title: Early multimodal rehabilitation following lumbar disc surgery: a randomised clinical trial comparing the effects of two exercise programmes on clinical outcome and lumbar multifidus muscle function.
abstract: BACKGROUND
  The optimal components of postoperative exercise programmes following single-level lumbar discectomy have not been identified. Facilitating lumbar multifidus (LM) function after discectomy may improve postoperative recovery. The aim of this study was to compare the clinical and muscle function outcomes of patients randomised to receive early multimodal rehabilitation following lumbar discectomy consisting of exercises targeting specific trunk muscles including the LM or general trunk exercises.
  
  
  METHODS
  We included participants aged 18 to 60 years who were scheduled to undergo single-level lumbar discectomy. After two postoperative weeks, participants were randomly assigned to receive an 8-week multimodal exercise programme including either general or specific trunk exercises. The primary outcome was pain-related disability (Oswestry Index). Secondary outcomes included low back and leg pain intensity (0-10 numeric pain rating scale), global change, sciatica frequency, sciatica bothersomeness and LM function measured with real-time ultrasound imaging. Treatment effects 10 weeks and 6 months after surgery were estimated with linear mixed models.
  
  
  RESULTS
  61 participants were randomised to receive a general trunk (n=32) or specific (n=29) exercise programme. There were no between-group differences in clinical or muscle function outcomes. Participants in both groups experienced improvements in most outcome measures.
  
  
  CONCLUSIONS
  Following lumbar discectomy, multimodal rehabilitation programmes comprising specific or general trunk exercises have similar effects on clinical and muscle function outcomes. Local factors such as the individual patient characteristics identified by specific assessment findings, clinician expertise and patient preferences should direct therapy selection when considering the types of exercises tested in this trial for inclusion in rehabilitation programmes following lumbar disc surgery.
authors.affiliation: School of Psychology and Exercise Science, Murdoch University, Murdoch, Western Australia, Australia.
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Hebert
authors.affiliation: Department of Physical Therapy, University of Utah and Clinical Research Outcomes Scientist, Intermountain Healthcare, Salt Lake City, Utah, USA.
authors.forename: Julie M
authors.initials: JM
authors.lastname: Fritz
authors.affiliation: Department of Physical Therapy, University of Utah, Salt lake City, Utah, USA.
authors.forename: Anne
authors.initials: A
authors.lastname: Thackeray
authors.affiliation: School of Psychology and Exercise Science, Murdoch University, Murdoch, Western Australia, Australia U.S. Army-Baylor University Doctoral Program in Physical Therapy, San Antonio, Texas, USA.
authors.forename: Shane L
authors.initials: SL
authors.lastname: Koppenhaver
authors.affiliation: Telemedicine and Advanced Technology Research Center, U.S. Army Medical Research and Material Command, Ft Detrick, Maryland, USA.
authors.forename: Deydre
authors.initials: D
authors.lastname: Teyhen
mesh_terms: D000293:Adolescent; D000328:Adult; D003131:Combined Modality Therapy; D017586:Diskectomy / Q000379:methods / Q000534:rehabilitation; D005081:Exercise Therapy / Q000379:methods*; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000534:rehabilitation* / Q000601:surgery; D017116:Low Back Pain / Q000601:surgery; D008875:Middle Aged; D010147:Pain Measurement; D064170:Paraspinal Muscles / Q000502:physiology; D011182:Postoperative Care / Q000379:methods; D011446:Prospective Studies; D016896:Treatment Outcome; D055815:Young Adult
keywords: Back injuries; Core stability/pelvis/hips, ribs; Exercise rehabilitation; Physiotherapy; Skeletal Muscle Physiology