Early Individualized Physical Therapy After First-Time Lumbar Microdiscectomy and the Effect on Proprioceptive Postural Control, Disability and Pain: A Pilot RCT

Janssens, Lotte; Brumagne, Simon; Spriet, Ann; Maeckelberghe, T.; Thys, Tinne; Bruyninckx, Dominike; Wambeke, Peter Van; Depreitere, Bart

doi:10.1016/j.wneu.2011.12.028

Cited by 1 publication

(16 citation statements)

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“…After removing duplicates from 22 418 citations, 6695 unique citations were identified and 16 clinical trials with concurrent comparison groups for our systematic review from 11 countries across 3 continents were included (figure 1 and online supplemental eTable 1 for the reasons of exclusion). Of the 16 included trials, 4 eligible studies (25%) were conducted in Turkey43–46; 2 (12.5%) in Sweden47 48 and Brazil,35 36 and one each in Iran,49 Norway,50 Belgium,39 Switzerland,37 Wales,51 China,52 Korea53 and Pakistan 38. All trials were published in English.…”

Section: Resultsmentioning

confidence: 99%

“…Seven of the studies enrolled participants with LDH who did not undergo surgery35 36 43 49 51–53 and nine studies included patients with LBP and previous surgery for disc herniation 37–39 44–48 50. The age range of included participants at baseline was 29–65 years with a mean (SD) of 54.38 (9.81) years.…”

Section: Resultsmentioning

confidence: 99%

“…The age range of included participants at baseline was 29–65 years with a mean (SD) of 54.38 (9.81) years. In total (n=16), 25% of the studies did not specify the sex/gender of the study population 39 49 51 53. Sixty-nine per cent reported including both male and female participants, and 6% included male participants only 52.…”

Section: Resultsmentioning

confidence: 99%

“…Sixty-nine per cent reported including both male and female participants, and 6% included male participants only 52. Most studies (87.5%; n=14) delivered the intervention programme to participants in outpatient clinics,35–38 44–53 and in the remainder it was unclear 39 43. The level of disc herniation was reported as L 4 –L 5 in four studies (25%),46 48–50 L 4 –S 1 in one study (6%),52 L 2 –S 1 in one study (6%)47 and L 3 –S 1 in one study (6%) 44.…”

Section: Resultsmentioning

confidence: 99%

“…After several team meetings, the authors decided to stratify the analyses according to (1) those who had not yet undergone surgery and (2) those who had undergone surgery and subsequently examined the effect of MCT for three to four different comparisons (ie, other forms of exercises; minimal intervention, self-management or no intervention; other physical therapist-led interventions, including electrotherapy,35 36 mixed physical therapy techniques37 or conventional physical therapy38 39 and surgery) and performed meta-analyses separately for each stratum. Sensitivity analysis is presented in online supplemental appendix 4.…”

Section: Methodsmentioning

confidence: 99%

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Does motor control training improve pain and function in adults with symptomatic lumbar disc herniation? A systematic review and meta-analysis of 861 subjects in 16 trials

et al. 2022

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ObjectiveTo evaluate the effectiveness of motor control training (MCT) compared with other physical therapist-led interventions, minimal/no intervention or surgery in patients with symptomatic lumbar disc herniation (LDH).DesignSystematic review and meta-analysis.Data sourcesEight databases and the ClinicalTrials.gov were searched from inception to April 2021.Eligibility criteriaWe included clinical trial studies with concurrent comparison groups which examined the effectiveness of MCT in patients with symptomatic LDH. Primary outcomes were pain intensity and functional status which were expressed as mean difference (MD) and standardised mean difference (SMD), respectively.ResultsWe screened 6695 articles, of which 16 clinical trials (861 participants) were eligible. Fourteen studies were judged to have high risk of bias and two studies had some risk of bias. In patients who did not undergo surgery, MCT resulted in clinically meaningful pain reduction compared with other physical therapist-led interventions (ie, transcutaneous electrical nerve stimulation (TENS)) at short-term (MD –28.85, –40.04 to −17.66, n=69, studies=2). However, the robustness of the finding was poor. For functional status, a large and statistically significant treatment effect was found in favour of MCT compared with traditional/classic general exercises at long-term (SMD −0.83 to –1.35 to −0.31, n=63, studies=1) and other physical therapist-led interventions (ie, TENS) at short-term (SMD −1.43 to –2.41 to −0.46, n=69, studies=2). No studies compared MCT with surgery. In patients who had undergone surgery, large SMDs were seen. In favour of MCT compared with traditional/classic general exercises (SMD −0.95 to –1.32 to −0.58, n=124, studies=3), other physical therapist-led interventions (ie, conventional treatments; SMD −2.30 to –2.96 to −1.64, n=60, studies=1), and minimal intervention (SMD −1.34 to –1.87 to −0.81, n=68, studies=2) for functional improvement at short-term. The overall certainty of evidence was very low to low.ConclusionAt short-term, MCT improved pain and function compared with TENS in patients with symptomatic LDH who did not have surgery. MCT improved function compared with traditional/classic general exercises at long-term in patients who had undergone surgery. However, the results should be interpreted with caution because of the high risk of bias in the majority of studies.PROSPERO registration numberCRD42016038166.

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