Advertisement

European Spine Journal

, Volume 18, Issue 3, pp 398–409 | Cite as

Clinic-based training in comparison to home-based training after first-time lumbar disc surgery: a randomised controlled trial

  • Ann-Christin JohanssonEmail author
  • Steven J. Linton
  • Leif Bergkvist
  • Olle Nilsson
  • Michael Cornefjord
Original Article

Abstract

The effectiveness of physiotherapy after first-time lumbar disc surgery is still largely unknown. Studies in this field are heterogeneous and behavioural treatment principles have only been evaluated in one earlier study. The aim of this randomised study was to compare clinic-based physiotherapy with a behavioural approach to a home-based training programme regarding back disability, activity level, behavioural aspects, pain and global health measures. A total of 59 lumbar disc patients without any previous spine surgery or comorbidity participated in the study. Clinic-based physiotherapy with a behavioural approach was compared to home-based training 3 and 12 months after surgery. Additionally, the home training group was followed up 3 months after surgery by a structured telephone interview evaluating adherence to the exercise programme. Outcome measures were: Oswestry Disability Index (ODI), physical activity level, kinesiophobia, coping, pain, quality of life and patient satisfaction. Treatment compliance was high in both groups. There were no differences between the two groups regarding back pain disability measured by ODI 3 and 12 months after surgery. However, back pain reduction and increase in quality of life were significantly higher in the home-based training group. The patients in the clinic-based training group had significantly higher activity levels 12 months after surgery and were significantly more satisfied with physiotherapy care 3 months after surgery compared to the home-based training group. Rehabilitation after first-time lumbar disc surgery can be based on home training as long as the patients receive both careful instructions from a physiotherapist and strategies for active pain coping, and have access to the physiotherapist if questions regarding training arise. This might be a convenient treatment arrangement for most patients.

Keywords

Lumbar disc herniation Surgery Physiotherapy Behavioural Training 

Notes

Acknowledgments

This research was supported by grants from the County Council of Västmanland (Västmanlands läns Landsting) to Ann-Christin Johansson. The protocol has been examined and approved by the Ethics Committee at the Faculty of Medicine at Uppsala University.

References

  1. 1.
    Barrios C, Ahmed M, Arrotegui JI, Bjornsson A (1990) Clinical factors predicting outcome after surgery for herniated lumbar discs: an epedemiological multivariate analysis. J Spinal Disord 3:205–209. doi: 10.1097/00002517-199009000-00002 PubMedCrossRefGoogle Scholar
  2. 2.
    Bassett SF, Prapavessis H (2007) Home-based physical therapy intervention with adherence-enhancing strategies versus clinic-based management for patients with ankle sprains. Phys Ther 87:1132–1143PubMedGoogle Scholar
  3. 3.
    Brooks R (1996) EuroQol: the current state of play. Health Policy 37:53–72. doi: 10.1016/0168-8510(96)00822-6 PubMedCrossRefGoogle Scholar
  4. 4.
    Choi G, Pai-Raiturker P, Kim MJ, Dai Jin C, Chae YS, Lee YS (2005) The effect of early isolated lumbar extension exercise program for patients with herniated disc undergoing lumbar discectomy. Neurosurgery 57:764–772. doi: 10.1227/01.NEU.0000175858.80925.38 PubMedCrossRefGoogle Scholar
  5. 5.
    Danielsen J, Johnsen R, Kibsgaard S (2000) Early, aggresive exercise for postoperative rehabilitation after discectomy. Spine 25:1015–1020. doi: 10.1097/00007632-200004150-00017 PubMedCrossRefGoogle Scholar
  6. 6.
    Davidson M, Keating JL (2002) A comparison of five low back disability questionnaires: reliability and responsiveness. Phys Ther 82:8–24PubMedGoogle Scholar
  7. 7.
    De Carlo MS, Sell KE (1997) The effects of the number and frequency of physical therapy treatments on selected outcomes of treatment in patients with anterior cruciate ligament reconstruction. J Orthop Sports Phys Ther 26:332–339PubMedGoogle Scholar
  8. 8.
    den Boer J, Oosendorp R, Beems T, Munneke M, AW E (2006) Continued disability and pain after lumbar disc surgery: the role of cognitive-behavioural factors. Pain 123:45–52. doi: 10.1016/j.pain.2006.02.008 CrossRefGoogle Scholar
  9. 9.
    den Boer JJ, Oostendorp RA, Beems T, Munneke M, Evers AW (2006) Reduced work capacity after lumbar disc surgery: the role of cognitive-behavioral and work-related risk factors. Pain 126:72–78. doi: 10.1016/j.pain.2006.06.010 CrossRefGoogle Scholar
  10. 10.
    Doland P, Greenfield K, Nelson RJ, Nelson IW (2000) Can exercise therapy improve the outcome of microdiscectomy? Spine 25:1523–1532. doi: 10.1097/00007632-200006150-00011 CrossRefGoogle Scholar
  11. 11.
    Donaldson BL, Shipton EA, Inglis G, Rivett D, Frampton C (2006) Comparison of usual surgical advice versus a nonaggravating six-month gym-based exercise rehabilitation program post-lumbar discectomy: results at one-year follow-up. Spine J 6:357–363. doi: 10.1016/j.spinee.2005.10.009 PubMedCrossRefGoogle Scholar
  12. 12.
    Erdogmus CB, Resch KL, Sabitzer R, Muller H, Nuhr M, Schoggl A, Posch M, Osterode W, Ungersbock K, Ebenbichler GR (2007) Physiotherapy-based rehabilitation following disc herniation operation: results of a randomized clinical trial. Spine 32:2041–2049. doi: 10.1097/BRS.0b013e318145a386 PubMedCrossRefGoogle Scholar
  13. 13.
    Fairbank JC, Couper J, Davies JB, O’Brien JP (1980) The Oswestry low back pain disability questionnaire. Physiotherapy 66:271–273PubMedGoogle Scholar
  14. 14.
    Fairbank JC, Pynsent PB (2000) The Oswestry disability index. Spine 25:2940–2952. doi: 10.1097/00007632-200011150-00017 Discussion 2952PubMedCrossRefGoogle Scholar
  15. 15.
    Filiz M, Cakmak A, Ozcan E (2005) The effectiveness of exercise programmes after lumbar disc surgery: a randomized controlled study. Clin Rehabil 19:4–11. doi: 10.1191/0269215505cr836oa PubMedCrossRefGoogle Scholar
  16. 16.
    Fordyce WE (1976) Behavioral methods for chronic pain and illness. Mosby, St LouisGoogle Scholar
  17. 17.
    George SZ, Fritz JM, Bialosky JE, Donald DA (2003) The effect of a fear-avoidance-based physical therapy intervention for patients with acute low back pain: results of a randomized clinical trial. Spine 28:2551–2560. doi: 10.1097/01.BRS.0000096677.84605.A2 PubMedCrossRefGoogle Scholar
  18. 18.
    Gijsen R, Hoeymans N, Schellevis FG, Ruwaard D, Satariano WA, van den Bos GA (2001) Causes and consequences of comorbidity: a review. J Clin Epidemiol 54:661–674. doi: 10.1016/S0895-4356(00)00363-2 PubMedCrossRefGoogle Scholar
  19. 19.
    Hakkinen A, Ylinen J, Kautiainen H, Tarvainen U, Kiviranta I (2005) Effects of home strength training and stretching versus stretching alone after lumbar disk surgery: a randomized study with a 1-year follow-up. Arch Phys Med Rehabil 86:865–870. doi: 10.1016/j.apmr.2004.11.012 PubMedCrossRefGoogle Scholar
  20. 20.
    Hurme M, Alaranta H (1987) Factors predicting the results of surgery for lumbar intervertebral disc herniation. Spine 12:933–938. doi: 10.1097/00007632-198711000-00016 PubMedCrossRefGoogle Scholar
  21. 21.
    Häkkinen A, Kautiainen H, Jarvenpaa S, Arkela-Kautiainen M, Ylinen J (2006) Changes in the total Oswestry Index and its items in females and males pre- and post-surgery for lumbar disc herniation: a 1-year follow up. Eur Spine J 16:347–352. doi: 10.1007/s00586-006-0187-8 PubMedCrossRefGoogle Scholar
  22. 22.
    Johannsen F, Remvig L, Kryger P, Beck P, Lybeck K, Larsen LH, Warming S, Dreyer V (1994) Supervised endurance exercise training compared to home training after first lumbar diskectomy: a clinical trial. Clin Exp Rheumatol 12:609–614PubMedGoogle Scholar
  23. 23.
    Jönsson B, Strömqvist B (1995) Influence of age on symptoms and signs in lumbar disc herniation. Eur Spine J 4:202–205. doi: 10.1007/BF00303410 PubMedCrossRefGoogle Scholar
  24. 24.
    Kjellby-Wendt G, Carlsson SG, Styf J (2002) Results of early active rehabilitation 5–7 years after surgical treatment for lumbar disc herniation. J Spinal Disord Tech 15:404–409PubMedGoogle Scholar
  25. 25.
    Kjellby-Wendt G, Styf J, Carlsson SG (2001) Early active rehabilitation after surgery for lumbar disc herniation: a prospective, randomized study of psychometric assessment in 50 patients. Acta Orthop Scand 72:518–524. doi: 10.1080/000164701753532871 PubMedCrossRefGoogle Scholar
  26. 26.
    Kjellby-Wendt G, Styyf J (1998) Early active training after lumbar discectomy. A prospective, randomized, and controlled study. Spine 23:2345–2351. doi: 10.1097/00007632-199811010-00019 PubMedCrossRefGoogle Scholar
  27. 27.
    Korres DS, Loupassis G, Stamos K (1992) Results of lumbar discectomy: a study using 15 different evaluation methods. Eur Spine J 1:20–24. doi: 10.1007/BF00302137 CrossRefGoogle Scholar
  28. 28.
    Lawson K, Reesor KA, Keefe FJ, Turner JA (1990) Dimensions of pain-related cognitive coping: cross-validation of the factor structure of the Coping Strategy Questionnaire. Pain 43:195–204. doi: 10.1016/0304-3959(90)91073-R PubMedCrossRefGoogle Scholar
  29. 29.
    Lindstrom I, Ohlund C, Nachemson A (1995) Physical performance, pain, pain behavior and subjective disability in patients with subacute low back pain. Scand J Rehabil Med 27:153–160PubMedGoogle Scholar
  30. 30.
    Lindstrom I, Öhlund C, Eek C, Wallin L, Peterson LE, Fordyce WE, Nachemson AL (1992) The effect of graded activity on patients with subacute low back pain. Phys Ther 72:279–293PubMedGoogle Scholar
  31. 31.
    Manniche C, Asmussen KH, Vinterberg H, Rose Hansen EB, Kramhoft J, Jordan A (1994) Analysis of preoperative prognostic factors in first-time surgery for lumbar disc herniation, including Finneson’s and modified Sprengler’s score systems. Dan Med Bull 41:110–115PubMedGoogle Scholar
  32. 32.
    Manniche C, Asmussen KH, Vinterberg H, Rose Hansen EB, Kramhoft J, Jordan A (1994) Back pain, sciatica and disability following first time conventional haemilaminectomy for lumbar disc herniation. Use of “Low Back Pain Rating Scale” as a postal questionnaire. Dan Med Bull 41:103–106PubMedGoogle Scholar
  33. 33.
    Manniche C, Skall H, Braendholt B, Christensen B, Christophersen L, Ellegaard B, Heilbuth A, Ingerslev M, Jorgensen O, Larsen E, Lorentzen L, Nielsen C, Nielsen H, Windelin M (1993) Clinical trial of postoperative dynamic back exercises after first lumbar discectomy. Spine 18:92–97. doi: 10.1097/00007632-199301000-00014 PubMedCrossRefGoogle Scholar
  34. 34.
    Mannion AF, Denzler R, Dvorak J, Muntener M, Grob D (2007) A randomised controlled trial of post-operative rehabilitation after surgical decompression of the lumbar spine. Eur Spine J 16:1101–1117. doi: 10.1007/s00586-007-0399-6 PubMedCrossRefGoogle Scholar
  35. 35.
    Mannion AF, Dvorak J, Muntener M, Grob D (2005) A prospective study of the interrelationship between subjective and objective measures of disability before and 2 months after lumbar decompression surgery for disc herniation. Eur Spine J 14:454–465. doi: 10.1007/s00586-004-0787-0 PubMedCrossRefGoogle Scholar
  36. 36.
    Miller RP, Kori SH, Todd DD (1991) The Tampa Scale. Unpublished Report, Tampa, FLGoogle Scholar
  37. 37.
    Millisdotter M, Stromqvist B (2007) Early neuromuscular customized training after surgery for lumbar disc herniation: a prospective controlled study. Eur Spine J 16:19–26. doi: 10.1007/s00586-005-0044-1 PubMedCrossRefGoogle Scholar
  38. 38.
    Moore JE, Von Korff M, Cherkin D, Saunders K, Lorig K (2000) A randomized trial of a cognitive-behavioral program for enhancing back pain self care in a primary care setting. Pain 88:145–153. doi: 10.1016/S0304-3959(00)00314-6 PubMedCrossRefGoogle Scholar
  39. 39.
    O’Sullivan PB, Twomey LT, Allison GT (1997) Evaluation of specific stabilizing exercise in the treatment of chronic low back pain with radiologic diagnosis of spondylosis or spondylolisthesis. Spine 22:2959–2967. doi: 10.1097/00007632-199712150-00020 PubMedCrossRefGoogle Scholar
  40. 40.
    Ostelo RJ, de Vet HCW, Wadell G, Kerckhoffs MR, Leffers P, van Tulder MW (2002) Rehabilitation after lumbar disc surgery. Cochrane Database Syst RevGoogle Scholar
  41. 41.
    Ostelo RWJG, de Vet HCW, Wadell G, Kerckhoffs MR, Lefflers P, van Tulder M (2003) Rehabilitation following first-time lumbar disc surgery. Spine 28:209–218. doi: 10.1097/00007632-200302010-00003 PubMedCrossRefGoogle Scholar
  42. 42.
    Ostelo RWJG, van Tulder MW, Vlaeyen JWS, Linton SJ, Morley SJ, Assendelft WJJ (2005) Behavioural treatment for chronic low-back-pain. Cochrane Database Syst RevGoogle Scholar
  43. 43.
    Pappas CTE, Harrington T, Sonntag VKH (1992) Outcome analysis in 654 surgically treated lumbar disc herniations. Neurosurgery 30:862–866. doi: 10.1097/00006123-199206000-00007 PubMedCrossRefGoogle Scholar
  44. 44.
    Roddey TS, Olson SL, Gartsman GM, Hanten WP, Cook KF (2002) A randomized controlled trial comparing 2 instructional approaches to home exercise instruction following arthroscopic full-thickness rotator cuff repair surgery. J Orthop Sports Phys Ther 32:548–559PubMedGoogle Scholar
  45. 45.
    Rosenstiel AK, Keefe FJ (1983) The use of coping strategies in chronic low back pain patients: relationship to patient characteristics and current adjustment. Pain 17:33–44. doi: 10.1016/0304-3959(83)90125-2 PubMedCrossRefGoogle Scholar
  46. 46.
    Stromqvist B, Fritzell P, Hagg O, Jonsson B (2005) One-year report from the Swedish National Spine Register. Swedish Society of Spinal Surgeons. Acta Orthop Suppl 76:1–24. doi: 10.1080/17453690510041950 PubMedCrossRefGoogle Scholar
  47. 47.
    Sullivan M, Karlsson J, Ware JE (1994) Hälsoenkät SF-36. Svensk manual och tolkningsguide (SF-36 Health survey, Swedish Manual and Interpretation Guide), Sahlgrenska University Hospital, Göteborg. Göteborgs UniversitetGoogle Scholar
  48. 48.
    Sullivan MJ, Adams H, Rhodenizer T, Stanish WD (2006) A psychosocial risk factor-targeted intervention for the prevention of chronic pain and disability following whiplash injury. Phys Ther 86:8–18PubMedGoogle Scholar
  49. 49.
    Ware JEJ, Sherbourne CD (1992) The MOS 36-item Short-Form health survey (SF-36). 1. Conceptual framework and item selection. Med Care 30:473–483. doi: 10.1097/00005650-199206000-00002 PubMedCrossRefGoogle Scholar
  50. 50.
    Vlaeyen JW, Haazen IW, Schuerman JA, Kole-Snijders AM, van Eek H (1995) Behavioural rehabilitation of chronic low back pain: comparison of an operant treatment, an operant-cognitive treatment and an operant-respondent treatment. Br J Clin Psychol 34:95–118PubMedGoogle Scholar
  51. 51.
    Vlaeyen JW, Kole-Snijders AM, Boeren RG, van Eek H (1995) Fear of movement/(re) injury in chronic low back pain and its relation to behavioural performance. Pain 62:363–372. doi: 10.1016/0304-3959(94)00279-N PubMedCrossRefGoogle Scholar
  52. 52.
    Yilmaz F, Yilmaz A, Merdol F, Parlar D, Sahin F, Kuran B (2003) Efficacy of dynamic lumbar stabilization exercise in lumbar microdiscectomy. J Rehabil Med 35:163–167. doi: 10.1080/16501970306125 PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  • Ann-Christin Johansson
    • 1
    Email author
  • Steven J. Linton
    • 2
  • Leif Bergkvist
    • 3
  • Olle Nilsson
    • 4
  • Michael Cornefjord
    • 4
  1. 1.Department of Orthopaedic Surgery, Center for Clinical Research, Central HospitalUppsala UniversityVästeråsSweden
  2. 2.Department of Behavioural, Social and Legal Sciences PsychologyÖrebro UniversityÖrebroSweden
  3. 3.Department of Surgery, Center for Clinical Research, Central HospitalUppsala UniversityVästeråsSweden
  4. 4.Department of OrthopaedicsUppsala University HospitalUppsalaSweden

Personalised recommendations