Abstract
Objectives
To determine whether physiotherapy commenced within the first 4 weeks post–spinal
surgery is safe and effective.
Data Sources
Electronic databases CINAHL, MEDLINE, AMED, PubMed, Embase, and PEDro were searched
from the earliest date possible through May 2015. An additional trial was identified
through reference list scanning.
Study Selection
Controlled trials evaluating comprehensive physiotherapy rehabilitation commenced
within 4 weeks postoperatively compared with a control group receiving no physiotherapy,
standard postoperative care, rest, less active physiotherapy, or sham physiotherapy
after spinal surgery of a musculoskeletal etiology. Two reviewers independently applied
inclusion and exclusion criteria, with disagreements discussed until consensus could
be reached. Searching identified 3162 potentially relevant articles, of which 4 trials
with 250 participants met the inclusion criteria.
Data Extraction
Data were extracted using a predefined data extraction form. Methodological quality
of trials was assessed independently by 2 reviewers using the Downs and Black checklist.
Pooled analyses were performed using a random-effects model with inverse variance
methods to calculate risk differences and 95% confidence intervals (CIs) (dichotomous
outcomes), and standardized mean differences (SMDs) and 95% CIs (continuous outcomes).
Data Synthesis
When compared with no or sham physiotherapy, early comprehensive physiotherapy did
not increase the risk of adverse events (risk difference, −.01; 95% CI, −.07 to .05;
I2=0%). In addition, there is moderate-quality evidence demonstrating a reduction in
pain by a moderate and significant amount at 12 weeks (SMD=−.38; 95% CI, −.66 to −.10;
I2=0%) and at 12+ months (SMD=−.30; 95% CI, −.59 to −.02; I2=0%).
Conclusions
Early comprehensive physiotherapy commenced within the first 4 weeks post–spinal surgery
does not increase the potential for an adverse event and leads to a moderate, statistically
significant reduction in pain when compared with a control group.
Keywords
List of abbreviations:
CI (confidence interval), DRI (Disability Rating Index), RMQ (Roland Morris Questionnaire), SMD (standardized mean difference)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: September 23, 2015
Footnotes
Disclosures: none.
Identification
Copyright
© 2016 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
