Effectiveness of postsurgical rehabilitation following lumbar disc herniation surgery: A systematic review.

Introduction: The effectiveness of post-surgical rehabilitation following lumbar disc herniation (LDH) surgery is unclear. Research question: To investigate the effectiveness and safety of rehabilitation interventions initiated within three months post-surgery for adults treated surgically for LDH. Material and methods: This systematic review searched seven databases from inception to November 2023. Independent reviewers screened studies, assessed and extracted data, and rated the certainty of the evidence using the GRADE approach. Results: This systematic review retrieved 20,531 citations and included 25 randomized controlled trials. The high certainty evidence suggests that adding Pilates exercise to routine care and cognitive behavioral therapy may improve function immediately post-intervention (1 RCT), and that adding whole-body magnetic therapy to exercise, pharmacological and aquatic therapy may reduce low back pain intensity (1 RCT) immediately post-intervention. Compared to placebo, pregabalin did not reduce low back pain or leg pain intensity (1 RCT) (moderate to high certainty evidence). We found no differences between: 1) behavioral graded activity vs. physiotherapy (1 RCT); 2) exercise and education vs. neck massage or watchful waiting (1 RCT); 3) exercise, education, and in-hospital usual care vs. in-hospital usual care (1 RCT); 4) functional or staged exercise vs. usual post-surgical care including exercise (2 RCTs); and 5) supervised exercise with education vs. education (1 RCT). No studies assessed adverse events. Discussion and conclusion: Evidence on effective and safe post-surgical rehabilitation interventions is sparse. This review identified two interventions with potential short-term benefits (Pilates exercises, whole-body magnetic therapy) but safety is unclear, and one with an iatrogenic effect (pregabalin).

Measures for low back pain: a proposal for clinical use

Low back pain represents a serious public health problem. Therefore, great efforts have been made in order to improve and assess the efficacy of its treatment. Reports in international literature have presented important studies concerning instruments to assess pain and functional incapacity in patients with low back pain. This study presents a clinical protocol which was developed by a multidisciplinary team. This protocol consists of the evaluation and distribution of pain, The Spitzer Quality of Life, The Oswestry Low Back Pain Disability Questionnaire, and The Center for Epidemiological Studies Depression Scale. Instruments must be urgently developed or adapted in order to be used according to the Brazilian reality.

Predictors of compliance with short-term treatment among patients with back pain / Factores predictivos del cumplimiento del tratamiento a corto plazo en pacientes con lumbalgia

Objective. Great efforts have been made to find effective treatments for back pain. Nevertheless, the effectiveness of a particular treatment can depend on patient compliance. The objective of this study was to prospectively investigate whether patients' demographic factors, clinical factors, external barriers in following the treatment, and perceptions of disability, quality of life, depression, and control over health were predictive of compliance with a physical therapy program carried out with patients with low back pain. Methods. This was an exploratory prospective cohort study that was carried out in New York City during 1999. All study participants answered a questionnaire at the initial clinical evaluation by a physical therapist and were followed during the treatment. The study assessed compliance with the three treatment regimens that were prescribed for every patient: attending scheduled physical therapy sessions, following a program of home exercises, and watching back-education videotapes. Depending on the individual patient, the planned treatment program could last from 2 to 6 weeks. The study employed a battery of instruments to measure patient characteristics that included perceived functional limitations, perceived quality of life, depression, and their beliefs about their health. Student's t tests and chi-square tests were used to determine if non- and low-compliant patients differed significantly from high-compliant patients. Logistic regression was used to estimate adjusted odds ratios expressing the association of selected variables with compliance. Results. We found that 51% of the patients were either noncompliant or low-compliant overall with the low back pain treatment program. There were differences in compliance behavior among the three treatment regimens, with compliance being highest for watching the back-education videotapes and lowest for doing the home exercises. Poor compliance overall was positively associated with the expectation of barriers in following the proposed treatment, with comorbidity, and with longer duration of treatment in this program. Conclusions. The findings of our study indicate that patient compliance with back pain treatment is a serious and complex problem. Nevertheless, while this study was only an exploratory one, we believe that the results of this study can be used by care providers to identify patients likely to become noncompliant and also by researchers to plan specific studies on the effectiveness of treatment programs for patients with low back pain

Objetivos. Aunque se han hecho grandes esfuerzos por encontrar tratamientos eficaces para las lumbalgias, la eficacia de las diferentes modalidades terapéuticas puede depender de su cumplimiento por parte del paciente. El objetivo de este estudio prospectivo consistió en investigar si las características demográficas del paciente, los factores clínicos, los obstáculos externos al cumplimiento del tratamiento y la percepción subjetiva de la discapacidad y la calidad de vida, la depresión y el control sobre la salud permiten predecir el cumplimiento de un programa fisioterapéutico para pacientes con lumbalgia. Métodos. El estudio, de cohorte, prospectivo y exploratorio, se realizó en la ciudad de Nueva York en 1999. Todos los participantes contestaron un cuestionario durante el examen clínico inicial, realizado por un fisioterapeuta, y fueron seguidos durante el tratamiento. Se investigó el cumplimiento de los tres regímenes terapéuticos prescritos a cada uno de los pacientes, que consistieron en asistir a sesiones programadas de fisioterapia, realizar un programa de ejercicios en su casa y visionar cintas de vídeo educativas sobre la espalda. Dependiendo de cada caso, el programa terapéutico planeado podía durar entre 2 y 6 semanas. Para caracterizar a los pacientes se empleó un conjunto de instrumentos que medían la limitación funcional subjetiva, la calidad de vida, la depresión y las creencias sobre su salud. Para detectar diferencias estadísticamente significativas entre los pacientes no cumplidores o con bajo cumplimiento y aquellos con alto cumplimiento se utilizaron las pruebas de la t de Student y de la 2. Las razones de probabilidades (odds ratios) ajustadas que expresaban la asociación entre determinadas variables y el cumplimiento se estimaron mediante regresión logística. Resultados. En términos generales, 51% de los pacientes incumplieron total o parcialmente el programa terapéutico. Hubo diferencias entre los tres regímenes en lo que se refiere a su cumplimiento; el mayor correspondió a los vídeos educativos y el menor al programa de ejercicios a realizar en casa. El bajo cumplimiento global se asoció de forma positiva a la previsión de obstáculos para seguir el tratamiento propuesto, a la comorbilidad y a la mayor duración del tratamiento. Conclusiones. Los resultados de este estudio indican que el cumplimiento de los tratamientos de la lumbalgia es un problema serio y complejo. Aunque solo se trató de un estudio exploratorio, los autores creen que sus resultados pueden servir a los profesionales de la salud para identificar a los pacientes con probabilidades de no cumplir el tratamiento, y a los investigadores para planear estudios específicos sobre la eficacia de los programas detratamiento de la lumbalgia.