Department of Physical and Rehabilitation Medicine, University Hospitals Leuven, Leuven, Belgium.
Reval Rehabilitation Research Center, Hasselt University, Diepenbeek, Belgium.
Eur Spine J. 2022 Jun;31(6):1525-1545. doi: 10.1007/s00586-022-07158-2. Epub 2022 Mar 8.
To evaluate the effectiveness of rehabilitation strategies on disability, pain, pain-related fear, and return-to-work in patients undergoing lumbar fusion surgery for degenerative conditions or adult isthmic spondylolisthesis.
Six electronic databases were systematically searched for randomized controlled trials (RCTs) evaluating the effect of rehabilitation (unimodal or multimodal). The estimated effect size was calculated for interventions with homogeneous content using a random-effects model. Certainty of evidence was assessed by GRADE.
In total, 18 RCTs, including 1402 unique patients, compared specific rehabilitation to other rehabilitation strategies or usual care. Most described indications were degenerative disc disease and spondylolisthesis. All rehabilitation interventions were delivered in the postoperative period, and six of them also included a preoperative component. Intervention dose and intensity varied between studies (ranging from one session to daily sessions for one month). Usual care consisted mostly of information and postoperative mobilization. At short term, low quality of evidence shows that exercise therapy was more effective for reducing disability and pain than usual care (standardized mean difference [95% CI]: -0.41 [-0.71; -0.10] and -0.36 [-0.65; -0.08], four and five studies, respectively). Multimodal rehabilitation consisted mostly of exercise therapy combined with cognitive behavioral training, and was more effective in reducing disability and pain-related fear than exercise therapy alone (-0.31 [-0.49; -0.13] and -0.64 [-1.11; -0.17], six and four studies, respectively). Effects disappeared beyond one year. Rehabilitation showed a positive tendency towards a higher return-to-work rate (pooled relative risk [95% CI]: 1.30 [0.99; 1.69], four studies).
There is low-quality evidence showing that both exercise therapy and multimodal rehabilitation are effective for improving outcomes up to six months after lumbar fusion, with multimodal rehabilitation providing additional benefits over exercise alone in reducing disability and pain-related fear. Additional high-quality studies are needed to demonstrate the effectiveness of rehabilitation strategies in the long term and for work-related outcomes.
评估康复策略对退行性疾病或成人峡部裂性脊柱滑脱行腰椎融合术患者的残疾、疼痛、与疼痛相关的恐惧以及重返工作的有效性。
系统检索了 6 个电子数据库中的随机对照试验（RCT），评估了康复（单一模式或多模式）的效果。使用随机效应模型计算具有同质内容的干预措施的估计效应大小。通过 GRADE 评估证据的确定性。
共有 18 项 RCT，包括 1402 名独特患者，将特定康复与其他康复策略或常规护理进行了比较。大多数描述的适应症是退行性椎间盘疾病和脊柱滑脱。所有康复干预措施均在术后进行，其中 6 项还包括术前部分。干预剂量和强度在研究之间有所不同（范围从一次到一个月每天一次）。常规护理主要包括信息和术后活动。短期来看，低质量证据表明，运动疗法比常规护理更能有效减轻残疾和疼痛（标准化均数差[95%CI]：-0.41[-0.71；-0.10]和-0.36[-0.65；-0.08]，分别有 4 项和 5 项研究）。多模式康复主要由运动疗法结合认知行为训练组成，与单纯运动疗法相比，在减轻残疾和疼痛相关恐惧方面更有效（-0.31[-0.49；-0.13]和-0.64[-1.11；-0.17]，分别有 6 项和 4 项研究）。效果在一年后消失。康复显示出较高的重返工作率的积极趋势（合并相对风险[95%CI]：1.30[0.99；1.69]，4 项研究）。
有低质量证据表明，运动疗法和多模式康复在腰椎融合术后 6 个月内都有效改善结果，多模式康复在减轻残疾和疼痛相关恐惧方面比单纯运动疗法提供额外的益处。需要更多高质量的研究来证明康复策略在长期和与工作相关的结果方面的有效性。
