arise. This might be a convenient treatment arrangement for most patients.

Preoperative and postoperative psychologically informed physical therapy: A systematic review of randomized trials among patients with degenerative spine, hip, and knee conditions

“…Two independent reviewers assessed full‐text manuscripts of the remaining 42 articles for inclusion, excluding 30 full‐text articles that did not meet review inclusion criteria (Table S5). In total, 12 articles representing 10 unique studies met eligibility criteria (Abbott, Tyni‐Lenne, & Hedlund, ; Archer et al, ; Christensen, Laurberg, & Bunger, ; Ilves et al, ; Johansson, Linton, Bergkvist, Nilsson, & Cornefjord, ; Lindback, Tropp, Enthoven, Abbott, & Oberg, ; Monticone et al, ; Ostelo, Vet, Berfelo, et al, ; Ostelo, Vet, Vlaeyen, et al, ; Saw, Kruger‐Jakins, Edries, & Parker, ; Wibault et al, ). For the purposes of this review, results from related studies by Ostelo, Vet, Berfelo, et al (), Ostelo, Vet, Vlaeyen, et al (), and Wibault et al () were consolidated as these data were from the same sample and included different outcomes (Wibault et al, ) or outcomes measured at different time points (Ostelo, Vet, Berfelo, et al, ; Ostelo, Vet, Vlaeyen, et al, ).…”

“…One study included postoperative physician advice to stay active as a comparator (Monticone et al, ). A home‐based exercise program was the primary comparison group in three studies (Abbott et al, ; Ilves et al, ; Johansson et al, ). Two studies included structured in‐person physical therapy (Christensen et al, ; Ostelo, Vet, Berfelo, et al, ).…”

A prospective study of cognitive behavioural factors as predictors of pain, disability and quality of life one year after lumbar disc surgery

“…The patients in this study are part of the Middle Sweden Disc Surgery Recovery Study and the results of the intervention are reported elsewhere [32].…”

Tai chi exercise for treatment of pain and disability in people with persistent low back pain: A randomized controlled trial

“…It has recently gained popularity in Australia, Canada, the UK, and the US for use in various health conditions, including fall prevention (11) and management of arthritis (12). It is currently endorsed by the Arthritis Foundation of Australia (13), Arthritis Care of the UK (14), and the Arthritis Foundation of the US (15). This increased recognition and widespread use of tai chi for health problems has driven the need for scientific research to establish its value.…”