Effects of a prehabilitation program on patients’ recovery following spinal stenosis surgery: study protocol for a randomized controlled trial

Abstract

BackgroundDegenerative lumbar spinal stenosis is a prevalent condition in adults over the age of 65 and often leads to deconditioning. Although the benefits of surgery outweigh those of conservative approaches, physical rehabilitation may be used to improve function and to minimize the risk of persistent dysfunction. This study protocol was designed to establish the feasibility of a full-scale randomized controlled trial and to assess the efficacy of an active preoperative intervention program on the improvement of clinical parameters and functional physical capacity in patients undergoing surgery for lumbar spinal stenosis.Methods/DesignForty patients will be recruited and randomly allocated to one of the 2 treatment arms: 6 weeks supervised preoperative rehabilitation program (experimental group) or hospital standard preoperative management (control group). The intervention group will be trained three times per week, with each session aiming to improve strength, muscular endurance, spinal stabilization and cardiovascular fitness. Intensity and complexity of exercises will be gradually increased throughout the sessions, depending on each participant’s individual progress. Primary outcomes are level of low back disability and level of pain. Secondary outcomes include the use of pain medication, quality of life, patient’s global impression of change, lumbar extensor muscles endurance, maximum voluntary contraction of lumbar flexor and extensor muscles, maximum voluntary contraction of knee extensors, active lumbar ranges of motion, walking abilities, and cardiovascular capacity. Both the primary and secondary outcomes will be measured at baseline, at the end of the training program (6 weeks after baseline evaluation for control participants), and at 6 weeks, 3 and 6 months postoperatively.DiscussionThis study will inform the design of a future large-scale trial. Improvements of physical performances before undergoing lumbar surgery may limit functional limitations occurring after a surgical intervention. Results of this study will provide opportunity to efficiently improve spinal care and advance our knowledge of favorable preoperative strategies to optimize postoperative recovery.Trial registrationUS National Institutes of Health Clinical Trials registry NCT02258672, 10 February 2014.

Association between preoperative activity level and functional outcome at 12 months following surgical decompression for lumbar spinal stenosis

“…comes of conservatively and surgically managed patients with lumbar spinal stenosis have been reported at 4 to 5 years postoperatively. 13,20,28 A recent trend has been to use prospectively collected clinical registries to evaluate the quality of lumbar spinal stenosis care and to optimize healthcare resource distribution. 4,8 A key field of investigation involves identification of preoperative factors and/or patient characteristics that may affect patient-reported outcomes after surgical intervention for lumbar spinal stenosis.…”

Preoperative sense of coherence associated with the 10-year outcomes of lumbar spinal stenosis surgery

“…Moreover, considering the persistent connection between preoperative disability and 10-year disability in our results, a question arises of whether preoperative rehabilitation could strengthen the postsurgical functional ability of LSS patients. This approach is currently being studied by Marchand et al (2015) who have designed an RCT study to determine the effects of an active preoperative intervention programme on the clinical parameters and functional physical capacity in patients undergoing LSS surgery. Our results suggest that the preoperative strategies to optimize long-term postoperative recovery might include physical rehabilitation as well as strengthening the salutogenic resources of LSS patients.…”

Feasibility of conducting an active exercise prehabilitation program in patients awaiting spinal stenosis surgery: a randomized pilot study

“…The present study was a single-blinded, two-arm randomized pilot trial and its detailed methods have been previously published elsewhere 24 . The trial received ethical approval from the institutional review boards of the Université du Québec à Trois-Rivières (UQTR) and the Centre intégré universitaire de santé et de services sociaux de la Mauricie-et-du-Centre-du-Québec (CIUSSS-MCQ - formerly known as Centre de Santé et de Services Sociaux de Trois-Rivières) (CÉR-2014-008-00).…”

“…Physical tests included lumbar extensor muscles endurance (modified Sorensen test), trunk flexor and extensor muscle strength (isometric contraction), knee extensor muscle strength (isometric contraction), active lumbar ranges of motion, walking abilities (time to first symptoms and total ambulation time), and maximal aerobic capacity. Study protocol provides further information about the selected outcomes 24 .…”