Rehabilitation Following Surgery for Lumbar Spinal Stenosis: A Cochrane Review

Alison H. Mcgregor, Katrin Probyn, Suzie Cro, Caroline J. Doré, A. Kim Burton, Federico Balagué, Tamar Pincus, Jeremy Fairbank

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

Study Design
A systematic review of randomised controlled trials (RCTs)

Objective
To determine the effects of active rehabilitation on functional outcome following 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. Post-operative rehabilitation has been suggested as a tool to improve post-operative 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. Randomised controlled trials (RCTs) 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 1,726 articles, of which three 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 following 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.

Conclusions
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.
LanguageEnglish
Pages1044-1054
Number of pages11
JournalSpine
Volume39
Issue number13
DOIs
Publication statusPublished - 1 Jun 2014

Fingerprint

Spinal Stenosis
Rehabilitation
Low Back Pain
Decompression
Meta-Analysis
Leg
Randomized Controlled Trials
Pain
Postoperative Care
MEDLINE
Libraries
Cost-Benefit Analysis
Outcome Assessment (Health Care)
Databases
Health

Cite this

Mcgregor, A. H., Probyn, K., Cro, S., Doré, C. J., Burton, A. K., Balagué, F., ... Fairbank, J. (2014). Rehabilitation Following Surgery for Lumbar Spinal Stenosis: A Cochrane Review. Spine, 39(13), 1044-1054. https://doi.org/10.1097/BRS.0000000000000355
Mcgregor, Alison H. ; Probyn, Katrin ; Cro, Suzie ; Doré, Caroline J. ; Burton, A. Kim ; Balagué, Federico ; Pincus, Tamar ; Fairbank, Jeremy. / Rehabilitation Following Surgery for Lumbar Spinal Stenosis : A Cochrane Review. In: Spine. 2014 ; Vol. 39, No. 13. pp. 1044-1054.
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Mcgregor, AH, Probyn, K, Cro, S, Doré, CJ, Burton, AK, Balagué, F, Pincus, T & Fairbank, J 2014, 'Rehabilitation Following Surgery for Lumbar Spinal Stenosis: A Cochrane Review', Spine, vol. 39, no. 13, pp. 1044-1054. https://doi.org/10.1097/BRS.0000000000000355

Rehabilitation Following Surgery for Lumbar Spinal Stenosis : A Cochrane Review. / Mcgregor, Alison H.; Probyn, Katrin; Cro, Suzie; Doré, Caroline J.; Burton, A. Kim; Balagué, Federico; Pincus, Tamar; Fairbank, Jeremy.

In: Spine, Vol. 39, No. 13, 01.06.2014, p. 1044-1054.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Rehabilitation Following Surgery for Lumbar Spinal Stenosis

T2 - Spine

AU - Mcgregor, Alison H.

AU - Probyn, Katrin

AU - Cro, Suzie

AU - Doré, Caroline J.

AU - Burton, A. Kim

AU - Balagué, Federico

AU - Pincus, Tamar

AU - Fairbank, Jeremy

PY - 2014/6/1

Y1 - 2014/6/1

N2 - Study DesignA systematic review of randomised controlled trials (RCTs) ObjectiveTo determine the effects of active rehabilitation on functional outcome following lumbar spinal stenosis surgery when compared with 'usual postoperative care'.Summary of background dataSurgery rates for lumbar spinal stenosis have risen, yet outcomes remain suboptimal. Post-operative rehabilitation has been suggested as a tool to improve post-operative function but, to date, there is limited evidence to support its use.MethodsCENTRAL (The Cochrane Library), the Cochrane Back Review Group Trials Register, MEDLINE, EMBASE, CINAHL and PEDro electronic databases were searched. Randomised controlled trials (RCTs) 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.ResultsOur searches yielded 1,726 articles, of which three 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 following 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. ConclusionsWe 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.

AB - Study DesignA systematic review of randomised controlled trials (RCTs) ObjectiveTo determine the effects of active rehabilitation on functional outcome following lumbar spinal stenosis surgery when compared with 'usual postoperative care'.Summary of background dataSurgery rates for lumbar spinal stenosis have risen, yet outcomes remain suboptimal. Post-operative rehabilitation has been suggested as a tool to improve post-operative function but, to date, there is limited evidence to support its use.MethodsCENTRAL (The Cochrane Library), the Cochrane Back Review Group Trials Register, MEDLINE, EMBASE, CINAHL and PEDro electronic databases were searched. Randomised controlled trials (RCTs) 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.ResultsOur searches yielded 1,726 articles, of which three 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 following 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. ConclusionsWe 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.

KW - systematic review

KW - Cochrane Back Review Group

KW - postoperative management

KW - meta-analysis

KW - functional outcome

U2 - 10.1097/BRS.0000000000000355

DO - 10.1097/BRS.0000000000000355

M3 - Article

VL - 39

SP - 1044

EP - 1054

JO - Spine

JF - Spine

SN - 0362-2436

IS - 13

ER -