Early aggressive exercise for postoperative rehabilitation after discectomy. Clinical trial of postoperative dynamic back exercises after first lumbar discectomy. Can exercise therapy improve the outcome of microdiscectomy? Early active training after lumbar discectomy. A prospective, randomized, and controlled study. The effectiveness of exercise programmes after lumbar disc surgery: a randomized controlled study. Supervised endurance exercise training compared to home training after first lumbar diskectomy: a clinical trial. The efficacy of active rehabilitation in chronic low back pain. Effect on pain intensity, self-experienced disability, and lumbar fatigability. Active treatment programs for patients with chronic low back pain: a prospective, randomized, observer-blinded study. A trial of an activating intervention for chronic back pain in primary care and physical therapy settings.
A randomized clinical trial of postoperative medical exercise therapy in patients after operation for lumbar disc herniation with blind assessment of clinical outcomes.
                To assess the effect of an early regimen of vigorous medical exercise compared with an ordinary care program.
                
                Patients offered an operation for lumbar disc herniation were consecutively randomized to a training group or to a control group. The training consisted of an 8-week active rehabilitation program including a regimen of vigorous lumbar stabilizing exercises. The control subjects participated in a mild program of 2 to 3 back exercises at home, after relaxing and resting their backs for 2 months after the surgery. The outcomes were evaluated 6 and 12 months after the operation. The results are based on intention-to-treat analyses.
                Sixty-three of 65 eligible patients agreed to participate in the trial. Fifty-eight and 53 patients attended for evaluation at 6 and 12 months, respectively. There was a significantly larger improvement in the mean Roland's disability index (from 8.9 to 5.4 [P = 0.02] at 6 months and from 8. 7 to 5.3 [P = 0.03] at 12 months) and in reported pain (from 3.7 to 2.0 [P = 0.04] at 6 months and from 3.2 to 1.8 [P = 0.09] at 12 months) in the training group. A significantly (P = 0.05) higher proportion of the training group reported that they participated in daily activities as usual. There were more patients in the training group who reported improvement in self-evaluated health after surgery at both 6 (P = 0.02) and at 12 months (P = 0.05). Finally, no differences in clinical end points were observed between the groups.
                Vigorous medical exercise therapy, started 4 weeks after surgery for lumbar disc herniation, reduced disability and pain after surgery. Because no differences in clinical end points were observed, there is hardly any danger associated with early and vigorous training after operation for disc herniation. Ninety-six patients who had undergone first-time discectomy for herniated lumbar intervertebral discs were consecutively randomized to two physical rehabilitation programs: a program of high-intensity, dynamic back extension and abdominal exercises with occurrence of low back pain being the limiting factor or a traditional program of mild, generally mobility-improving exercises within pain limits. Both groups underwent 14 hours of treatment during a 6-week period 5 weeks after surgery. At 26 weeks' follow-up, results indicated that patients who did the high-intensity exercises experienced greater success with regard to the patient disability-index and work capabilities. After 1 year, a trend that favored the use of intensive exercises could be observed. No differences were found in pain or objective measurements. A rehabilitation program of intensive exercises with occurrence of back pain being the limiting factor appears to increase patient behavioral support, resulting in work capacity improvements and patient self-rated disability levels. The results indicate that a 6-wk, 14-hr postoperative rehabilitation program is inadequate if objective postoperative deficit improvements are the desired goal. A prospective randomized controlled trial of exercise therapy in patients who underwent microdiscectomy for prolapsed lumbar intervertebral disc. Results of a pilot study are presented.
                To determine the effects of a postoperative exercise program on pain, disability, psychological status, and spinal function.
                Microdiscectomy is often used successfully to treat prolapsed lumbar intervertebral disc. However, some patients do not have a good outcome and many continue to have low back pain. The reasons for this are unclear but impairment of back muscle function due to months of inactivity before surgery may be a contributing factor. A postoperative exercise program may improve outcome in such patients.
                Twenty patients who underwent lumbar microdiscectomy were randomized into EXERCISE and CONTROL groups. After surgery, all patients received normal postoperative care that included advice from a physiotherapist about exercise and a return to normal activities. Six weeks after surgery, patients in the EXERCISE group undertook a 4-week exercise program that concentrated on improving strength and endurance of the back and abdominal muscles and mobility of the spine and hips. Assessments of spinal function were performed in all patients during the week before surgery and at 6, 10, 26, and 52 weeks after. The assessment included measures of posture, hip and lumbar mobility, back muscle endurance capacity and electromyographic measures of back muscle fatigue. On each occasion, patients completed questionnaires inquiring about pain, disability and psychological status.
                Surgery improved pain, disability, back muscle endurance capacity and hip and lumbar mobility in both groups of patients. After the exercise program, the EXERCISE group showed further improvements in these measures and also in electromyographic measures of back muscle fatigability. All these improvements were maintained 12 months after surgery. The only further improvement showed by the CONTROL group between 6 and 52 weeks was an increase in back muscle endurance capacity.
                A 4-week postoperative exercise program can improve pain, disability, and spinal function inpatients who undergo microdiscectomy. [Key words: electromyogram median frequency, exercise therapy, intervertebral disc prolapse, microdiscectomy, randomized controlled trial, spinal function. A prospective, randomized, and controlled study was conducted.
                To evaluate two training programs, both of which started immediately after lumbar discectomy.
                In previous studies, patients began physiotherapy between 4 weeks and 60 months after surgery. No studies have been conducted to evaluate a physiotherapy program that begins immediately after surgery.
                Twenty-six patients were treated according to an early active training program. Twenty-six patients were treated with a traditional, less active training program (control group). All patients were examined immediately before and after surgery and 3, 6, 12, and 52 weeks after surgery by an unbiased observer. Two years after surgery, patients completed a questionnaire. Range of motion of the lumbar spine and straight leg raising were measured. pain intensity and location was measured by a visual analog scale. The duration of sick leave was documented.
                Six and 12 weeks after surgery, patients with dominating residual leg pain had significantly less intense pain in the early active training group than those in the control group (P < 0.05). Twelve weeks after surgery, range of motion of the lumbar spine was significantly more increased in the early active training group (P < 0.01). One year after surgery, there was no significant difference between the groups regarding the duration of sick leave, results in a positive straight leg raising, or pain intensity. Twenty-two (88%) patients in the early active training group and 16 (67%) in the control group were satisfied with the treatment outcome 2 years after surgery (P < 0.10).
                Patients rehabilitated according to the early active training program had a better short-term outcome of objective values. At 2 years' follow-up, more patients were satisfied with the result of the operation. The early active treatment program is recommended. To compare two different exercise programmes versus a control group, after lumbar disc surgery.
                A prospective, single-blind, randomized controlled study.
                Outpatient clinic of Istanbul Faculty of Medicine, Department of Physical Medicine and Rehabilitation.
                Sixty patients diagnosed as having single level lumbar disc herniation with clinical examination and MRI evaluation and who had undergone lumbar discectomy (post-operative first month) at a single level. Patients with serious pathologies involving the cardiac and respiratory systems that could prevent them from doing exercises were excluded. Intervention: The patients were randomly split into three groups. The first group received an intensive exercise programme and back school education while the second group received a home exercise programme and back school education. The third group was defined as the control group and did not receive education or exercise.
                The patients were evaluated at the beginning and end of the treatment with clinical parameters, pain levels, endurance tests and weight-lifting tests, modified Oswestry Disability Index, Beck Depression Inventory, Low Back Pain Rating Scale and return to work.
                The groups doing exercises experienced a decrease in the severity of pain and disability, also functional parameters showed better improvement than the control group. The intensive exercise programme was better than the home exercise programme.
                It seems that intensive exercise is more effective in reduction of pain and disability, but whether it is cost-effective is not clear. We performed a randomised trial to evaluate if intensive supervised training of the back should be offered to all patients after a first lumbar diskectomy.
                Forty consecutive patients were, after a first lumbar diskectomy, randomly allocated to 2 groups undergoing "supervised training" twice a week for 3 months in an outpatient clinic or "home training" after 2 hours of instruction.
                The two rehabilitation models both showed a significant effect on spinal mobility, isokinetic trunk flexion strength, isokinetic trunk extension strength and daily function. These improvements were unchanged at follow up 3 months later. The pain score remained unchanged, however, throughout the trial in both groups. No differences in effect between the two rehabilitation models could be found for any of the assessed parameters. Thirteen patients did not complete the trial, including 9 from the supervised endurance trained group, mainly because of increased pain and reprolaps (n = 4). Four patients dropped out of the home trained group, only one because of increased pain. The differences in drop-out rate and training side effects were, however, not statistically significant.
                We conclude that it is not worthwhile to implement 3 months of supervised intensive endurance training as opposed to home training in all cases of first lumbar diskectomy, although a beneficial effect and better compliance might be found for a selected group of such patients. A randomized study comparing the results of active rehabilitation and passive control treatment in patients with chronic low back pain with follow-up at 6 months and 1 year.
                To study the efficacy of active rehabilitation on pain, self-experienced disability, and lumbar fatigability.
                Exercises in an outpatient setting are widely used for the treatment of chronic low back pain. The efficacy of the active rehabilitation approach has been documented in randomized control studies, but these studies have seldom been focused on lumbar fatigability, which is now recognized as a frequent problem among patients with chronic low back pain.
                Fifty-nine middle-aged patients (37 men and 22 women) with nonspecific chronic low back pain were randomly assigned to 12 weeks' active rehabilitation or to a passive control treatment (massage, thermal therapy). Pain and disability index, low back pain intensity (visual analog scale, 100 mm), and the objectively assessed lumbar muscle fatigability (spectral electromyogram, mean power frequency slope [MPFSLOPE]) in a new 90-second submaximal isoinertial back endurance test were recorded before and after the interventions and at 6-month and 1-year follow-up visits.
                Results of repeated measures multivariate analysis of variance indicated that back pain intensity (visual analog scale) and functional disability (pain and disability index score) decreased, and lumbar endurance (MPFSLOPE) improved significantly more (P < 0.05) in the active rehabilitation group than in the passive control treatment group, when measured at a 1-year follow-up examination. The group difference in visual analog scale and pain and disability index changes became even more significant at the end of 1 year. The change in lumbar endurance was significantly greater in the active rehabilitation group than in the passive control treatment group at the 6-month follow-up, but not at the 1-year follow-up.
                The active progressive treatment program was more successful in reducing pain and self-experienced disability and also in improving lumbar endurance than was the passive control treatment. However, the group difference in lumbar endurance tended to diminish at the 1-year follow-up. Several new studies have indicated that an active approach to patients with chronic disabling low back pain (LBP) seems effective. Some of these studies emphasize the importance of dealing with the patient's total situation in comprehensive multidisciplinary programs--the bio-psycho-social model. However, these programs are expensive. The aim of this study was to evaluate the rehabilitation outcome from three different active programs in terms of: (1) return-to-work rate, (2) days of sick leave, (3) health-care contacts, (4) pain and disability scores, and (5) staying physically active. The subjects included 132 patients randomized to the study, of whom 123 started one of the treatment programs. They had all had at least 6 months of chronic LBP. The patients were randomized into one of three programs: group 1--a full-time, intensive 3-week multidisciplinary program, including active physical and ergonomic training and psychological pain management, followed by 1 day weekly for the subsequent 3 weeks; group 2--active physical training, twice a week for 6 weeks, for a total of 24h; group 3--psychological pain management combined with active physical training, twice a week for 6 weeks, also for a total of 24h. The results presented here are based on data collected 4 months following treatment, which shows an 86% response rate. The initial examination and the follow-up evaluation were performed by a blinded observer. The results show that 4 months after treatment, the intensive multidisciplinary program is superior to the less intensive programs in terms of return-to-work rate, health-care contacts, pain and disability scores, and staying physically active.(ABSTRACT TRUNCATED AT 250 WORDS) In primary care and physical therapy settings, we evaluated an intervention for chronic back pain patients which incorporated fear reducing and activating techniques. Primary care patients seen for back pain in primary care were screened to identify persons with significant activity limitations 8-10 weeks after their visit. Eligible and willing patients were randomized (N=240). A brief, individualized program to reduce fear and increase activity levels was delivered by a psychologist and physical therapists. Over a 2 year follow-up period, intervention patients reported greater reductions in pain-related fear (P<0.01), average pain (P<0.01) and activity limitations due to back pain (P<0.01) relative to control patients. The percent with greater than a one-third reduction in Roland Disability Questionnaire scores at 6 months was 42% among Intervention patients and 24% among control patients (P<0.01). Over the 2 year follow-up, fewer intervention patients reported 30 or more days unable to carry out usual activities in the prior 3 months (P<0.01). The adjusted mean difference in activity limitation days was 4.5 days at 6 months, 2.8 days at 12 months, and 6.9 days at 24 months. No differences were observed in the percent unemployed or the percent receiving worker's compensation or disability benefits, but these outcomes were relatively uncommon. We conclude that an intervention integrating fear reducing and activating interventions into care for chronic back pain patients produced sustained reductions in patient fears, common activity limitations related to back pain, and days missed from usual activities due to back pain.
Exercise programs starting four to six weeks post-surgery seem to lead to a faster decrease in pain and disability than no treatment. High intensity exercise programs seem to lead to a faster decrease in pain and disability than low intensity programs. There were no significant differences between supervised and home exercises for pain relief, disability, or global perceived effect. There is no evidence that active programs increase the re-operation rate after first-time lumbar surgery.