Erdogmus Celal B, Resch Karl-Ludwig, Sabitzer Ronald, Müller Horst, Nuhr Martin, Schöggl Andreas, Posch Martin, Osterode Wolf, Ungersböck Karl, Ebenbichler Gerold R
Department of Physical Medicine & Rehabilitation, Vienna Medical University, Vienna, Austria.
Spine (Phila Pa 1976). 2007 Sep 1;32(19):2041-9. doi: 10.1097/BRS.0b013e318145a386.
Three-group, randomized, single blinded, controlled trial.
To test the effectiveness of physiotherapy-based rehabilitation starting 1 week after lumbar disc surgery. In addition, we tried to estimate the contribution of specific effects to the observed outcome (efficacy).
Physiotherapy-based rehabilitation is usually recommended for patients following lumbar disc surgery. Few and conflicting data exist for the relative effectiveness of this intervention.
A total of 120 patients following first-time, uncomplicated lumbar disc surgery were randomly assigned to "comprehensive" physiotherapy, "sham" neck massage, or no therapy. Before enrollment, all subjects completed a minimal physiotherapeutic intervention. Physiotherapy was administered by experienced physiotherapists and consisted of 20 sessions per patient over 12 weeks. Masseurs administered "sham massage" to the neck. The amount of treatment time was equal to that of physiotherapy. The main outcome measure was the Low Back Pain Rating Score (LBPRS) at 6 and 12 weeks, and 1.5 years after randomization. Secondary parameters were patients' overall satisfaction with treatment outcome and socioeconomic and psychologic measures.
At the end of therapy (12 weeks), the LBPRS revealed a significantly better improvement in the physiotherapy group than in the untreated group. LBPRS outcome, however, did not significantly differ between physiotherapy and "sham" therapy. There was a tendency toward significance between the sham therapy and no therapy. Within the 1.5-year follow-up, LBP rating scales remained significantly improved compared with baseline, but there were no significant outcome differences. No statistically significant between-group differences were found for the secondary outcome parameters.
As compared with no therapy, physiotherapy following first-time disc herniation operation is effective in the short-term. Because of the limited benefits of physiotherapy relative to "sham" therapy, it is open to question whether this treatment acts primarily physiologically in patients following first-time lumbar disc surgery, but psychological factors may contribute substantially to the benefits observed.
三组随机单盲对照试验。
测试腰椎间盘手术后1周开始的基于物理治疗的康复效果。此外，我们试图评估特定效应对观察到的结果（疗效）的贡献。
基于物理治疗的康复通常推荐给腰椎间盘手术后的患者。关于这种干预措施的相对有效性，现有数据很少且相互矛盾。
总共120例首次进行无并发症腰椎间盘手术的患者被随机分配到“综合”物理治疗组、“假”颈部按摩组或不接受治疗组。在入组前，所有受试者均完成了最低限度的物理治疗干预。物理治疗由经验丰富的物理治疗师进行，每位患者在12周内接受20次治疗。按摩师对颈部进行“假按摩”。治疗时间与物理治疗相同。主要结局指标是随机分组后6周、12周和1.5年时的下腰痛评分（LBPRS）。次要参数包括患者对治疗结果的总体满意度以及社会经济和心理指标。
在治疗结束时（12周），物理治疗组的LBPRS改善情况明显优于未治疗组。然而，物理治疗组和“假”治疗组之间的LBPRS结果没有显著差异。假治疗组和不治疗组之间有显著差异的趋势。在1.5年的随访期内，与基线相比，腰痛评分量表仍有显著改善，但结果没有显著差异。次要结局参数在组间未发现统计学上的显著差异。
与不治疗相比，首次椎间盘突出症手术后进行物理治疗在短期内是有效的。由于物理治疗相对于“假”治疗的益处有限，对于首次腰椎间盘手术后的患者，这种治疗是否主要通过生理作用尚存在疑问，但心理因素可能对观察到的益处有很大贡献。
