Ostelo RW, Costa LO, Maher CG, de Vet HC, van Tulder MW.
The objective of this review was to evaluate the effects of active rehabilitation for adults after first-time lumbar disc surgery.Fourteen studies were included, 7 of which had a low risk of bias. Most programs were only assessed in 1 study. Statistical pooling was only completed for 3 comparisons in which exercises started 4 to 6 weeks postsurgery: exercise programs versus no treatment, high versus low intensity exercise programs, and supervised versus home exercises.Â The study found low quality evidence that exercises are more effective than no treatment for pain at short-term follow-up and moderate evidence that exercises are more effective for functional status on short-term follow-up. None of the studies reported that exercises increased the reoperation rate. It also found low quality evidence that high intensity exercises are slightly more effective than low intensity exercise programs for pain in the short-term and moderate evidence that they are more effective for functional status in the short-term. Finally, it found low quality evidenceÂ that there were no significant differences between supervised and home exercises for short-term pain relief or functional status.
The study concluded that exercise programs starting 4 to 6 weeks postsurgery seem to lead to a faster decrease in pain and disability than no treatment. High intensity exercise programs seem to lead to a faster decrease in pain and disability than low intensity programs. There were no significant differences between supervised and home exercises for pain relief, disability, or global perceived effect. There is no evidence that active programs increase the reoperation rate after first-time lumbar surgery.
Spine, 2009, 34(17):1839-48.