Article

Restoration of physical function following lumbar microdiskectomy may
be influenced by the postoperative care provided. OBJECTIVE: The purpose of this
study was to examine the effectiveness of a new interventional protocol to
improve functional performance in patients who have undergone a single-level
lumbar microdiskectomy. SETTING: The study was conducted in physical therapy
outpatient clinics. DESIGN AND PARTICIPANTS: Ninety-eight participants (53 male,
45 female) who had undergone a single-level lumbar microdiskectomy were randomly
allocated to receive education only or exercise and education. INTERVENTION AND
MEASUREMENTS: The exercise intervention consisted of a 12-week periodized program
of back extensor strength (force-generating capacity) and endurance training and
mat and upright therapeutic exercises. The Oswestry Disability Index (ODI) and
physical measures of functional performance were tested 4 to 6 weeks postsurgery
and 12 weeks later, following completion of the intervention program. Because
some participants sought physical therapy outside of the study, postintervention
scores were analyzed for both an as-randomized (2-group) design and an as-treated
(3-group) design. RESULTS: In the 2-group analyses, exercise and education
resulted in a greater reduction in ODI scores and a greater improvement in
distance walked. In the 3-group analyses, post hoc comparisons showed a
significantly greater reduction in ODI scores following exercise and education
compared with the education-only and usual physical therapy groups. LIMITATIONS:
The limitations of this study include a lack of adherence to group assignment,
disproportionate therapist contact time among treatment groups, and multiple use
of univariate analyses. CONCLUSIONS: An intensive, progressive exercise program
combined with education reduces disability and improves function in patients who
have undergone a single-level lumbar microdiskectomy.

Langue : ANGLAIS