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A prospective, randomised trial of immediate exercise following lumbar microdiscectomy: a preliminary study
R J Newsome1, S May, N Chiverton
1Sheffield Teaching Hospitals, Physiotherapy Department, Sheffield, UK.
Objective:
To investigate whether immediate commencement of exercises after lumbar microdiscectomy enabled patients to become independently mobile more rapidly with no increase in risk of complications.
Study Design:
Randomised, single-blind, controlled trial.
Setting:
One secondary care teaching hospital in the UK.
Participants:
Thirty patients were recruited. The follow-up rate was 28 (93%) at 4 weeks and 23 (77%) at 3 months.
Interventions:
Patients were randomised to an intervention group commencing exercises within 2 hours after surgery, or a control group commencing exercises on the first postoperative day.
Main Outcome Measures:
Primary outcome measures included the time taken for the patient to become independently mobile and attain discharge criteria following surgery. Secondary outcome measures were disability and pain scores collected before surgery, and 4 weeks and 3 months after surgery; and return to work rates.
Results:
The two groups were similar at baseline. The results indicated significantly reduced time to independent mobility [median 7 vs 19 hours, median difference 9 hours, 95% confidence interval (CI) 1.25 to 14.5, P=0.009] and return to work (median 6 vs 8 weeks, median difference 2 weeks, 95% CI 0 to 6, P=0.002) in the intervention group compared with the control group. At 15 hours after surgery, independent mobility was attained in 80 and 40% of the intervention and control groups, respectively. There were no significant differences in disability and pain scores at 4 weeks and 3 months.
Conclusions:
Immediate commencement of exercises following first-time single-level lumbar microdiscectomy enabled patients to become independently mobile more rapidly and return to work sooner. Immediate commencement of exercises may enable patients to be discharged earlier, with associated cost benefits to health care and no increase in the rate of revision surgery.