An intensive, progressive exercise program reduces disability and improves functional performance in patients after single-level lumbar microdiskectomy.
BACKGROUND
Restoration of physical function following lumbar microdiskectomy may be influenced by the postoperative care provided.


OBJECTIVE
The purpose of this study was to examine the effectiveness of a new interventional protocol to improve functional performance in patients who have undergone a single-level lumbar microdiskectomy.


METHODS
The study was conducted in physical therapy outpatient clinics.


METHODS
Ninety-eight participants (53 male, 45 female) who had undergone a single-level lumbar microdiskectomy were randomly allocated to receive education only or exercise and education.


METHODS
The exercise intervention consisted of a 12-week periodized program of back extensor strength (force-generating capacity) and endurance training and mat and upright therapeutic exercises. The Oswestry Disability Index (ODI) and physical measures of functional performance were tested 4 to 6 weeks postsurgery and 12 weeks later, following completion of the intervention program. Because some participants sought physical therapy outside of the study, postintervention scores were analyzed for both an as-randomized (2-group) design and an as-treated (3-group) design.


RESULTS
In the 2-group analyses, exercise and education resulted in a greater reduction in ODI scores and a greater improvement in distance walked. In the 3-group analyses, post hoc comparisons showed a significantly greater reduction in ODI scores following exercise and education compared with the education-only and usual physical therapy groups.


CONCLUSIONS
The limitations of this study include a lack of adherence to group assignment, disproportionate therapist contact time among treatment groups, and multiple use of univariate analyses.


CONCLUSIONS
An intensive, progressive exercise program combined with education reduces disability and improves function in patients who have undergone a single-level lumbar microdiskectomy.
Division of Biokinesiology and Physical Therapy, University of Southern California, 1540 E Alcazar St, CHP-155, Los Angeles, CA 90089-9006, USA. kulig@usc.edu
Kornelia
K
Kulig
George J
GJ
Beneck
David M
DM
Selkowitz
John M
JM
Popovich
Ting Ting
TT
Ge
Sean P
SP
Flanagan
Elizabeth M
EM
Poppert
Kimiko A
KA
Yamada
Christopher M
CM
Powers
Stan
S
Azen
Carolee J
CJ
Winstein
James
J
Gordon
Srinath
S
Samudrala
Thomas C
TC
Chen
Arya Nick
AN
Shamie
Larry T
LT
Khoo
Mark J
MJ
Spoonamore
Jeffrey C
JC
Wang
D000293:Adolescent; D000328:Adult; D000704:Analysis of Variance; D004185:Disability Evaluation; D017586:Diskectomy / Q000379:methods / Q000534:rehabilitation*; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic; D011446:Prospective Studies; D020127:Recovery of Function; D016896:Treatment Outcome