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Rehabilitation Following Surgery for Lumbar Spinal Stenosis: A Cochrane Review

McGregor, Alison H. PhD*; Probyn, Katrin MPH*; Cro, Suzie MSc; Doré, Caroline J; Burton, A. Kim PhD; Balagué, Federico MD§; Pincus, Tamar PhD; Fairbank, Jeremy PhD

Spine:
doi: 10.1097/BRS.0000000000000355
Cochrane Collaboration
Abstract

Study Design. A systematic review of randomized controlled trials.

Objective. To determine the effects of active rehabilitation on functional outcome after lumbar spinal stenosis surgery when compared with “usual postoperative care.”

Summary of Background Data. 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.

Methods. 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.

Results. 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.

Conclusion. 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.

Level of Evidence: 1

In Brief

This review sought to determine whether there is any evidence supporting the use of rehabilitation after surgery for lumbar spinal stenosis. It concluded that there is moderate-quality evidence to suggest that active rehabilitation can lead to improvements in function and pain.

Author Information

*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.

Address correspondence and reprint requests to Alison H. McGregor, PhD, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, Charing Cross Hospital, London W6 8RF, United Kingdom; E-mail: a.mcgregor@imperial.ac.uk

Acknowledgment date: March 19, 2014. Acceptance date: March 20, 2014.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work.

Relevant financial activities outside the submitted work: consultancy, employment, grants.

© 2014 by Lippincott Williams & Wilkins