Rehabilitation Status Post Spinal Fusion

Objective: To evaluate the effectiveness of physiotherapy intervention following lumbar spinal fusion. Design: Systematic review and meta-analysis. 2 independent reviewers searched information sources, assessed studies for inclusion and evaluated risk of bias. Quantitative synthesis using standardised mean differences was conducted on comparable outcomes across trials with similar interventions. Information sources: Predefined terms were employed to search electronic databases. Additional studies were identified from key journals, reference lists, authors and exp rts. Eligibility criteria for included studies: Randomised control trials published in English prior to 30 September 2011 investigating physiotherapy outpatient management of patients (>16 years), following lumbar spinal fusion, with measurements reported on one or more outcome of disability, function and health were included. Results: 2 Randomised control trials (188 participants) from two countries were included. Both trials included a behavioural and an exercise intervention. 1 trial was evaluated as high risk of bias and one as unclear. 159 participants were incorporated in the meta-analysis. Although evidence from both trials suggested that intervention might reduce back pain short term (6 months) and long term (12 months and 2 years), and a behavioural intervention might be more beneficial than an exercise intervention, the pooled effects (0.72, 95% CI !0.25 to 1.69 at 6 months; 0.52, 95% CI !0.45 to 1.49 at 12 months and 0.75, 95% CI !0.46 to 1.96 at 2 years) did not demonstrate statistically significant effects. There was no evidence that intervention changes pain in the short (6 months) or long term (12 months and 2 years). The wide CI for pooled effects indicated that intervention could be potentially beneficial or harmful. Considerable heterogeneity was evident. Conclusions: Inconclusive, very low-quality evidence exists for the effectiveness of physiotherapy management following lumbar spinal fusion. Best practice remains unclear. Limited comparability of outcomes and retrieval of only two trials reflect a lack of research in this area that requires urgent consideration. INTRODUCTION Rationale In the UK National Health Service, surgery is the greatest single component of expenditure for managing low back pain, with increasing numbers of lumbar fusions being performed. More than 4036 operations were To cite: Rushton A, Eveleigh G, Petherick E-J, et al. Physiotherapy rehabilitation following lumbar spinal fusion: a systematic review and meta-analysis of randomised controlled trials. BMJ Open 2012;2:e000829. doi:10. 1136/bmjopen-2012-000829 < Prepublication history for this paper is available online. To view these files please visit the journal online (http:// dx.doi.org/10.1136/ bmjopen-2012-000829). Received 16 January 2012 Accepted 18 June 2012 This final article is available for use under the terms of the Creative Commons Attribution Non-Commercial 2.0 Licence; see http://bmjopen.bmj.com School of Health and Population Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK Clinical Physiotherapist, Glasgow, UK Correspondence to Dr Alison Rushton; [email protected] ARTICLE SUMMARY