title: Physiotherapeutic interventions before and after surgery for degenerative lumbar conditions: a systematic review.
abstract: BACKGROUND
  Physiotherapeutic management of patients immediately following lumbar spinal surgery is common. However, there is considerable variability in the interventions provided.
  
  
  OBJECTIVE
  To assess the effect of peri-operative physiotherapeutic intervention in adults undergoing surgery for the management of degenerative lumbar conditions.
  
  
  METHODS
  The Cochrane Library, Medline, Embase, CINAHL and PEDro were searched from inception to August 2012.
  
  
  METHODS
  Randomised controlled trials investigating physiotherapeutic interventions prior to and immediately following surgery for degenerative lumbar conditions were included.
  
  
  METHODS
  Two reviewers extracted data independently using a standardised form. Risk of bias was assessed using a modified version of the Cochrane Collaboration tool. The quality of evidence was assessed using the GRADE approach, and the treatment effect size was calculated where comparable outcome measures were used across multiple trials.
  
  
  RESULTS
  Four studies were included. There is very-low-quality evidence that pre- and post-operative exercise in addition to standard physiotherapeutic care may reduce pain, time taken to achieve post-operative functional milestones, and post-operative time off work. Results from one study indicated that there is no clear benefit or risk of harm from performing either prone or side-lying transfers.
  
  
  CONCLUSIONS
  Very-low-quality evidence suggests that physiotherapy may improve pain and function following lumbar surgery. Due to low numbers of included studies and variation in the interventions assessed, the current evidence provides limited guidance for physiotherapeutic practice. Further research is required to determine the effectiveness of physiotherapeutic interventions in this population.
authors.affiliation: Department of Physiotherapy, La Trobe University, Melbourne, Australia. Electronic address: sarah.gilmore@svpm.org.au.
authors.forename: S J
authors.initials: SJ
authors.lastname: Gilmore
authors.affiliation: Department of Physiotherapy, La Trobe University, Melbourne, Australia.
authors.forename: J A
authors.initials: JA
authors.lastname: McClelland
authors.affiliation: Department of Physiotherapy, La Trobe University, Melbourne, Australia.
authors.forename: M
authors.initials: M
authors.lastname: Davidson
mesh_terms: D005081:Exercise Therapy / Q000379:methods; D006801:Humans; D008161:Lumbosacral Region; D019635:Neurosurgical Procedures / Q000534:rehabilitation*; D019637:Orthopedic Procedures / Q000534:rehabilitation*; D010149:Postoperative Pain / Q000534:rehabilitation; D026741:Physical Therapy Modalities; D016032:Randomized Controlled Trials as Topic; D020127:Recovery of Function
keywords: Discectomy; Laminectomy; Physiotherapy; Rehabilitation; Spinal fusion; Systematic review