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| The effect of early initiation of rehabilitation after lumbar spinal fusion -- a randomized clinical study [with consumer summary] |
| Oestergaard LG, Nielsen CV, Bunger CE, Sogaard R, Fruensgaard S, Helmig P, Christensen FB |
| Spine 2012 Oct 1;37(21):1803-1809 |
| clinical trial |
| 6/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: Yes; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: No; Adequate follow-up: No; Intention-to-treat analysis: Yes; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed* |
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STUDY DESIGN: A multicenter RCT including 82 patients. OBJECTIVE: To examine the effect of early initiation of rehabilitation after instrumented lumbar spinal fusion. SUMMARY OF BACKGROUND DATA: Lumbar spinal fusion has been performed for more than 70 years. Yet, only few studies have examined patients' subsequent rehabilitation. Group-based rehabilitation is both efficient and cost-effective in rehabilitation of lumbar spinal fusion patients. METHODS: Patients with degenerative disc diseases undergoing instrumented lumbar spinal fusion were randomly assigned to initiate their rehabilitation 6 weeks (6w-group) or 12 weeks after lumbar spinal fusion (12w-group). Both groups received the same group-based rehabilitation. Primary outcome was the Oswestery Disability Index (ODI). Secondary outcome was the Dallas Pain Questionnaire (DPQ), the Low Back Pain Rating Scale, and absence from work. Wilcoxon rank sum test was used to compare the groups in terms of differences from baseline to 6 months and 1-year follow-up. RESULTS: According to the ODI, at 1-year follow-up, the 6w-group had a median reduction of -6 (-19 to 4) compared with -20 (-30 to -7) in the 12w-group (p < 0.05). The DPQ showed overall the same tendency and within daily activities were a significantly reduced in favour of the 12w-group (p < 0.05). For back pain, the 6w-group had a median reduction of -2.2 (-3.0 to -0.7) similar with -3.3 (-4.7 to -1.7) in the 12-w group (p < 0.05). The results at 6 months of follow-up were similar. No difference was found according to return to work 1-year post surgery. CONCLUSION: Early start of rehabilitation (6 weeks versus 12 weeks) after lumbar spinal fusion resulted in inferior outcomes. The improvements in the 12w-group was four times better than that of the 6w-groups indicating that the star-up time of rehabilitation is an important contributing factor for the overall outcome.
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