The effect of early initiation of rehabilitation after lumbar spinal fusion: a randomized clinical study.

Abstract

STUDY DESIGN:

A multicenter randomized clinical trial including 82 patients.

OBJECTIVE:

To examine the effect of early initiation of rehabilitation after instrumented lumbar spinal fusion.

SUMMARY OF BACKGROUND DATA:

Lumbar spinal fusion has been performed for more than 70 years. Yet, few studies have examined patients' subsequent rehabilitation. Group-based rehabilitation is both efficient and cost-effective in rehabilitation of lumbar spinal fusion patients.

METHODS:

Patients with degenerative disc diseases undergoing instrumented lumbar spinal fusion were randomly assigned to initiate their rehabilitation 6 weeks (6-wk group) or 12 weeks after lumbar spinal fusion (12-wk group). Both groups received the same group-based rehabilitation. Primary outcome was the Oswestry Disability Index. Secondary outcome was the Dallas Pain Questionnaire, the Low Back Pain Rating Scale, and absence from work. Wilcoxon rank-sum test was used to compare the groups in terms of differences from baseline to 6 months and 1-year follow-up. Results are presented in median with 25th and 75th percentiles.

RESULTS:

According to the Oswestry Disability Index, at 1-year follow-up, the 6-week-group had a median reduction of -6 (-19; 4) compared with -20 (-30;-7) in the 12-week group (P, 0.05). The Dallas Pain Questionnaire showed overall the same tendency, and within daily activities were significantly reduced in favor of the 12-week group (P, 0.05). For back pain, the 6-week group had a median reduction of -2.2 (-3.0; -0.7) similar with -3.3 (-4.7; -1.7) in the 12-week group (P, 0.05). The results at 6 months of follow-up were similar. No difference was found according to return to work 1 year postsurgery.

CONCLUSION:

Early start of rehabilitation (6 wk vs. 12 wk) after lumbar spinal fusion resulted in inferior outcomes. The improvements in the 12-week group were 4 times better than that in the 6-week group, indicating that the start-up time of rehabilitation is an important contributing factor for the overall outcome.

CITATION:

The Effect of Early Initiation of Rehabilitation after Lumbar Spinal Fusion. / Oestergaard, Lisa Gregersen ; Nielsen, Claus Vinther; Bünger, Cody E; Søgaard, Rikke; Fruensgaard, Søren; Helmig, Peter; Christensen, Finn B.
Spine (Philadelphia), Bind 37, Nr. 21, 10.2012, s. 1803-9.