Rehabilitation after lumbar disc surgery.
BACKGROUND
Several rehabilitation programs are available for individuals after lumbar disc surgery.


OBJECTIVE
To evaluate the effects of active rehabilitation for adults after first-time lumbar disc surgery.


METHODS
We searched CENTRAL (The Cochrane Library 2007, Issue 2) and MEDLINE, EMBASE, CINAHL and PsycINFO to May 2007.


METHODS
We only included randomised controlled trials (RCTs).


METHODS
Pairs of review authors independently assessed studies for eligibility and risk of bias. A meta-analysis was performed with clinically homogeneous studies. The GRADE approach was used to determine the quality of evidence.


RESULTS
Fourteen studies were included, seven of which had a low risk of bias. Most programs were only assessed in one study. Statistical pooling was only completed for three comparisons in which exercises were started four to six weeks post-surgery: exercise programs versus no treatment, high versus low intensity exercise programs, and supervised versus home exercises.There is low quality evidence (three RCTS, N = 156) that exercises are more effective than no treatment for pain at short-term follow-up (WMD -11.13; 95% CI -18.44 to -3.82) and moderate evidence (two RCTs, N = 136) that they are more effective for functional status on short-term follow-up (WMD -6.50; 95% CI -9.26 to -3.74). None of the studies reported that exercises increased the re-operation rate.There is low quality evidence (two RCTs, N =103) that high intensity are slightly more effective than low intensity exercise programs for pain in the short term (WMD -10.67; 95% CI -17.04 to -4.30) and moderate evidence (two RCTs, N = 103) that they are more effective for functional status in the short term (SMD -0.77; 95% CI -1.17 to -0.36).There is low quality evidence (three RCTS, N = 95) that there were no significant differences between supervised and home exercises for short-term pain relief (SMD -1.12; 95% CI -2.77 to 0.53) or functional status (three RCTs, N = 88; SMD -1.18; 95% CI -2.63 to 0.26).


CONCLUSIONS
Exercise programs starting four to six weeks post-surgery seem to lead to a faster decrease in pain and disability than no treatment. High intensity exercise programs seem to lead to a faster decrease in pain and disability than low intensity programs. There were no significant differences between supervised and home exercises for pain relief, disability, or global perceived effect. There is no evidence that active programs increase the re-operation rate after first-time lumbar surgery.
EMGO Institute - Institute for Health Sciences, Department of Health Sciences - VU University; VU University Medical Centre, Van der Boechorststraat 7, Amsterdam, Netherlands, 1081 BT. r.ostelo@vumc.nl
Raymond W J G
RW
Ostelo
Leonardo Oliveira Pena
LO
Costa
Christopher G
CG
Maher
Henrica C W
HC
de Vet
Maurits W
MW
van Tulder
D005081:Exercise Therapy; D006801:Humans; D007403:Intervertebral Disc / Q000601:surgery*; D008159:Lumbar Vertebrae; D011184:Postoperative Period; D016032:Randomized Controlled Trials as Topic; D020127:Recovery of Function