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Clinic-based training in comparison to home-based training after first-time lumbar disc surgery: a randomised controlled trial
Örebro University, School of Health and Medical Sciences.
Örebro University, School of Law, Psychology and Social Work.ORCID iD: 0000-0001-5359-0452
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2009 (English)In: European spine journal, ISSN 0940-6719, E-ISSN 1432-0932, Vol. 18, no 3, p. 398-409Article in journal (Refereed) Published
Abstract [en]

The effectiveness of physiotherapy after first-time lumbar disc surgery is still largely unknown. Studies in this field are heterogeneous and behavioural treatment principles have only been evaluated in one earlier study. The aim of this randomised study was to compare clinic-based physiotherapy with a behavioural approach to a home-based training programme regarding back disability, activity level, behavioural aspects, pain and global health measures. A total of 59 lumbar disc patients without any previous spine surgery or comorbidity participated in the study. Clinic-based physiotherapy with a behavioural approach was compared to home-based training 3 and 12 months after surgery. Additionally, the home training group was followed up 3 months after surgery by a structured telephone interview evaluating adherence to the exercise programme. Outcome measures were: Oswestry Disability Index (ODI), physical activity level, kinesiophobia, coping, pain, quality of life and patient satisfaction. Treatment compliance was high in both groups. There were no differences between the two groups regarding back pain disability measured by ODI 3 and 12 months after surgery. However, back pain reduction and increase in quality of life were significantly higher in the home-based training group. The patients in the clinic-based training group had significantly higher activity levels 12 months after surgery and were significantly more satisfied with physiotherapy care 3 months after surgery compared to the home-based training group. Rehabilitation after first-time lumbar disc surgery can be based on home training as long as the patients receive both careful instructions from a physiotherapist and strategies for active pain coping, and have access to the physiotherapist if questions regarding training arise. This might be a convenient treatment arrangement for most patients.

Place, publisher, year, edition, pages
2009. Vol. 18, no 3, p. 398-409
Keyword [en]
Lumbar disc herniation, Surgery, Physiotherapy, Behavioural, Training
National Category
Psychology Medical and Health Sciences
Research subject
Psychology; Medicine
Identifiers
URN: urn:nbn:se:oru:diva-13367DOI: 10.1007/s00586-008-0826-3ISI: 000263870200015OAI: oai:DiVA.org:oru-13367DiVA: diva2:388356
Available from: 2011-01-17 Created: 2011-01-11 Last updated: 2017-12-11Bibliographically approved
In thesis
1. Psychosocial factors in patients with lumbar disc herniation: enhancing postoperative outcome by the identifiction of predictive factors and optimised physiotherapy
Open this publication in new window or tab >>Psychosocial factors in patients with lumbar disc herniation: enhancing postoperative outcome by the identifiction of predictive factors and optimised physiotherapy
2008 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Psychosocial factors have been advanced as an explanation for the development of chronic disability in 20 to 30% of patients treated by lumbar disc surgery.

Aims: The overall aim of this thesis was to study the role of psychosocial factors in patients undergoing first-time lumbar disc surgery in relation to the outcome of both surgery and subsequent physiotherapy.

Methods: Sixty-nine patients with lumbar disc herniation undergoing first-time disc surgery participated in the studies; in addition, Study I included 162 knee patients for comparison. Psychosocial factors were assessed preoperatively, as was the activation of the physiological stress response system. Pain, disabil-ity and quality of life were assessed before, and 3 and 12 months after surgery. Coping and kinesiophobia were analysed before and one year after surgery. The results of two different postoperative training programmes were compared.

Results: There were no differences between disc and knee patients regarding the presence of psychosocial stress factors preoperatively (Study I). Disc patients with low diurnal cortisol variability had lower physical function, perceived fewer possibilities to influence their pain and were more prone to catastrophise than patients with high diurnal cortisol variability (Study II). The results of clinic-based physiotherapy and home training did not differ regarding postoperative disability and pain 3 months after surgery. The home-based group had less pain and higher quality of life in comparison to the clinic-based group 12 months after surgery (Study III). Patients’ expectations of returning to work could best predict pain, disability, quality of life and sick leave one year after surgery (Study IV). Psychosocial factors were only weakly asso-ciated to pain, disability, quality of life and sick leave preoperatively. However, these associations were stronger in patients with residual pain one year after surgery.

Conclusion: Psychosocial factors and, in particular, patients’ expectations regarding outcome are associated with the results of lumbar disc surgery. Assessing psychosocial factors preoperatively and developing an active home training programme after surgery could create options leading to better results for these patients.

Place, publisher, year, edition, pages
Örebro: Örebro universitet, 2008. p. 85
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 22
Keyword
Lumbar disc herniation, surgery, psychosocial factors, physio-therapy, expectations
National Category
Medical and Health Sciences
Research subject
Medicine
Identifiers
urn:nbn:se:oru:diva-2516 (URN)978-91-7668-633-1 (ISBN)
Public defence
2008-11-21, Aulan, ingång 21, Centrallasarettet, Västerås, 13:15 (English)
Opponent
Supervisors
Available from: 2008-10-15 Created: 2008-10-15 Last updated: 2017-10-18Bibliographically approved

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Johansson, Ann-ChristinLinton, Steven J.

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