Researchers recently examined the Cochrane Back Review Group Trials Register electronic databases to analyze articles comparing the effectiveness of active rehabilitation with usual care in adults who underwent primary spinal decompression for lumbar spinal stenosis and published their results in Spine.
There were three studies included in the meta-analysis, all of which were deemed to have low risk of bias and none of the studies had an unacceptably high dropout rate. Here are five things to know about the study:
1. There was moderate evidence suggesting active rehabilitation was more effective than usual care to improve short- and long-term functional status.
2. Additional evidence found active rehabilitation had better secondary outcomes, including:
• Short term low back pain improvement
• Long term low back pain improvement
• Long term leg pain improvement
3. The study did not address the cost-effectiveness of active rehabilitation compared with usual rehabilitation. However a 2011 report published in Spine examined the cost-effectiveness of spinal rehabilitation programs in Europe based on data from the EuroQol-5D. The researchers found no significant cost or outcomes difference among patients who underwent a rehabilitation program and/or an educational booklet when compared with usual care for patients who underwent discectomy or lateral nerve root decompression surgery.
4. The timeline for starting rehabilitation is also a factor in the program's success. A 2012 study published in Spine examined 82 patients who either initiated their rehabilitation at six or 12 weeks after their instrumented lumbar spinal fusion. At the one-year follow-up, the earlier group had a median Oswestry Disablity Index of -6 (-19, 4) compared with the 12 week group at -20 (-30; -7). Daily activities were also significantly reduced in favor of the 12-week group. No difference was found in return to work among the two groups.
"Early start of rehabilitation after lumbar spinal fusion resulted in inferior outcomes. The improvements in the 12-week group were four times better than the six-week group, indicating that the start-up time of rehabilitation is an important contributing factor in the overall outcome," concluded the study authors.
5. The Patient Centered Outcomes Research Institute recently granted $1.7 million to Vanderbilt University Medical Center to study postoperative management for degenerative spinal conditions, according to the Reporter. The three-year study will evaluate whether a cognitive-behavioral-based physical therapy program focusing on self-management or an educational program about postoperative recovery is more effective to improve outcomes.
The study will include 260 patients who will undergo six weekly telephone sessions with a physical therapist after undergoing lumbar spinal surgery. The patients will be followed for 12 months after surgery to see which program makes the biggest impact on clinical care.
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