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

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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.

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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.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Center for Clinical Research, Central Hospital, Uppsala University, 721 89, Västerås, Sweden

    Ann-Christin Johansson

  2. Department of Behavioural, Social and Legal Sciences Psychology, Örebro University, 701 82, Örebro, Sweden

    Steven J. Linton

  3. Department of Surgery, Center for Clinical Research, Central Hospital, Uppsala University, 721 89, Västerås, Sweden

    Leif Bergkvist

  4. Department of Orthopaedics, Uppsala University Hospital, 756 85, Uppsala, Sweden

    Olle Nilsson & Michael Cornefjord

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  1. Ann-Christin Johansson
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  2. Steven J. Linton
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Correspondence to Ann-Christin Johansson.

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Johansson, AC., Linton, S.J., Bergkvist, L. et al. Clinic-based training in comparison to home-based training after first-time lumbar disc surgery: a randomised controlled trial. Eur Spine J 18, 398–409 (2009). https://doi.org/10.1007/s00586-008-0826-3

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