title: The effect of timing of rehabilitation on physical performance after lumbar spinal fusion: a randomized clinical study.
abstract: BACKGROUND
  The number of patients undergoing lumbar spinal fusion procedures (LSF) has risen in recent years, but only few studies have examined different rehabilitation strategies for this patient group.
  
  
  OBJECTIVE
  To evaluate the impact of initiating rehabilitation either 6 or 12 weeks after a LSF based on the patients' physical performance using the 6-min walking test (6MWT) and the Åstrand Fitness test (AF-test) as measurement.
  
  
  METHODS
  A multicentre RCT including 82 patients with degenerative disc diseases undergoing LSF randomly assigned to initiate rehabilitation either 6 or 12 weeks after surgery. Both groups received the same group-based rehabilitation. The main outcome measures were the 6MWT and the AF-test, secondarily questionnaire-based measures. Follow-up at baseline as well as at 3, 6 and 12 months after surgery.
  
  
  RESULTS
  Comparing the two groups no statistically significant difference was found in walking distance or fitness over time. In both groups, the patients achieved an overall increase in walking distance (p < 0.01), but no improvement in fitness. The 6MWT showed significant correlation (-0.37 to -0.59) with the questionnaire-based outcome measures (p < 0.01). The AF-test did not correlate to either the 6MWT or any of the questionnaire-based outcome measures.
  
  
  CONCLUSIONS
  No difference was found in the effect of initiating rehabilitation either 6 or 12 weeks after LSF on the patients' physical performance in terms of fitness and walking distance. The 6MWT showed fair to moderate correlation to the questionnaire-based outcome measures. The AF-test showed no significant independent value, and we question its use in LSF patients.
authors.affiliation: Department of Occupational Therapy and Physiotherapy, Aarhus University Hospital, Noerrebrogade 44, 8000 Aarhus C, Denmark. lisaoest@rm.dk
authors.forename: Lisa G
authors.initials: LG
authors.lastname: Oestergaard
authors.forename: Claus V
authors.initials: CV
authors.lastname: Nielsen
authors.forename: Cody E
authors.initials: CE
authors.lastname: Bünger
authors.forename: Karen
authors.initials: K
authors.lastname: Svidt
authors.forename: Finn B
authors.initials: FB
authors.lastname: Christensen
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009043:Motor Activity / Q000502:physiology*; D017063:Outcome Assessment, Health Care; D010809:Physical Fitness / Q000502:physiology*; D026741:Physical Therapy Modalities; D013123:Spinal Fusion / Q000534:rehabilitation*; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome; D016138:Walking / Q000502:physiology*
references.citation: Pain. 1994 Jun;57(3):317-326
references.pmid: 7936710
references.citation: Respir Care. 2003 Aug;48(8):783-5
references.pmid: 12890299
references.citation: Eur Spine J. 2008 Feb;17(2):262-71
references.pmid: 17713794
references.citation: Clin Rehabil. 2010 Feb;24(2):137-48
references.pmid: 20103575
references.citation: Spine (Phila Pa 1976). 2003 Dec 1;28(23):2561-9
references.pmid: 14652472
references.citation: Physiotherapy. 1980 Aug;66(8):271-3
references.pmid: 6450426
references.citation: Spine (Phila Pa 1976). 2010 Apr 15;35(8):848-57
references.pmid: 20354468
references.citation: Biometrics. 1977 Jun;33(2):363-74
references.pmid: 884196
references.citation: BMJ. 2005 May 28;330(7502):1233
references.pmid: 15911537
references.citation: Spine (Phila Pa 1976). 2000 Jun 15;25(12):1523-32
references.pmid: 10851101
references.citation: Spine (Phila Pa 1976). 1989 May;14(5):511-6
references.pmid: 2524890
references.citation: Eur Spine J. 2012 Jan;21(1):115-21
references.pmid: 21863462
references.citation: Pain. 2006 May;122(1-2):145-55
references.pmid: 16545523
references.citation: Eur Spine J. 2006 Jan;15 Suppl 1:S17-24
references.pmid: 16320034
references.citation: Spine (Phila Pa 1976). 2012 Oct 1;37(21):1803-9
references.pmid: 22565381
references.citation: Am J Respir Crit Care Med. 2002 Jul 1;166(1):111-7
references.pmid: 12091180
references.citation: Acta Orthop Scand. 2001 Oct;72(5):518-24
references.pmid: 11728081
references.citation: Spine (Phila Pa 1976). 2000 Nov 15;25(22):2940-52; discussion 2952
references.pmid: 11074683
references.citation: Spine (Phila Pa 1976). 2000 Apr 15;25(8):1015-20
references.pmid: 10767815
references.citation: Disabil Rehabil. 2009;31(24):1988-95
references.pmid: 19874077
references.citation: BMC Health Serv Res. 2008 Oct 09;8:209
references.pmid: 18842157
references.citation: Clin Rehabil. 2006 Nov;20(11):989-97
references.pmid: 17065542
references.citation: Nat Clin Pract Rheumatol. 2007 Nov;3(11):610-8
references.pmid: 17968331
references.citation: Occup Environ Med. 2012 Jan;69(1):21-8
references.pmid: 21597108
references.citation: Am J Respir Crit Care Med. 1998 Nov;158(5 Pt 1):1384-7
references.pmid: 9817683