Quality of life and disability: can they be improved by active postoperative rehabilitation after spinal fusion surgery in patients with spondylolisthesis? A randomised controlled trial with 12-month follow-up.
The aim of the study was to investigate the effectiveness of the postoperative 12-month exercise program compared to usual care on disability and health-related quality of life (HRQoL) in patients after lumbar spine fusion surgery (LSF).



Altogether, 98 patients with isthmic (31) or degenerative (67) spondylolisthesis were randomised to exercise therapy group (EG) (n = 48) or usual care group (UCG) (n = 50) 3 months after LSF. EG patients had home-based progressive strength and aerobic training program for 12 months. UCG patients received only oral and written instructions of exercises. Oswestry Disability Index (ODI) and HRQoL (RAND-36) were evaluated at the time of randomization, at the end of the intervention and 1 year after intervention.



The mean ODI score decreased from 24 (12) to 18 (14) in the EG and from 18 (12) to 13 (11) in the UCG during intervention (between-groups p = 0.69). At 1-year follow-up, 25 % of the EG and 28 % of the UCG had an ODI score ≥20. No between-group differences in HRQoL change were found at any time point. The mean (95 % CI) physical functioning dimension of the HRQoL improved by 10.0 (4.6-15.3) in the EG and by 7.8 (2.5-13.0) in the UCG. In addition, the role physical score improved by 20.0 (7.7-32.3) in the EG and by 16.4 (4.4-28.4) in the UCG during the intervention.



The exercise intervention did not have an impact on disability or HRQoL beyond the improvement achieved by usual care. However, disability remained at least moderate in considerable proportion of patients.
Department of Health Sciences, University of Jyväskylä, Viveca Building, P.O. Box 35, 40014, Jyväskylä, Finland. outi.e.ilves@jyu.fi.|Department of Physical Medicine and Rehabilitation, Central Finland Health Care District, Keskussairaalantie 19, 40620, Jyväskylä, Finland. outi.e.ilves@jyu.fi.
Outi
O
Ilves
Department of Health Sciences, University of Jyväskylä, Viveca Building, P.O. Box 35, 40014, Jyväskylä, Finland.|Department of Physical Medicine and Rehabilitation, Central Finland Health Care District, Keskussairaalantie 19, 40620, Jyväskylä, Finland.
Arja
A
Häkkinen
Department of Rehabilitation Medicine, VU University Medical Center, P.O. Box 7057, 1007MB, Amsterdam, The Netherlands.|Department of Psychiatry, VU University Medical Center, P.O. Box 7057, 1007MB, Amsterdam, The Netherlands.
Joost
J
Dekker
Department of Orthopaedic Medicine, Central Finland Health Care District, Keskussairaalantie 19, 40620, Jyväskylä, Finland.
Liisa
L
Pekkanen
Department of Health Sciences, University of Jyväskylä, Viveca Building, P.O. Box 35, 40014, Jyväskylä, Finland.|Department of Physical Medicine and Rehabilitation, Central Finland Health Care District, Keskussairaalantie 19, 40620, Jyväskylä, Finland.
Kirsi
K
Piitulainen
Department of Physical Medicine and Rehabilitation, Central Finland Health Care District, Keskussairaalantie 19, 40620, Jyväskylä, Finland.
Salme
S
Järvenpää
Department of Orthopaedics and Trauma, Tampere University Hospital, P.O. BOX 2000, 33521, Tampere, Finland.
Ilkka
I
Marttinen
Department of Orthopaedics and Trauma, Tampere University Hospital, P.O. BOX 2000, 33521, Tampere, Finland.
Kimmo
K
Vihtonen
Department of Orthopaedics and Trauma, Tampere University Hospital, P.O. BOX 2000, 33521, Tampere, Finland.
Marko H
MH
Neva
D000368:Aged; D006233:Persons with Disabilities / Q000534:rehabilitation / Q000706:statistics & numerical data; D005081:Exercise Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D013123:Spinal Fusion / Q000009:adverse effects / Q000706:statistics & numerical data; D013168:Spondylolisthesis / Q000453:epidemiology / Q000534:rehabilitation / Q000601:surgery
Disability; Health-related quality of life; Lumbar spine fusion; Physiotherapy; Spine surgery
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