Physiotherapy Rehabilitation Post First Lumbar Discectomy A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Study Design. Systematic review and meta-analysis. Objective. To evaluate effectiveness of physiotherapy intervention in patients post first lumbar discectomy on clinically relevant outcomes short (3 months) and longer term (12 months). Summary of Background Data. Physiotherapy intervention is recommended post discectomy, although the most beneficial intervention and the effectiveness of physiotherapy management is unclear. Methods. Randomized Controlled Trials (RCTs) published in English before December 31, 2009 investigating physiotherapy outpatient management of patients (>16 years), post first single level lumbar discectomy were included. Measurements reported on >= 1 outcome of disability, function, and health were included. Two reviewers independently searched information sources, assessed studies for inclusion, and evaluated risk of bias. Quantitative synthesis was conducted on comparable outcomes across studies with similar interventions and no clearly identified overall risk of bias. Results. Sixteen RCTs (1336 participants) from 11 countries were included. Interventions were categorized as intervention versus control/sham, and less versus more intensive comparisons. Eight of 16 trials were evaluated as high risk of bias, 7 as unclear and 1 as low. Six hundred and thirty-five participants were incorporated in the meta-analysis on eight trials. Although evidence from two trials suggested that intervention might reduce disability short-term, and more intensive intervention may be more beneficial than less intensive, the pooled effects (-0.89, 95% CI -1.84 to 0.06 for intervention vs. control/sham; -0.27, 95% CI -0.80 to 0.25 for more vs. less intensive) did not show statistically significant effects. There was no evidence that intervention changes range of movement flexion (ROM) or overall impairment short term, or disability or back pain longer term. There was no evidence that intensity of intervention affects back pain short or longer term, ROM short term, or patients' satisfaction with outcome longer term. Substantial heterogeneity was evident. Conclusion. Inconclusive evidence exists for the effectiveness of outpatient physiotherapy post first lumbar discectomy. Best practice remains unclear.