The effect of timing of rehabilitation on physical performance after lumbar spinal fusion: a randomized clinical study
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ORIGINAL ARTICLE
The effect of timing of rehabilitation on physical performance after lumbar spinal fusion: a randomized clinical study Lisa G. Oestergaard • Claus V. Nielsen • Cody E. Bu¨nger • Karen Svidt • Finn B. Christensen
Received: 21 May 2012 / Revised: 4 December 2012 / Accepted: 5 February 2013 / Published online: 6 April 2013 Ó Springer-Verlag Berlin Heidelberg 2013
Abstract 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) ˚ strand Fitness test (AF-test) as measurement. and the A 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. Keywords Spinal fusion Rehabilitation Physical performance Occupational therapy Physiotherapy
L. G. Oestergaard (&) Department of Occupational Therapy and Physiotherapy, Aarhus University Hospital, Noerrebrogade 44, 8000 Aarhus C, Denmark e-mail: [email protected] L. G. Oestergaard C. E. Bu¨nger F. B. Christensen Department of Orthopaedic Surgery, Aarhus University Hospital, Noerrebrogade 44, 8000 Aarhus C, Denmark L. G. Oestergaard K. Svidt Orthopaedic Department, Region Hospital of Silkeborg, 8600 Silkeborg, Denmark C. V. Nielsen Section of Social Medicine and Rehabilitation, Department of Public Health, Aarhus University, 8000 Aarhus C, Denmark
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Introduction 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 [1–5]. A study published in 2003 compared the effect of three different postoperative rehabilitation programs initiated 3 months after LSF.
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