McGregor Alison H, Probyn Katrin, Cro Suzie, Doré Caroline J, Burton A Kim, Balagué Federico, Pincus Tamar, Fairbank Jeremy
*Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, United Kingdom †Medical Research Council Clinical Trials Unit, London, United Kingdom ‡Spinal Research Unit, University of Huddersfield, Huddersfield, United Kingdom §HFR Fribourg-Hôpital Cantonal, Fribourg, Switzerland ¶Department of Psychology, Royal Holloway University of London, Egham, United Kingdom; and ‖Department of Orthopaedic Surgery, Nuffield Orthopaedic Centre, Oxford, United Kingdom.
Spine (Phila Pa 1976). 2014 Jun 1;39(13):1044-54. doi: 10.1097/BRS.0000000000000355.
A systematic review of randomized controlled trials.
To determine the effects of active rehabilitation on functional outcome after lumbar spinal stenosis surgery when compared with "usual postoperative care."
Surgery rates for lumbar spinal stenosis have risen, yet outcomes remain suboptimal. Postoperative rehabilitation has been suggested as a tool to improve postoperative function but, to date, there is limited evidence to support its use.
CENTRAL (The Cochrane Library), the Cochrane Back Review Group Trials Register, MEDLINE, EMBASE, CINAHL, and PEDro electronic databases were searched. Randomized controlled trials comparing the effectiveness of active rehabilitation with usual care in adults with lumbar spinal stenosis who had undergone primary spinal decompression surgery were included. Two authors independently selected studies, assessed the risk of bias, and extracted the data in line with the recommendations of the Cochrane Back Review Group. Study results were pooled in a meta-analysis when appropriate using functional status as the primary outcome, with secondary outcomes including measures of leg pain, low back pain, and global improvement/general health. The GRADE approach was used to assess the quality of the evidence.
Our searches yielded 1726 articles, of which 3 studies (N = 373 participants) were suitable for inclusion in meta-analysis. All included studies were deemed to have low risk of bias; no study had unacceptably high dropout rates. There was moderate evidence suggesting that active rehabilitation was more effective than usual care in improving both short- and long-term functional status after surgery. Similar findings were noted for secondary outcomes, including short-term improvement in low back pain and long-term improvement in both low back pain and leg pain.
We obtained moderate-quality evidence indicating that postoperative active rehabilitation after decompression surgery for lumbar spinal stenosis is more effective than usual care. Further work is required particularly with respect to the cost-effectiveness of such interventions.
对随机对照试验的系统评价。
与“常规术后护理”相比，确定积极康复对腰椎管狭窄症手术后功能结局的影响。
腰椎管狭窄症的手术率有所上升，但结局仍不尽人意。术后康复被认为是改善术后功能的一种手段，但迄今为止，支持其使用的证据有限。
检索CENTRAL（考克兰图书馆）、考克兰背部综述小组试验注册库、MEDLINE、EMBASE、CINAHL和PEDro电子数据库。纳入比较积极康复与常规护理对接受初次脊柱减压手术的腰椎管狭窄症成年患者有效性的随机对照试验。两位作者独立选择研究、评估偏倚风险并按照考克兰背部综述小组的建议提取数据。在适当时，以功能状态作为主要结局进行荟萃分析汇总研究结果，次要结局包括腿痛、腰痛和整体改善/总体健康状况的测量指标。采用GRADE方法评估证据质量。
我们的检索共获得1726篇文章，其中3项研究（N = 373名参与者）适合纳入荟萃分析。所有纳入研究的偏倚风险均较低；没有研究的失访率高到不可接受。有中等证据表明，积极康复在改善手术后短期和长期功能状态方面比常规护理更有效。次要结局也有类似发现，包括腰痛的短期改善以及腰痛和腿痛的长期改善。
我们获得了中等质量的证据，表明腰椎管狭窄症减压手术后的术后积极康复比常规护理更有效。特别是在这种干预措施的成本效益方面，还需要进一步开展工作。
1级
