Center for Spine Surgery and Research, Spine Center of Southern Denmark, Lillebaelt Hospital, Middelfart, Denmark.
Department of Occupational Medicine, Hospital of South West Jutland, Esbjerg, Denmark.
Spine J. 2020 Jan;20(1):41-47. doi: 10.1016/j.spinee.2019.09.019. Epub 2019 Sep 23.
Patients undergoing lumbar discectomy are typically referred for postoperative rehabilitation. However, evidence regarding effectiveness of postoperative rehabilitation to improve surgical outcome and hasten return to work is scarce with conflicting results in the published literature.
This study investigates the effect of postoperative rehabilitation on return to work, duration of sick leave and working ability after surgery for lumbar disc herniation.
STUDY DESIGN/SETTING: Single center randomized controlled trial.
Patients scheduled for primary discectomy due to lumbar disc herniation were included in the study.
Self-reported measures included working ability, work status, and job type defined by the International Standard Classification of Occupations. All outcomes including duration of sick leave were obtained from follow-up questionnaires at 1 and 2 years after surgery.
This is a secondary analysis from a randomized controlled trial comparing patients who were referred to rehabilitation at the municipal facility starting 4-6 weeks postoperative (REHAB) and patients sent home after surgery without any planned rehabilitation course (HOME). Linear regression was performed to identify baseline characteristics associated with duration of sick leave.
One hundred forty-six patients were included and equally distributed between the groups. Follow-up rate was 78% after 1 and 2 years. Both groups had a similar postoperative sick leave period of approximately 9 weeks. After 1 year 79% had returned to work in the HOME-group versus 74% in the REHAB-group, which was not statistically significant. Working ability improved from baseline to 1 year in both groups and this improvement was sustained at 2-year follow-up. Stepwise linear regression showed that preoperative duration of leg pain and working ability was associated with duration of postoperative sick leave.
Referral for unstandardized municipal rehabilitation does not affect duration of postoperative sick leave, return to work or working ability in patients recovering after surgery for lumbar disc herniation. Duration of preoperative leg pain and preoperative working ability was significantly associated with the duration of postoperative sick leave.
接受腰椎间盘切除术的患者通常会接受术后康复治疗。然而，关于术后康复对改善手术结果和加快重返工作岗位的有效性的证据很少，而且已发表的文献中结果相互矛盾。
本研究调查腰椎间盘突出症手术后康复对重返工作岗位、病假时间和手术后工作能力的影响。
研究设计/设置：单中心随机对照试验。
纳入研究的患者因腰椎间盘突出症而接受初次椎间盘切除术。
自我报告的结果包括工作能力、工作状态和职业类型，由国际标准职业分类定义。所有结果（包括病假时间）均来自术后 1 年和 2 年的随访问卷。
这是一项对比较术后 4-6 周在市康复机构接受康复治疗（康复组）和手术后直接回家且无计划康复课程（家庭组）患者的随机对照试验的二次分析。线性回归用于确定与病假时间相关的基线特征。
共有 146 名患者入组，两组患者分布均匀。1 年和 2 年的随访率分别为 78%和 78%。两组术后病假时间相似，约为 9 周。家庭组在术后 1 年时 79%的患者重返工作岗位，康复组为 74%，但无统计学意义。两组的工作能力均从基线改善到 1 年随访时，并且这种改善在 2 年随访时持续存在。逐步线性回归显示术前腿痛和工作能力持续时间与术后病假时间有关。
未经标准化的市康复治疗对腰椎间盘突出症术后康复患者的术后病假时间、重返工作岗位或工作能力没有影响。术前腿痛和术前工作能力持续时间与术后病假时间显著相关。
