Rehabilitation after lumbar disc surgery: an update Cochrane review.
METHODS
Cochrane systematic review of randomized controlled trials.


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


BACKGROUND
Several rehabilitation programs are available for individuals after lumbar disc surgery, however, little is known about the efficacy of these treatments.


METHODS
Search strategies were performed on CENTRAL (The Cochrane Library 2007, Issue 2) and MEDLINE, EMBASE, CINAHL, and PsycINFO up to May 2007. All randomized controlled trials without language limitations were included. 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, 7 of which had a low risk of bias. Most programs were only assessed in 1 study. Statistical pooling was only completed for 3 comparisons in which exercises started 4 to 6 weeks postsurgery: exercise programs versus no treatment, high versus low intensity exercise programs, and supervised versus home exercises. We found low quality evidence (3 randomized controlled trials [RCTs], N = 122) that exercises are more effective than no treatment for pain at short-term follow-up (weighted mean difference [WMD]:-11.13; 95% CI: -18.44 to -3.82) and moderate evidence (2 RCTs, N = 102) that exercises 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 reoperation rate. We also found low quality evidence (2 RCTs, N = 103) that high intensity exercises 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 (2 RCTs, N = 103) that they are more effective for functional status in the short-term (standardized mean difference [SMD] -0.77; 95% CI: -1.17 to -0.36). Finally, we found low quality evidence (3 RCTs, N = 95) that there were no significant differences between supervised and home exercises for short-term pain relief (SMD: -1.12; 95% CI: -2.77-0.53) or functional status (3 RCT, N = 95; SMD -1.17; 95% CI: -2.63-0.28).


CONCLUSIONS
Exercise programs starting 4 to 6 weeks postsurgery 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 reoperation rate after first-time lumbar surgery.
Ostelo
Raymond W J G
RW
EMGO Institute VU University Medical Centre, Amsterdam, The Netherlands. r.ostelo@vumc.nl
Costa
Leonardo Oliveira Pena
LO
Maher
Christopher G
CG
de Vet
Henrica C W
HC
van Tulder
Maurits W
MW
D017586:Diskectomy / Q000534:rehabilitation* / Q000706:statistics & numerical data; D005081:Exercise Therapy / Q000379:methods / Q000706:statistics & numerical data*; D006699:Home Care Services / Q000706:statistics & numerical data; D006801:Humans; D007403:Intervertebral Disc / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D007405:Intervertebral Disc Displacement / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D017063:Outcome Assessment, Health Care / Q000379:methods; D010149:Postoperative Pain / Q000628:therapy*; D011859:Radiography; D013997:Time Factors; D016896:Treatment Outcome