Physiotherapy rehabilitation following lumbar spinal fusion: a systematic review and meta-analysis of randomised controlled trials

Abstract

ObjectiveTo evaluate the effectiveness of physiotherapy intervention following lumbar spinal fusion.DesignSystematic review and meta-analysis. 2 independent reviewers searched information sources, assessed studies for inclusion and evaluated risk of bias. Quantitative synthesis using standardised mean differences was conducted on comparable outcomes across trials with similar interventions.Information sourcesPredefined terms were employed to search electronic databases. Additional studies were identified from key journals, reference lists, authors and experts.Eligibility criteria for included studiesRandomised control trials published in English prior to 30 September 2011 investigating physiotherapy outpatient management of patients (>16 years), following lumbar spinal fusion, with measurements reported on one or more outcome of disability, function and health were included.Results2 Randomised control trials (188 participants) from two countries were included. Both trials included a behavioural and an exercise intervention. 1 trial was evaluated as high risk of bias and one as unclear. 159 participants were incorporated in the meta-analysis. Although evidence from both trials suggested that intervention might reduce back pain short term (6 months) and long term (12 months and 2 years), and a behavioural intervention might be more beneficial than an exercise intervention, the pooled effects (0.72, 95% CI −0.25 to 1.69 at 6 months; 0.52, 95% CI −0.45 to 1.49 at 12 months and 0.75, 95% CI −0.46 to 1.96 at 2 years) did not demonstrate statistically significant effects. There was no evidence that intervention changes pain in the short (6 months) or long term (12 months and 2 years). The wide CI for pooled effects indicated that intervention could be potentially beneficial or harmful. Considerable heterogeneity was evident.ConclusionsInconclusive, very low-quality evidence exists for the effectiveness of physiotherapy management following lumbar spinal fusion. Best practice remains unclear. Limited comparability of outcomes and retrieval of only two trials reflect a lack of research in this area that requires urgent consideration.

Quality of life and disability: can they be improved by active postoperative rehabilitation after spinal fusion surgery in patients with spondylolisthesis? A randomised controlled trial with 12-month follow-up

“…Thus far, a limited number of randomised controlled trials (RCTs) have been published and the evidence of exercise therapy in restoring the spinal functioning and improving disability or HRQoL after fusion surgery is weak [10][11][12][13][14][15][16]. The commencement time and structure of the rehabilitation programs in previous RCT's varies [10][11][12][13][14]17].…”

Determining clinical practice of expert physiotherapy for patients undergoing lumbar spinal fusion: a cross-sectional survey study

“…There is little knowledge on the optimal physiotherapy practice in patients undergoing LSF. In a systematic review of the literature, Rushton et al [3] demonstrated that studies on the effectiveness of physiotherapy after LSF are of low quality and too heterogeneous to pool. Consequently, physiotherapists have to depend on their own competence and experience in their day-to-day practice.…”

“…This results in highly variable clinical care with unknown effectiveness, as demonstrated by Rushton et al [4] in the UK. Thus, best clinical physiotherapy practice in LSF remains to be elucidated [3,5].…”

Strukturierte Rehabilitation nach lumbaler Wirbelsäulenoperation

“…Unter der Kenntnis, dass ein Rehabilitationsteam definierte Rehabilitationskriterien und Standards benötigt, um den Rehabilitationsprozess und die Therapieintensität festzulegen, wurden drei Belastungsgruppen definiert [15]. Gruppe A umfasst die Patienten mit einer gegebenen Primärstabilität ohne wesentliche Einschränkung hinsichtlich des postoperativen Belastungsaufbaus, Gruppe B umfasst Patienten mit geringen Einschränkungen und Gruppe C betrifft Patienten, welche eine geringere Primärsta-bilität aufweisen.…”

“…Die Evidenz postoperativer Physiotherapiekonzepte nach Spondylodesen und anderen Eingriffen im Bereich der Lendenwirbelsäule (LWS) ist sehr klein, es existieren fast keine Untersuchungen, wobei auch das physiotherapeutische Management nach lumbalen Spondylodesen unklar und intransparent bleibt [3,15,17]. Nach Mikrodiskektomien und Dekompression von Spinalkanalstenosen scheint ein intensiviertes physiothe- rapeutisches Behandlungskonzept von Vorteil [6,12].…”