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Researchers discourage use of rehab after spinal decompression surgery
Costly postoperative rehabilitation programs produced no additional pain relief or function.
Patients randomized to two rehabilitation programs or a control group following lumbar spinal decompression surgery experienced no further pain relief beyond that reported immediately postoperatively.
According to Swiss investigators who conducted the randomized controlled study, physicians who simply advise patients to participate in physical activities that they enjoy can expect the same effect as with structured physiotherapy programs.
“Postoperative physiotherapy did not influence the course of change in pain or disability for up to 24 months after decompression surgery,” Anne F. Mannion, PhD, said. She and her co-investigators theorized that performing activities that keep the patient moving mimics a supervisory program, but without the added cost to health care providers.
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Mannion presented these results at the 9th Annual Meeting of the Spine Society of Europe (SSE). She and her co-authors won the SSE Clinical Science Award 2007 for their research.
Two physiotherapy groups
In the study, the small subgroup of patients with a poor outcome following decompression surgery also reported no pain or disability improvements with structured rehabilitation.
“Postoperative physiotherapy does not appear to be able to compensate for an initial poor surgical result,” she said.
Investigators included 159 patients who underwent lumbar decompression surgery for spinal stenosis or a herniated disc and randomized them to one of three groups (100 men, 59 women; age 65 years ± 11 years). The rehabilitation program commenced at 2 months postop.
Group one consisted of 54 patients who served as controls. They were instructed to just keep active following surgery and to keep an exercise diary. Group two had 56 patients who underwent physiotherapy consisting primarily of spine stabilization exercises performed under supervision, as well as at home for up to 12 weeks. Group three consisted of 49 patients who underwent active physiotherapy involving mixed techniques and home exercises done according to the same schedule as group two.
The supervised physiotherapy programs consisted of two 30-minute sessions per week.
Pain, disability measures
Prior to surgery, all patients evaluated their own back and leg pain separately on a 0-to-10-point graphic rating scale and completed the Roland Morris Disability Questionnaire. They repeated those outcome instruments before the rehabilitation period began, immediately after it ended, and then 12 and 24 months after its conclusion. At final follow-up, 97% returned completed questionnaires, Mannion said.
Back and leg pain decreased significantly after surgery, but it did not decrease further through the 24-month follow-up, Mannion noted.
“Disability declined further during the rehabilitation phase (P<.05), then stabilized, but with no significant group differences,” according to the abstract.
During the paper’s discussion, Mannion said she felt a supervised rehabilitation program was unnecessary for these patients.
For more information:
- Anne F. Mannion, PhD, can be reached at Schulthess Klinik, Lengghalde 2, Zurich, Switzerland CH-8008; +41-44-385-7584; e-mail: anne.mannion@kws.ch. Her study was jointly funded by the Schulthess Klinik Research Funds and the Swiss National Science Foundation, grant 32-57123.99.
References:
- Mannion AF, Denzler R, Dvorak J, Muntener M, Grob D. A randomized controlled trial of post-operative rehabilitation after surgical decompression of the lumbar spine. Presented at the 9th Annual Meeting of the Spine Society of Europe. Oct. 2-6, 2007. Brussels.
- Mannion AF, Denzler R, Dvorak J, Muntener M, Grob D. A randomized controlled trial of post-operative rehabilitation after surgical decompression of the lumbar spine. Eur Spine J. 2007;16(8):1101-1117.