Early active rehabilitation after surgical treatment for lumbar disc herniation. A biopsychosocial function analysis

Abstract

Introduction. Active rehabilitation initiated directly after surgical treatment after lumbar disc herniation has not previously been evaluated.Aims. The aim was to evaluate the effects of two home training programs, an early active training concept and a less active training program, after surgical treatment for lumbar disc herniation. Patients and methods. Sixty consecutive patients were randomized into 2 treatment groups after surgical treatment for lumbar disc herniation. In Studies I and IV, there was 8 dropouts. Thus, 26 patients received an early active training (EAT) concept with an active pain coping model and 26 patients had a less active training program with a passive pain coping model (control group). In Studies II and III, there were 2 more dropouts in the control group. An unbiased observer examined patients in both groups on the following occasions: before surgery, within a week after surgery and 3, 6, 12 and 52 weeks after surgery. The clinical assessment included the following measurements: range of motion of the lumbar spine, length of the hamstring muscles, prevalence of a positive SLR test and location and intensity of pain. The psychometric assessment included the Multidimensional Pain Inventory (MPI), Beck Depression Inventory (BDI) and State and Trait Anxiety Inventory (STAI). Sick leave and medication use was documented. Follow-up questionnaires were sent to the patients 1-3 and 5-7 years after surgery. Results. Pain intensity decreased significantly in both groups after surgery. At 6 weeks follow-up the prevalence of a positive SLR was significantly less in the EAT group. At 12 weeks follow-up range of motion of the lumbar spine was significantly increased in the EAT group. Scores of pain interference in the MPI questionnaire decreased significantly more in the EAT group at 12 and 52 weeks. Scores of state anxiety decreased in both groups. 5-7 years after surgery, 35 patients had returned to work and 32 patients were satisfied with the treatment outcome. In a discriminant analysis, the predictive value of the psychometric assessment showed that a combination of BDI, STAI and VAS correctly classified 78% of the patients that were dissatisfied 1-3 years after surgery and 76% of the satisfied patient. Patients who were dysphoric before surgery (BDI exceeding 9) did as well as nondysphoric patients 5-7 years after surgery.Conclusions. The early active training program had a positive effect on the physical parameters at the 6 and 12 week follow-ups, that subsided 52 weeks after surgery. Pain interference was significantly more improved in the EAT group 12 and 52 weeks after surgery. Psychometric analysis and pain intensity was a valuable tool for predicting the outcome of surgical treatment for lumbar disc herniation. The preoperative state of depression did not influence the long term results. The reoperation rate for lumbar disc herniation was not greater in patients treated in the early active training program 5-7 years after surgery.