Prepare: pre-surgery physiotherapy for patients with degenerative lumbar spine disorder: a randomized controlled trial

The number of studies reported that there was mild to moderate improvements in pain and disability at 5-year follow-up after the Surgery for radiculopathy. Prehabilitation has been defined as augmenting functional capacity before surgery, which may have the beneficial effect on outcome after surgery. The results of the present study demonstrated that pre-surgery physiotherapy decreases pain, the risk for avoidance behavior and worsening of psychological well-being and improves quality of life.    

Surgery due to spinal stenosis or disc herniation triggers a substantial improvement in the short-term, but mild to modest improvement for disability and pain at long-term follow-up. Prehabilitation has been determined as increasing functional ability prior to surgery, which may have an advantageous effect on consequence after the surgery. The study aimed to evaluate whether the pre-surgery physiotherapy reduces pain, enhances function and health among patients with degenerative lumbar spine disorder registered for surgery.

A total of 197 consecutive patients were randomly categorized either to pre-surgery physiotherapy or standardized information, with follow-up following the pre-surgery approach as well as 3 and 12 months after the surgery. The inclusion criteria on which the selection was done were 25 to 80 years of age and patients listed for surgery due to disc herniation, degenerative disc disease, spondylolisthesis or spinal stenosis. Regional research funds for US$77,342 funded the study. No conflict of interest was reported. Further, the Oswestry Disability Index (ODI) was considered as the primary outcome and depression, pain intensity, fear avoidance, anxiety, treatment effect, physical activity, and self-efficacy were as secondary outcomes.  

Better EQ-5D, ODI, HADS depression scores, activity level, VAS back pain, SES, FABQ-PA, and EQ-VAS was noticed among the pre-surgery physiotherapy group than the waiting-list group following the pre-surgery therapy. The improvements were modest but higher than the study particular minimal clinically important change (MCIC) in VAS leg and back pain, FABQ-PA and EQ-5D and nearly in line with MCIC in PCS and ODI in the physiotherapy-group. Post-surgery difference within the groups only managed for greater activity level in the physiotherapy-group.

Pre-surgery physiotherapy reduces the risk of avoidance behavior, pain, worsening of psychological well-being, improves physical activity levels and quality of life prior to surgery than waiting-list controls. These effects were only sustained for activity levels post-surgery. However, the dosage of exercises, content, pre-surgery selection, and the importance of being active in a pre-surgery physiotherapy treatment is of interest to study more to improve the long-term result.