Effectiveness of Rehabilitation After Lumbar Disc Surgery
Effectiveness of Rehabilitation After Lumbar Disc Surgery
A systematic review that summarised results of several randomised controlled trials yielded moderate to low quality evidence for effectiveness of postoperative exercise programmes starting 4–6 weeks after first time lumbar disc surgery. Exercise programmes seem to be more beneficial than no treatment, and high intensity exercises may be more effective than low intensity exercises. Little is known about the effectiveness of immediate postoperative interventions in these patients. Besides, knowledge about cost-effectiveness of postoperative management is scarce. Therefore, the REALISE trial aims to evaluate the effectiveness of an exercise therapy intervention starting in the first postoperative week, compared to a watchful waiting policy during the first six to eight weeks after surgery. To that end we mainly focus on the question whether exercise treatment leads to a faster recovery as compared to watchful waiting during this immediate post operative period. Furthermore, cost-effectiveness will be assessed by means of an economic evaluation. Treatment in the intervention group is based on a protocol that allows therapists to provide a tailored intervention. Also, both physiotherapists and exercise therapist will deliver the treatment, as this reflects current practice in the Netherlands. This will result in a variation across treatments and will improve generalisability of the findings. The results of this trial may lead to a more consistent postoperative strategy for patients who underwent surgery for lumbar disc herniation.
Discussion
A systematic review that summarised results of several randomised controlled trials yielded moderate to low quality evidence for effectiveness of postoperative exercise programmes starting 4–6 weeks after first time lumbar disc surgery. Exercise programmes seem to be more beneficial than no treatment, and high intensity exercises may be more effective than low intensity exercises. Little is known about the effectiveness of immediate postoperative interventions in these patients. Besides, knowledge about cost-effectiveness of postoperative management is scarce. Therefore, the REALISE trial aims to evaluate the effectiveness of an exercise therapy intervention starting in the first postoperative week, compared to a watchful waiting policy during the first six to eight weeks after surgery. To that end we mainly focus on the question whether exercise treatment leads to a faster recovery as compared to watchful waiting during this immediate post operative period. Furthermore, cost-effectiveness will be assessed by means of an economic evaluation. Treatment in the intervention group is based on a protocol that allows therapists to provide a tailored intervention. Also, both physiotherapists and exercise therapist will deliver the treatment, as this reflects current practice in the Netherlands. This will result in a variation across treatments and will improve generalisability of the findings. The results of this trial may lead to a more consistent postoperative strategy for patients who underwent surgery for lumbar disc herniation.