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BMC Musculoskeletal Disorders
Published in: BMC Musculoskeletal Disorders 1/2019

Open Access 01-12-2019 | Back Pain | Research article

Effects of pre-surgery physiotherapy on walking ability and lower extremity strength in patients with degenerative lumbar spine disorder: Secondary outcomes of the PREPARE randomised controlled trial

Authors: Maria Fors, Paul Enthoven, Allan Abbott, Birgitta Öberg

Published in: BMC Musculoskeletal Disorders | Issue 1/2019

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Abstract

Background

Degenerative lumbar spine disorders are common among musculoskeletal disorders. When disabling pain and radiculopathy persists after adequate course of rehabilitation and imaging confirms compressive pathology, surgical decompression is indicated. Prehabilitation aiming to augment functional capacity pre-surgery may improve physical function and activity levels pre and post-surgery. This study aims to evaluate the effect and dose-response of pre-surgery physiotherapy on quadriceps femoris strength and walking ability in patients with degenerative lumbar spine disorders compared to waiting-list controls and their association with postoperative physical activity level.

Method

In this single blinded, 2-arm randomised controlled trial, 197 patients were consecutively recruited. Inclusion criteria were: MRI confirmed diagnosis and scheduled for surgery due to disc herniation, lumbar spinal stenosis, degenerative disc disease or spondylolisthesis, ages 25-80 years. Patients were randomised to 9 weeks of pre-surgery physiotherapy or to waiting-list. Patient reported physical activity level, walking ability according to Oswestry Disability Index item 4, walking distance according to the SWESPINE national register and physical outcome measures including the timed ten-meter walk test, maximum voluntary isometric quadriceps femoris muscle strength, patient-rated were collected at baseline and follow-up. Parametric or non-parametric within and between group comparisons as well as multivariate regression was performed.

Results

Patients who received pre-surgery physiotherapy significantly improved in all variables from baseline to follow-up (p < 0.001 – p < 0.05) and in comparison to waiting-list controls (p < 0.001 – p < 0.028). Patients adhering to ≥12 treatment sessions significantly improved in all variables (p < 0.001 – p < 0.032) and those receiving 0-11 treatment session in only normal walking speed (p0.035) but there were no significant differences when comparing dosages. Physical outcome measures after pre-surgery physiotherapy together significantly explain 27.5% of the variation in physical activity level 1 year after surgery with pre-surgery physical activity level having a significant multivariate association.

Conclusion

Pre-surgery physiotherapy increased walking ability and lower extremity strength in patients with degenerative lumbar spine disorders compared to waiting-list controls. A clear treatment dose-response response relationship was not found. These results implicate that pre-surgery physiotherapy can influence functional capacity before surgical treatment and has moderate associations with maintained postoperative physical activity levels mostly explained by physical activity level pre-surgery.

Trial registration

NCT02454400. Trial registration date: August 31st 2015, retrospectively registered.
Literature
1.
Hoy D, Williams G, March L, Brooks P, Blyth F, Woolf A, Vos TBR. A systematic review of the global prevalence of low back pain. Arthritis Rheum. 2012;64(6):2028–37.CrossRefPubMed
2.
Gibson J, Waddell G. Surgical interventions for lumbar disc prolapse. In: Gibson JA, editor. Cochrane Database of Systematic Reviews. Chichester, UK: John Wiley & Sons, Ltd; 2007. p. CD001350.
3.
Strömqvist B, Fritzell P, Hägg O, Jönsson B, Sandén B. Swedish Society of Spinal Surgeons. Swespine: the Swedish spine register : the 2012 report. Eur Spine J. 2013;22(4):953–74.CrossRefPubMedPubMedCentral
4.
Winter CC, Brandes M, Müller C, Schubert T, Ringling M, Hillmann A, et al. Walking ability during daily life in patients with osteoarthritis of the knee or the hip and lumbar spinal stenosis: a cross sectional study. BMC Musculoskelet Disord. 2010;11(1):233.CrossRefPubMedPubMedCentral
5.
Iversen MKJ. Research Report Examination Findings and Self-Reported Walking Capacity in Patients With Lumbar Spinal Stenosis. Phys Ther. 2001;81:1296–306.PubMed
6.
Jönsson B, Strömqvist B. The straight leg raising test and the severity of symptoms in lumbar disc herniation. A preoperative evaluation, Spine (Phila Pa 1976). 1995 Jan 1;20(1):27–30.
7.
Jansson KA, Nemeth G, Granath F, Jonsson B, Blomqvist P. Health-related quality of life in patients before and after surgery for a herniated lumbar disc. J Bone Joint Surg Br. 2005;87(7):959–64.CrossRefPubMed
8.
Suda Y, Saitou M, Shibasaki K, Yamazaki N, Chiba K, Toyama Y. Gait analysis of patients with neurogenic intermittent claudication. Spine (Phila Pa 1976). 2002;27(22):2509–13.CrossRef
9.
Tomkins-Lane CC, Holz SC, Yamakawa KS, Phalke VV, Quint DJ, Miner J, et al. Predictors of walking performance and walking capacity in people with lumbar spinal stenosis, low back pain, and asymptomatic controls. Arch Phys Med Rehabil. 2012;93(4):647–53.CrossRefPubMedPubMedCentral
10.
Norden J, Smuck M, Sinha A, Hu R, Tomkins-Lane C. Objective measurement of free-living physical activity (performance) in lumbar spinal stenosis: are physical activity guidelines being met? Spinal J. 2017;17:26–33.
11.
Morag E, Hurwitz DE, Andriacchi TP, Hickey M, Andersson GB. Abnormalities in muscle function during gait in relation to the level of lumbar disc herniation. Spine (Phila Pa 1976). 2000;25(7):829–33.CrossRef
12.
Zeifang F, Schiltenwolf M, Abel R, Moradi B. Gait analysis does not correlate with clinical and MR imaging parameters in patients with symptomatic lumbar spinal stenosis. BMC Musculoskelet Disord. 2008;9(1):89–97.CrossRefPubMedPubMedCentral
13.
Fritz JM, Lurie JD, Zhao W, Whitman JM, Delitto A, Brennan GP, et al. Associations between physical therapy and long-term outcomes for individuals with lumbar spinal stenosis in the SPORT study. Spine J. 2014;14(8):1611–21.CrossRefPubMed
14.
Ammendolia C, Stuber KJ, Rok E, Rampersaud R, Kennedy CA, Pennick V, et al. Nonoperative treatment for lumbar spinal stenosis with neurogenic claudication. Ammendolia C, editor. Cochrane Database Syst Rev. 2013 Aug 30;(8):CD010712.
15.
Jacobs WCH, Rubinstein SM, Willems PC, Moojen WA, Pellisé F, Oner CF, et al. The evidence on surgical interventions for low back disorders, an overview of systematic reviews. Eur Spine J. 2013;22(9):1936–49.CrossRefPubMedPubMedCentral
16.
Kreiner DS, Hwang SW, Easa JE, Resnick DK, Baisden JL, Bess S, et al. An evidence-based clinical guideline for the diagnosis and treatment of lumbar disc herniation with radiculopathy. Spine J. 2014;14(1):180–91.CrossRefPubMed
17.
Kreiner DS, Shaffer WO, Baisden JL, Gilbert TJ, Summers JT, Toton JF, et al. An evidence-based clinical guideline for the diagnosis and treatment of degenerative lumbar spinal stenosis (update). Spine J. 2013;13(7):734–43.CrossRefPubMed
18.
Watters WC 3rd, Bono CM, Gilbert TJ, Kreiner DS, Mazanec DJ, Shaffer WO, Baisden J, Easa JE, Fernand R, Ghiselli G, Heggeness MH, Mendel RC, O’Neill C, Reitman CA, Resnick DK, Summers JT, Timmons RBTJ. North American Spine Society an evidence-based clinical guideline for the diagnosis and treatment of degenerative lumbar spondylolisthesis. Spine J. 2009;9(7):609–14.CrossRefPubMed
19.
The National Institute for Health and Care Excellence (NICE). Low back pain and sciatica in over 16s: assessment and management. London; 2016.
20.
Qaseem A, Wilt TJ, McLean RM, Forciea MA. Clinical Guidelines Committee of the American College of Physicians. Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians. Ann Intern Med. 2017;166(7):514.CrossRefPubMed
21.
Santa Mina D, Clarke H, Ritvo P, Leung YW, Matthew AG, Katz J, et al. Effect of total-body prehabilitation on postoperative outcomes: a systematic review and meta-analysis. Physiother (United Kingdom). 2014;100(3):196–207.
22.
Carli F, Zavorsky GS. Optimizing functional exercise capacity in the elderly surgical population. Curr Opin Clin Nutr Metab Care. 2005;8(1):23–32.CrossRefPubMed
23.
Delitto A, George SZ, Van Dillen L, Whitman JM, Sowa G, Shekelle P, Denninger TRGJ. Low Back pain clinical practice guidelines linked to the international classification of functioning, disability, and health from the Orthopaedic section of the American Physical Therapy Association. J Orthop Sport Phys Ther. 2012;42(4):A1–57.CrossRef
24.
Lindbäck Y, Tropp H, Enthoven P, Abbott A, Öberg B. PREPARE: pre-surgery physiotherapy for patients with degenerative lumbar spine disorder: a randomized controlled trial protocol. BMC Musculoskelet Disord. 2016;17(1):270.CrossRefPubMedPubMedCentral
25.
Lindbäck Y, Tropp H, Enthoven P, Abbott A, Öberg B. Prepare: pre-surgery physiotherapy for patients with degenerative lumbar spine disorder: a randomized controlled trial. Spine J. 2018;18(8):1347–55.CrossRefPubMed
26.
Ammendolia C, Stuber K, Tomkins-Lane C, Schneider M, Rampersaud YR, Furlan AD, et al. What interventions improve walking ability in neurogenic claudication with lumbar spinal stenosis? A systematic review. Eur Spine J. 2014;23(6):1282–301.CrossRefPubMed
27.
Boutron I, Altman DG, Moher D, Schulz KF, Ravaud P. CONSORT statement for randomized trials of nonpharmacologic treatments: a 2017 update and a CONSORT extension for nonpharmacologic trial abstracts. Ann Intern Med. 2017;167(1):40.CrossRefPubMed
28.
Stanton TR, Fritz JM, Hancock MJ, Latimer J, Maher CG, Wand BMPE. Evaluation of a treatment-based classification algorithm for low back pain: a cross-sectional study. Phys Ther. 2011;91(4):496–509.CrossRefPubMed
29.
Fritz S, Lusardi M. Walking speed: the sixth vital sign. J Geriatr Phys Ther. 2009;32(2):1–5.CrossRef
30.
Middleton A, Fritz S, Lusardi M. Waking speed: the functional vital sign. J Aging Phys Act. 2015;23(2):314–22.CrossRefPubMed
31.
Steffen TM, Hacker T. A, Mollinger L. age- and gender-related test performance in community-dwelling elderly people: six-minute walk test, berg balance scale, timed up &amp; go test, and gait speeds. Phys Ther. 2002;82(2):128–37.CrossRefPubMed
32.
Rydwik E, Bergland A, Forsen L, Frandin K. Investigation into the reliability and validity of the measurement of elderly people’s clinical walking speed: a systematic review. Physiother Theory Pract. 2012;28(3):238–56.CrossRefPubMed
33.
Richards CL. Hemiparetic gait following stroke. Part 2: recovery and physical therapy. Gait Posture. 1996;4(2):149–62.CrossRef
34.
Fairbank JC, Couper JDJ. The Oswestry low back pain disability questionnaire. Physiotherapy. 1980;66:271–3.PubMed
35.
Fairbank JC, Pynsent PB. The Oswestry disability index. Spine (Phila Pa 1976). 2000;25(22):2940–52.CrossRef
36.
Tomkins-Lane CC, Battié MC. Validity and reproducibility of self-report measures of walking capacity in lumbar spinal stenosis. Spine (Phila Pa 1976). 2010;35(23):2097–102.CrossRef
37.
Scott DA, Bond EQ, Sisto SA, Nadler SF. The intra- and interrater reliability of hip muscle strength assessments using a handheld versus a portable dynamometer anchoring station. Arch Phys Med Rehabil. 2004;85(4):598–603.CrossRefPubMed
38.
Mentiplay BF, Perraton LG, Bower KJ, Adair B, Pua Y-H, Williams GP, et al. Assessment of lower limb muscle strength and power using hand-Held and fixed dynamometry: a reliability and validity study. PLoS One. 2015;10(10):1–18.CrossRef
39.
Arnold CM, Warkentin KD, Chilibeck PD, Magnus CRA. The reliability and validity of handheld dynamometry for the measurement of lower-extremity muscle strength in older adults. J Strength Cond Res. 2010;24(3):815–24.CrossRefPubMed
40.
Andrews AW, Thomas MW, Bohannon RW. Normative values for isometric muscle force measurements obtained with hand-held dynamometers. Phys Ther. 1996;76(3):248–59.CrossRefPubMed
41.
Mangione KK, Craik RL, Tomlinson SS, Palombaro KM. Can elderly patients who have had a hip fracture perform moderate- to high-intensity exercise at home? Phys Ther. 2005;85(8):727–39.PubMed
42.
43.
Hedges LV. Distribution theory for Glass’s estimator of effect size and related estimators. J Educ Stat. 1981;6(2):107–28.CrossRef
44.
Tomkins-Lane CC, Battié MC. Predictors of objectively measured walking capacity in people with degenerative lumbar spinal stenosis. J Back Musculoskelet Rehabil. 2013;26(4):345–52.CrossRefPubMed
45.
Cruz-Jimenez M. Normal changes in gait and mobility problems in the elderly. Phys Med Rehabil Clin N Am. 2017;28(4):713–25.CrossRefPubMed
46.
Cooper R, Kuh D, Hardy R. Mortality Review Group, FALCon and HALCyon Study Teams. Objectively measured physical capability levels and mortality: systematic review and meta-analysis. BMJ. 2010;341(9):c4467.CrossRefPubMedPubMedCentral
47.
Aalto TJ, Malmivaara A, Kovacs F, Herno A, Alen M, Salmi L, et al. Preoperative predictors for postoperative clinical outcome in lumbar spinal stenosis. Spine (Phila Pa 1976). 2006;31(18):E648–63.CrossRef
48.
49.
Bohannon RW, Glenney SS. Minimal clinically important difference for change in comfortable gait speed of adults with pathology: a systematic review. J Eval Clin Pract. 2014;20(4):295–300.CrossRefPubMed
50.
Nielsen P, Jørgensen L, Dahl B, Pedersen T. Prehabilitation and early rehabilitation after spinal surgery: randomized clinical trial. Clin Rehabil. 2010;24:137–48.CrossRefPubMed
51.
Zaina F, Tomkins-Lane C, Carragee E, Negrini S. Surgical versus non-surgical treatment for lumbar spinal stenosis. Cochrane Database Syst Rev. 2016;1:857–68.
52.
Watters WC, Baisden J, Gilbert TJ, Kreiner S, Resnick DK, Bono CM, et al. Degenerative lumbar spinal stenosis: an evidence-based clinical guideline for the diagnosis and treatment of degenerative lumbar spinal stenosis. Spine J. 2008;8(2):305–10.CrossRefPubMed
53.
Engel GL. The need for a new medical model: a challenge for biomedicine. Science (80- ). 1977;196(4286):129–36.CrossRef
54.
Juhl C, Christensen R, Roos EM, Zhang W, Lund H. Impact of exercise type and dose on pain and disability in knee osteoarthritis: a systematic review and meta-regression analysis of randomized controlled trials. Arthritis Rheumatol. 2014;66(3):622–36.CrossRefPubMed
55.
Wertli MM, Rasmussen-Barr E, Held U, Weiser S, Bachmann LM, Brunner F. Fear-avoidance beliefs-a moderator of treatment efficacy in patients with low back pain: a systematic review. Spine J. 2014;14(11):2658–78.CrossRefPubMed
56.
O’Connell NE, Cook CE, Wand BM, Ward SP. Clinical guidelines for low back pain: a critical review of consensus and inconsistencies across three major guidelines. Best Pract Res Clin Rheumatol. 2016;30(6):968–80.CrossRefPubMed
57.
Santa Mina D, Scheede-Bergdahl C, Gillis C, Carli F. Optimization of surgical outcomes with prehabilitation. Appl Physiol Nutr Metab. 2015;40(9):966–9.CrossRefPubMed
58.
Louw A, Diener I, Landers MR, Puentedura EJ. Preoperative pain neuroscience education for lumbar radiculopathy: a multi-center randomized controlled trial with one-year follow-up. Spine (Phila Pa 1976). 2014;39(18):1449–57.CrossRef
59.
Tomkins-Lane C, Battie M, Rogers T, Jiang H, Petersen S. A criterion measure of walking capacity in lumbar spinal stenosis and its comparison with a treadmill protocol. Spine (Phila Pa 1976). 2009;34(2444):9.
60.
Debono B, Lonjon G, Galovich LA, Kerever S, Guiot B, Eicker S-O, Hamel O, Ringel F. Indication variability in degenerative-lumbar spine surgery: a 4-nation survey. Spine (Phila Pa 1976). 2018;1(43):185–92.CrossRef
Metadata
Title
Effects of pre-surgery physiotherapy on walking ability and lower extremity strength in patients with degenerative lumbar spine disorder: Secondary outcomes of the PREPARE randomised controlled trial
Authors
Maria Fors
Paul Enthoven
Allan Abbott
Birgitta Öberg
Publication date
01-12-2019
Publisher
BioMed Central
Published in
BMC Musculoskeletal Disorders / Issue 1/2019
Electronic ISSN: 1471-2474
DOI
https://doi.org/10.1186/s12891-019-2850-3

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