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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

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Abstract

Purpose

The aim of the study was to investigate the effectiveness of the postoperative 12-month exercise program compared to usual care on disability and health-related quality of life (HRQoL) in patients after lumbar spine fusion surgery (LSF).

Methods

Altogether, 98 patients with isthmic (31) or degenerative (67) spondylolisthesis were randomised to exercise therapy group (EG) (n = 48) or usual care group (UCG) (n = 50) 3 months after LSF. EG patients had home-based progressive strength and aerobic training program for 12 months. UCG patients received only oral and written instructions of exercises. Oswestry Disability Index (ODI) and HRQoL (RAND-36) were evaluated at the time of randomization, at the end of the intervention and 1 year after intervention.

Results

The mean ODI score decreased from 24 (12) to 18 (14) in the EG and from 18 (12) to 13 (11) in the UCG during intervention (between-groups p = 0.69). At 1-year follow-up, 25 % of the EG and 28 % of the UCG had an ODI score ≥20. No between-group differences in HRQoL change were found at any time point. The mean (95 % CI) physical functioning dimension of the HRQoL improved by 10.0 (4.6–15.3) in the EG and by 7.8 (2.5–13.0) in the UCG. In addition, the role physical score improved by 20.0 (7.7–32.3) in the EG and by 16.4 (4.4–28.4) in the UCG during the intervention.

Conclusions

The exercise intervention did not have an impact on disability or HRQoL beyond the improvement achieved by usual care. However, disability remained at least moderate in considerable proportion of patients.

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References

  1. Möller H, Hedlund R (2000) Surgery versus conservative management in adult isthmic spondylolisthesis: a prospective randomized study: part 1. Spine 25(13):1711–1715

    Article  PubMed  Google Scholar 

  2. Weinstein JN, Lurie JD, Tosteson TD, Hanscom B, Tosteson ANA, Blood EA, Birkmeyer NJO, Hilibrand AS, Herkowitz H, Cammisa FP, Albert TJ, Emery SE, Lenke LG, Abdu WA, Longley M, Errico TJ, Hu SS (2007) Surgical versus nonsurgical treatment for lumbar degenerative spondylolisthesis. N Engl J Med 356(22):2257–2270. doi:10.1056/NEJMoa070302

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Pekkanen L, Neva MH, Kautiainen H, Dekker J, Piitulainen K, Wahlman M, Hakkinen A (2013) Disability and health-related quality of life in patients undergoing spinal fusion: a comparison with a general population sample. BMC Musculoskelet Disord 14:211. doi:10.1186/1471-2474-14-211

    Article  PubMed  PubMed Central  Google Scholar 

  4. van Dieën JH, Selen LPJ, Cholewicki J (2003) Trunk muscle activation in low-back pain patients, an analysis of the literature. J Electromyogr 13(4):333–351. doi:10.1016/S1050-6411(03)00041-5

    Article  Google Scholar 

  5. Smeets RJ, Wittink H, Hidding A, Knottnerus JA (2006) Do patients with chronic low back pain have a lower level of aerobic fitness than healthy controls?: are pain, disability, fear of injury, working status, or level of leisure time activity associated with the difference in aerobic fitness level? Spine 31(1):90–97. doi:10.1097/01.brs.0000192641.22003.83 (Phila PA 1976)

    Article  PubMed  Google Scholar 

  6. Motosuneya T, Asazuma TF, Tsuji TF, Watanabe HF, Nakayama YF, Nemoto K (2006) Postoperative change of the cross-sectional area of back musculature after 5 surgical procedures as assessed by magnetic resonance imaging. J Spinal Disord Tech 19(5):318–322. doi:10.1097/01.bsd.0000211205.15997.06

    Article  PubMed  Google Scholar 

  7. Hyun SJ, Kim YB, Kim YS, Park SW, Nam TK, Hong HJ, Kwon JT (2007) Postoperative changes in paraspinal muscle volume: comparison between paramedian interfascial and midline approaches for lumbar fusion. J Korean Med Sci 22(4):646–651. doi:10.3346/jkms.2007.22.4.646

    Article  PubMed  PubMed Central  Google Scholar 

  8. Fan S, Hu Z, Zhao F, Zhao X, Huang Y, Fang X (2010) Multifidus muscle changes and clinical effects of one-level posterior lumbar interbody fusion: minimally invasive procedure versus conventional open approach. Eur Spine J 19(2):316–324. doi:10.1007/s00586-009-1191-6

    Article  PubMed  Google Scholar 

  9. Tarnanen S, Neva MH, Hakkinen K, Kankaanpaa M, Ylinen J, Kraemer WJ, Newton RU, Hakkinen A (2014) Neutral spine control exercises in rehabilitation after lumbar spine fusion. J Strength Cond Res 7:2018–2025. doi:10.1519/JSC.0000000000000334

    Article  Google Scholar 

  10. Abbott AD, Tyni-Lenne R, Hedlund R (2010) Early rehabilitation targeting cognition, behavior, and motor function after lumbar fusion: a randomized controlled trial. Spine 35(8):848–857. doi:10.1097/BRS.0b013e3181d1049f (Phila Pa 1976)

    Article  PubMed  Google Scholar 

  11. Christensen FB, Laurberg I, Bunger CE (2003) Importance of the back-cafe concept to rehabilitation after lumbar spinal fusion: a randomized clinical study with a 2-year follow-up. Spine 28(23):2561–2569. doi:10.1097/01.BRS.0000097890.96524.A1 (Phila Pa 1976)

    Article  PubMed  Google Scholar 

  12. Monticone M, Ferrante S, Teli M, Rocca B, Foti C, Lovi A, Brayda Bruno M (2014) Management of catastrophising and kinesiophobia improves rehabilitation after fusion for lumbar spondylolisthesis and stenosis. A randomised controlled trial. Eur Spine J 23(1):87–95. doi:10.1007/s00586-013-2889-z

    Article  PubMed  Google Scholar 

  13. Nielsen PR, Andreasen J, Asmussen M, Tonnesen H (2008) Costs and quality of life for prehabilitation and early rehabilitation after surgery of the lumbar spine. BMC Health Serv Res 8:209. doi:10.1186/1472-6963-8-209

    Article  PubMed  PubMed Central  Google Scholar 

  14. Nielsen PR, Jørgensen LD, Dahl B, Pedersen T, Tønnesen H (2010) Prehabilitation and early rehabilitation after spinal surgery: randomized clinical trial. Clin Rehabil 24(2):137–148. doi:10.1177/0269215509347432

    Article  PubMed  Google Scholar 

  15. Rushton A, Eveleigh G, Petherick EJ, Heneghan N, Bennett R, James G, Wright C (2012) Physiotherapy rehabilitation following lumbar spinal fusion: a systematic review and meta-analysis of randomised controlled trials. BMJ Open. doi:10.1136/bmjopen-2012-000829 (Print 2012)

    PubMed  PubMed Central  Google Scholar 

  16. Soegaard R, Christensen FB, Lauerberg I, Bünger CE (2006) Lumbar spinal fusion patients’ demands to the primary health sector: evaluation of three rehabilitation protocols. A prospective randomized study. Eur Spine J 15(5):648–656. doi:10.1007/s00586-005-0884-8

    Article  PubMed  Google Scholar 

  17. Soegaard R, Christensen FB, Christiansen T, Bünger C (2007) Costs and effects in lumbar spinal fusion. A follow-up study in 136 consecutive patients with chronic low back pain. Eur Spine J 16(5):657–668. doi:10.1007/s00586-006-0179-8

    Article  PubMed  Google Scholar 

  18. Tarnanen S, Neva MH, Dekker J, Häkkinen K, Vihtonen K, Pekkanen L, Häkkinen A (2012) Randomized controlled trial of postoperative exercise rehabilitation program after lumbar spine fusion: study protocol. BMC Musculoskelet Disord 13:123. doi:10.1186/1471-2474-13-123

    Article  PubMed  PubMed Central  Google Scholar 

  19. Pekkanen L, Kautiainen H, Ylinen J, Salo P, Hakkinen A (2011) Reliability and validity study of the Finnish version 2.0 of the oswestry disability index. Spine 36(4):332–338. doi:10.1097/BRS.0b013e3181cdd702 (Phila Pa 1976)

    Article  PubMed  Google Scholar 

  20. Fairbank J, Couper J, Davies J, O’Brien J (1980) The Oswestry low back pain disability questionnaire. Physiotherapy 66:271–273

    CAS  PubMed  Google Scholar 

  21. Aalto A, Aro AR, Teperi J (1999) RAND-36 terveyteen liittyvän elämänlaadun mittarina. Mittarin luotettavuus ja suomalaiset väestöarvot. STAKES Sosiaali—ja terveysalan tutkimus—ja kehittämiskeskus, Helsinki

    Google Scholar 

  22. Hays R, Sherbourne C, Mazel R (1993) The RAND 36-item health survey 1.0. Health Econ 2(3):217–227. doi:10.1002/hec.4730020305

    Article  CAS  PubMed  Google Scholar 

  23. Price DD, McGrath PA, Rafii A, Buckingham B (1983) The validation of visual analogue scales as ratio scale measures for chronic and experimental pain. Pain 17(1):45–56

    Article  CAS  PubMed  Google Scholar 

  24. Oestergaard L, Christensen F, Nielsen C, Bunger C, Fruensgaard S, Sogaard R (2013) Early versus late initiation of rehabilitation after lumbar spinal fusion: economic evaluation alongside a randomized controlled trial. Spine 38(23):1979–1985. doi:10.1097/BRS.0b013e3182a7902c (Phila Pa 1976)

    Article  PubMed  Google Scholar 

  25. Lindgreen P, Rolving N, Nielsen CV, Lomborg K (2016) Interdisciplinary cognitive-behavioral therapy as part of lumbar spinal fusion surgery rehabilitation: experience of patients with chronic low back pain. Orthop Nurs 35(4):238–247. doi:10.1097/NOR.0000000000000259

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

The authors would like to thank Sami Tarnanen (Ph.D., PT) and Jari Ylinen (Ph.D., MD) for their contribution in intervention planning, study nurse Seija Rautiainen for the data collection and data management, and Päivi Kolu (MSc) and Mirja Vuorenmaa (MSc) for carrying out the intervention. The study is funded by the Academy of Finland, and The Competitive State Research Financing of the Expert Responsibility Area of Tampere University Hospital and Central Finland Central Hospital.

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Authors and Affiliations

  1. Department of Health Sciences, University of Jyväskylä, Viveca Building, P.O. Box 35, 40014, Jyväskylä, Finland

    Outi Ilves, Arja Häkkinen & Kirsi Piitulainen

  2. Department of Physical Medicine and Rehabilitation, Central Finland Health Care District, Keskussairaalantie 19, 40620, Jyväskylä, Finland

    Outi Ilves, Arja Häkkinen, Kirsi Piitulainen & Salme Järvenpää

  3. Department of Rehabilitation Medicine, VU University Medical Center, P.O. Box 7057, 1007MB, Amsterdam, The Netherlands

    Joost Dekker

  4. Department of Psychiatry, VU University Medical Center, P.O. Box 7057, 1007MB, Amsterdam, The Netherlands

    Joost Dekker

  5. Department of Orthopaedic Medicine, Central Finland Health Care District, Keskussairaalantie 19, 40620, Jyväskylä, Finland

    Liisa Pekkanen

  6. Department of Orthopaedics and Trauma, Tampere University Hospital, P.O. BOX 2000, 33521, Tampere, Finland

    Ilkka Marttinen, Kimmo Vihtonen & Marko H. Neva

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  1. Outi Ilves
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Correspondence to Outi Ilves.

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Ilves, O., Häkkinen, A., Dekker, J. et al. 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. Eur Spine J 26, 777–784 (2017). https://doi.org/10.1007/s00586-016-4789-5

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