Question: What is the effect of physiotherapeutic rehabilitation post total disc replacement?
Design: Retrospective cohort study.
Participants: Six hundred patients who received lumbar disc replacement (TDR) or hybrid surgery (TDR + fusion) between 1997 and 2008.
Intervention: Group 1 received no post-surgical physiotherapy. Group 2 received one to three physiotherapy sessions. Group 3 received four or more physiotherapy sessions.
Outcome Measures: Oswestry Disability Index (ODI), Roland Morris Disability Questionnaire (RMQ), Short Form-36 Physical (SF-36 PCS). Preoperative measures taken at baseline, and again at follow-up at 3, 6, 12 and 24 months postoperatively were audited.
Results: RMQ demonstrated a significant better improvement in Group 3 compared to Group 1 after 3, 6, 12 and 24 months (p = 0.001, <0.001, 0.001 and 0.04, respectively), and for Group 2 compared to Group 1 after 3 and 6 months (p = 0.01 and 0.01, respectively). A significant better change in Group 3 compared to Group 1 was seen in the ODI after 3, 6 and 12 months (p = 0.007, p = 0.006 and 0.003, respectively). A significant better change in Group 2 compared to Group 1 was observed in the SF-36 PCS after 6 months (p = 0.01). A significant better change in Group 3 compared to Group 1 for SF-36 PCS at 6, 12 and 24 months (p = <0.001, 0.012 and 0.004, respectively) was observed.
Conclusion: Four or more sessions of post-operative physiotherapy demonstrated consistent statistically significant improvements in functional disability outcomes. However, these results were not considered clinically significant.
Key Practice Points:
• Four or more sessions of post-operative physiotherapy may improve functional disability outcomes in patients post TDR surgery.
• Prospective randomised controlled trials evaluating the effectiveness of specific physiotherapy interventions post-TDR surgery are indicated.
Australian Physiotherapy Association , 2013. 2-2 p.
National Conference of the Australian Physiotherapy Association (APA) Conference 2013, Melbourne, Australia, 17-20 October 2013