EBP points regarding rehabilitation programs form reviews of Cochrane 2003-08 following lumbar disc surgery.

-

Although several rehabilitation programs, physical fitness programs, or protocols regarding instruction for patients to return to work after lumbar disc surgery have been suggested, little is known about the efficacy of these treatments, and there are still persistent fears of causing reinjury, reherniation, or instability.

Ostelo RW (2003) et al reviewed 13 studies 6 only ware of high quality from Cochrane only. The summary of this research is as follows:

Evidences:
1. For treatments that start 4 to 6 weeks postsurgery, there is strong evidence (level 1) that intensive exercise programs are more effective on functional status and faster return to work (short-term follow-up) as compared to mild exercise programs,
2. and there is strong evidence (level 1) that on long-term follow-up there is no difference between intensive exercise programs and mild exercise programs with regard to overall improvement.
3. For all other primary outcome measures for the comparison between intensive and mild exercise programs, there is conflicting evidence (level 3) with regard to long-term follow-up.
4. Furthermore, there is no strong evidence for the effectiveness of supervised training as compared to home exercises.
5. There is also no strong evidence for the effectiveness of multidisciplinary rehabilitation as compared to usual care.
6. There is limited evidence (level 3) that treatments in working populations that aim at return to work are more effective than usual care with regard to return to work.
7. Also, there is limited evidence (level 3) that low-tech and high-tech exercises, started more than 12 months postsurgery, are more effective in improving low-back functional status as compared to physical agents, joint manipulations, or no treatment.
8. Finally, there is no strong evidence for the effectiveness of any specific intervention when added to an exercise program, regardless of whether exercise programs start immediately postsurgery or later.
9. None of the investigated treatments seem harmful with regard to reherniation or reoperation.

Summay of conclusion is as follows:
There is no evidence that patients need to have their activities restricted after first-time lumbar disc surgery. There is strong evidence for intensive exercise programs (at least if started about 4-6 weeks postoperative) and no evidence they increase the reoperation rate. It is unclear what the exact content of postsurgery rehabilitation should be. Moreover, there are no studies that investigated whether active rehabilitation programs should start immediately postsurgery or possibly 4 to 6 weeks later.

The same authors Ostelo RW et al in 2008 reviewed RCTs only from Cochrane Library 2007, Issue 2. The conclusions is as follows:

Exercise programs starting four to six weeks post-surgery 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 re-operation rate after first-time lumbar surgery.

References: (reviews of Ostelo RW et al)
1. Spine. 2003 Feb 1;28(3):209-18.
2. Cochrane Database Syst Rev. 2008 Oct 8;(4):CD003007.


Comments

Post a Comment

Popular posts from this blog

Entrapment of medial calcaneal nerve (MCN)

-
Image
Peripheral nerve entrapment is a rare, but important, cause of foot and ankle pain that often is underdiagnosed and mistreated. A peripheral nerve may become entrapped anywhere along its course, but certain anatomic locations are characteristic (2). The medial calcaneal nerve (MCN) The Tibial nerve is called the planter nerve in the sole. The tibial nerve passes to the sole of the foot takes a turn on the medial side of the calcaneum is called MCN. The medial calcaneal nerve arises from tibial nerve of the inner side of the ankle, perforates the laciniate ligament, travels downwards passing below the bony projection on the inner side of the ankle, and supplies the skin over the medial aspect of the heel. Hence it is the most important nerve for heel sensations. MCN have 2 branches. The anterior branch dominate the cutaneous sensation of the anterior part of the medial calcaneal and heel weight loading field, while the posterior branch dominate the sensation of the posterior an
Read more

Review of Labral Tears of shoulder

-
Image
The glenoid labrum of the shoulder has extensive anatomic variation but appears to be important for contributing to shoulder stability and for increasing the depth of contact between the glenoid labrum and the humeral head. Tears of the labrum are commonly seen in association with other pathologic entities, such as instability and rotator cuff tears, and treatment of the labral pathology may be incidental to treatment of the other more significant pathology. However, conditions isolated to the labrum do occur and can be a significant source of shoulder problems. Effective treatment of these lesions may result in significant improvement in the patient's symptoms (4). Labral lesions are difficult to diagnose, and special diagnostic studies and, frequently, arthroscopy are required. How much we can rely on clinical tests is a question. Shoulder complaints are frequently recurrent. Instability might cause some of these complaints (3). History taking and clinical tests are commonly used
Read more

Differential diagnosis of Anatomic (Radial) snuffbox pain: It is not always DeQuervain’s tenosynovitis.

-
Image
Tendon, Bone & Ligament causes: 1. DeQuervain’s tenosynovitis: Swelling of tendon of APL (Abductor pollicis longus) & extensor pollicis brevis at lateral wrist near anatomic snuff box.  The primary complaint is radial sided wrist pain that radiates up the forearm with grasping or extension of the thumb. The pain has been described as a “constant aching, burning, pulling sensation." Pain is often aggravated by repetitive lifting, gripping, or twisting motions of the hand. Swelling in the anatomical snuff box, tenderness at the radial styloid process, decreased CMC abduction ROM of the 1st digit, palpable thickening of the extensor sheaths of the 1st dorsal compartment and crepitus of the tendons moving from the extensor sheath may be found upon examination. Other possible findings include weakness and paresthesia in the hand. Finkelstein’s diagnostic test will present positive provoking the patient’s symptoms. If left untreated, the inflammation and progressive narro
Read more