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The Effect of Early Initiation of Rehabilitation After Lumbar Spinal Fusion: A Randomized Clinical Study

Oestergaard, Lisa G. OT, MHSc*,†,‡; Nielsen, Claus V. MD, PhD§; Bünger, Cody E. MD, DMSc; Sogaard, Rikke MSc, MPH, PhD; Fruensgaard, Soeren MD; Helmig, Peter MD, PhD†,¶; Christensen, Finn B. MD, PhD, DMSc

doi: 10.1097/BRS.0b013e31825a17ab
Randomized Trial

Study Design. A multicenter randomized clinical trial including 82 patients.

Objective. To examine the effect of early initiation of rehabilitation after instrumented lumbar spinal fusion.

Summary of Background Data. Lumbar spinal fusion has been performed for more than 70 years. Yet, few studies have examined patients' subsequent rehabilitation. Group-based rehabilitation is both efficient and cost-effective in rehabilitation of lumbar spinal fusion patients.

Methods. Patients with degenerative disc diseases undergoing instrumented lumbar spinal fusion were randomly assigned to initiate their rehabilitation 6 weeks (6-wk group) or 12 weeks after lumbar spinal fusion (12-wk group). Both groups received the same group-based rehabilitation. Primary outcome was the Oswestry Disability Index. Secondary outcome was the Dallas Pain Questionnaire, the Low Back Pain Rating Scale, and absence from work. Wilcoxon rank-sum test was used to compare the groups in terms of differences from baseline to 6 months and 1-year follow-up. Results are presented in median with 25th and 75th percentiles.

Results. According to the Oswestry Disability Index, at 1-year follow-up, the 6-week-group had a median reduction of −6 (−19; 4) compared with −20 (−30;−7) in the 12-week group (P, 0.05). The Dallas Pain Questionnaire showed overall the same tendency, and within daily activities were significantly reduced in favor of the 12-week group (P, 0.05). For back pain, the 6-week group had a median reduction of −2.2 (−3.0; −0.7) similar with −3.3 (−4.7; −1.7) in the 12-week group (P, 0.05). The results at 6 months of follow-up were similar. No difference was found according to return to work 1 year postsurgery.

Conclusion. Early start of rehabilitation (6 wk vs. 12 wk) after lumbar spinal fusion resulted in inferior outcomes. The improvements in the 12-week group were 4 times better than that in the 6-week group, indicating that the start-up time of rehabilitation is an important contributing factor for the overall outcome.

The authors describe a multicenter randomized controlled trial including 82 patients, evaluating time of initiating rehabilitation for patients undergoing instrumented lumbar spinal fusion. Patients were randomly assigned to initiate their rehabilitation 6 or 12 weeks after lumbar surgery, respectively. It was found that early start of rehabilitation after lumbar spinal fusion resulted in inferior outcomes.

Departments of *Occupational Therapy and Physiotherapy

Orthopaedic Surgery, Aarhus University Hospital, Noerrebrogade, Aarhus C, Denmark

Orthopaedic Department, Region Hospital of Silkeborg, Silkeborg, Denmark

§Department of Social Medicine and Rehabilitation, School of Public Health, Aarhus University, Aarhus C, Denmark

Centre for Applied Health Services Research and Technology Assessment (CAST), Institute for Public Health, University of Southern Denmark, Odense, Denmark

Orthopaedic Private Hospital Aarhus, Aarhus C, Denmark.

Address correspondence and reprint requests to Lisa Gregersen Oestergaard, OT, MHSc, Aarhus University Hospital, Physiotherapy and Occupational Therapy Department, Noerrebrogade 44, building 3, 1, 8000 Aarhus, Denmark; E-mail:

Acknowledgment date: October 24, 2011. Revision date: February 24, 2012. Acceptance date: March 16, 2012.

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

Lundbeck Foundation (UCSF), The Danish Rheumatisme Associations (Gigtforeningen), the Health Insurance Foundation (Helsefonden), The Central Denmark Region, and The Danish Council for Strategic Research funds were received in support of this work.

No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

© 2012 Lippincott Williams & Wilkins, Inc.