Prehabilitation and early rehabilitation after spinal surgery: randomized clinical trial

Nielsen, Per Peetz; Jørgensen, Lars; Dahl, Benny; Pedersen, Thomas Bondo; Tønnesen, Hanne

doi:10.1177/0269215509347432

Cited by 201 publications

(234 citation statements)

References 40 publications

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“…The ODI score decreased from 24 (12) to 18 (14) in the EG (p=0.003) and from 18 (12) to 13 (11) in the UCG (p=0.012) during the intervention (between groups p=0.69) ( Table 2). At baseline, 54% of the EG had an ODI score of 20 or higher.…”

Section: Resultsmentioning

confidence: 98%

“…Thus far, a limited number of randomised controlled trials (RCTs) have been published and the evidence of exercise therapy in restoring the spinal functioning and improving disability or HRQoL after fusion surgery is weak [10][11][12][13][14][15][16]. The commencement time and structure of the rehabilitation programs in previous RCT's varies [10][11][12][13][14]17].…”

Section: Introductionmentioning

confidence: 99%

“…The commencement time and structure of the rehabilitation programs in previous RCT's varies [10][11][12][13][14]17]. Most trials were implemented close to time of surgery, starting preoperatively [13,14], during hospital stay or soon after discharge [10,12].…”

Section: Introductionmentioning

confidence: 99%

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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

et al. 2016

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Section: Resultsmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

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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

et al. 2016

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“…Patients were trained daily by a physiotherapist except at weekends during which the patients were mobilized with help of the ward staff. The criteria for discharge were mobilization from bed to standing position, independent personal hygiene, and independent or assisted stair climb corresponding to one floor [12].…”

Section: Interventionmentioning

confidence: 99%

A comprehensive multimodal pain treatment reduces opioid consumption after multilevel spine surgery

et al. 2013

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Purpose Major spine surgery with multilevel instrumentation is followed by large amount of opioid consumption, significant pain and difficult mobilization in a population of predominantly chronic pain patients. This case-control study investigated if a standardized comprehensive pain and postoperative nausea and vomiting (PONV) treatment protocol would improve pain treatment in this population. Methods A new regimen with acetaminophen, NSAIDs, gabapentin, S-ketamine, dexamethasone, ondansetron and epidural local anesthetic infusion or patient controlled analgesia with morphine, was introduced in a post-intervention group of 41 consecutive patients undergoing multilevel (median 10) instrumented spinal fusions and compared with 44 patients in a pre-intervention group. Results Compared to patients in the pre-intervention group, patients treated according to the new protocol consumed less opioid on postoperative day (POD) 1 (P = 0.024) and 2 (P = 0.048), they were mobilized earlier from bed (P = 0.003) and ambulation was earlier both with and without a walking frame (P = 0.027 and P = 0.027, respectively). Finally, patients following the new protocol experienced low intensities of nausea, sedation and dizziness on POD 1-6. Conclusions In this study of patients scheduled for multilevel spine surgery, it was demonstrated that compared to a historic group of patients receiving usual care, a comprehensive and standardized multimodal pain and PONV protocol significantly reduced opioid consumption, improved postoperative mobilization and presented concomitant low levels of nausea, sedation and dizziness.

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“…Recent years have seen a significant rise in the number of lumbar spinal fusion (LSF) procedures, but only few studies have reviewed different rehabilitation strategies after LSF [1][2][3][4][5]. A study published in 2003 compared the effect of three different postoperative rehabilitation programs initiated 3 months after LSF.…”

Section: Introductionmentioning

confidence: 99%

The effect of timing of rehabilitation on physical performance after lumbar spinal fusion: a randomized clinical study

et al. 2013

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Background The number of patients undergoing lumbar spinal fusion procedures (LSF) has risen in recent years, but only few studies have examined different rehabilitation strategies for this patient group. Purpose To evaluate the impact of initiating rehabilitation either 6 or 12 weeks after a LSF based on the patients' physical performance using the 6-min walking test (6MWT) and the Å strand Fitness test (AF-test) as measurement. Methods A multicentre RCT including 82 patients with degenerative disc diseases undergoing LSF randomly assigned to initiate rehabilitation either 6 or 12 weeks after surgery. Both groups received the same group-based rehabilitation. The main outcome measures were the 6MWT and the AF-test, secondarily questionnaire-based measures. Follow-up at baseline as well as at 3, 6 and 12 months after surgery.Results Comparing the two groups no statistically significant difference was found in walking distance or fitness over time. In both groups, the patients achieved an overall increase in walking distance (p \ 0.01), but no improvement in fitness. The 6MWT showed significant correlation (-0.37 to -0.59) with the questionnaire-based outcome measures (p \ 0.01). The AF-test did not correlate to either the 6MWT or any of the questionnaire-based outcome measures. Conclusion No difference was found in the effect of initiating rehabilitation either 6 or 12 weeks after LSF on the patients' physical performance in terms of fitness and walking distance. The 6MWT showed fair to moderate correlation to the questionnaire-based outcome measures. The AF-test showed no significant independent value, and we question its use in LSF patients.

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Prehabilitation and early rehabilitation after spinal surgery: randomized clinical trial

Abstract: The integrated programme of prehabilitation and early rehabilitation improved the outcome and shortened the hospital stay - without more complications, pain or dissatisfaction.

Cited by 201 publications

References 40 publications

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

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

A comprehensive multimodal pain treatment reduces opioid consumption after multilevel spine surgery

The effect of timing of rehabilitation on physical performance after lumbar spinal fusion: a randomized clinical study

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