Exercise speeds recovery, return to work following lumbar disc replacement

Patients in a pre- and postop exercise program had more confidence with physical activity and less fear of pain and disability.

PHILADELPHIA - A structured preoperative and postoperative exercise program implemented using a cognitive behavioral approach may improve rates of recovery following lumbar disc replacement surgery.

The approach may also help accelerate patients’ return to work, Australian researchers reported.

John Booth, MD, PhD, of RehWork-Rehabilitation and Consultancy in Wollongong, New South Wales, presented the preliminary evidence at the North American Spine Society 20th Annual Meeting.

“Intensive exercise has been shown to improve function and reduce pain in chronic back pain patients and following spinal surgery, primarily in discectomy patients,” Booth said. “In addition, cognitive behavioral therapy has also been shown effective for treating chronic back pain patients by addressing the beliefs and behaviors about physical activity and pain injury.”

Exercise-based program

The researchers enrolled 20 L5/SI disc replacement patients in the prospective, randomized, controlled trial. Separating the patients into two groups, they enlisted 10 patients in an intensive preoperative and postoperative exercise-based program beginning at four to five weeks before surgery and continued to 12 weeks postop. These patients had an average age of 39.1 ± 6.7 years, Booth said.

The exercise program involved supervised clinic- and 20- to 30-minute home-based exercises five days a week. Six weeks after surgery, patients exercised for a minimum 50 to 60 minutes per day. The researchers individualized the exercise program according to each patient's functional level, targeting endurance in global and deep trunk-stabilizing muscles with walking up to 45 minutes.

These patients were also enrolled in a cognitive-behavioral program, during which researchers taught them the importance of physical activity in spinal surgery recovery and the safety of progressively increasing activity levels after surgery.

The other 10 patients assigned to the control group received normal care involving inpatient physical therapy, activity and follow-up neurosurgical consultations. These patients had an average age of 41.7 ± 4.5 years.

Both groups completed the Roland-Morris Disability Questionnaire, Waddell's Fear Avoidance Beliefs Questionnaire, the McGill Pain Questionnaire and physical assessment, which included thoracolumbar flexion, self-paced stair climbing, a sit-to-stand test and a five-minute self-paced walking test.

Results at follow-up

At 12 weeks postop, researchers found no significant differences in pain levels between the two groups. However, results showed that the exercise-treated group scored significantly lower than the control group in both the Waddell's Fear Avoidance Beliefs Questionnaire (P<.01) and the Roland-Morris Disability score (P=.03).

“We're concluding that [the treatment] group was more confident with physical activity and less fearful of pain and reinjury,” Booth said. “They could also see themselves as less disabled.”

The treatment group also completed a greater distance for the five-minute self-paced walking test (P<.01) at 392 ± 57.4 meters vs. 279.9 ± 80.6 meters for the control group. By 13 weeks postop, three exercise-treated patients and none of the control patients returned to work.

Researchers found no significant differences between groups for lumbar range of motion, McGill Pain Questionnaire scores and for sit-to-stand and stair climbing tests, according to the abstract.

The researchers believe that the results justify a more comprehensive study currently being conducted in conjunction with the University of Sydney back pain research group. This study will also look at preoperative and postoperative exercise, cognitive behavioral treatment and recovery from lumbar disc replacement surgery.

For more information:
Booth J, Day J. Functional restoration following lumbar disc replacement: effect of pre- and post-exercise treatment. #10. Presented at the North American Spine Society 20th Annual Meeting. Sept. 27-Oct. 1, 2005. Philadelphia.