Johansson Ann-Christin, Linton Steven J, Bergkvist Leif, Nilsson Olle, Cornefjord Michael
Department of Orthopaedic Surgery, Center for Clinical Research, Central Hospital, Uppsala University, 721 89, Västerås, Sweden.
Eur Spine J. 2009 Mar;18(3):398-409. doi: 10.1007/s00586-008-0826-3. Epub 2008 Nov 20.
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.
首次腰椎间盘手术后物理治疗的效果在很大程度上仍不明确。该领域的研究存在异质性，行为治疗原则仅在一项早期研究中得到评估。这项随机研究的目的是比较基于诊所的物理治疗与采用行为方法的家庭训练计划在背部残疾、活动水平、行为方面、疼痛和整体健康指标方面的差异。共有59名未曾接受过脊柱手术或无合并症的腰椎间盘患者参与了该研究。将基于诊所的行为物理治疗与术后3个月和12个月的家庭训练进行比较。此外，对家庭训练组在术后3个月通过结构化电话访谈进行随访，评估其对锻炼计划的依从性。结果指标包括：奥斯威斯利残疾指数（ODI）、身体活动水平、运动恐惧症、应对方式、疼痛、生活质量和患者满意度。两组的治疗依从性都很高。术后3个月和12个月，两组在通过ODI测量的背痛残疾方面没有差异。然而，家庭训练组的背痛减轻和生活质量提高更为显著。与家庭训练组相比，基于诊所训练组的患者在术后12个月的活动水平显著更高，且在术后3个月对物理治疗护理的满意度显著更高。只要患者能从物理治疗师处获得仔细的指导和积极应对疼痛的策略，并且在出现训练相关问题时能够联系到物理治疗师，首次腰椎间盘手术后的康复可以基于家庭训练。这对大多数患者来说可能是一种方便的治疗安排。
