Revues et méta-analyses SRBMPR / SOFMER

Le 14/10/2021 de 16:30 à 18:00

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Réadaptation pour améliorer les résultats fonctionnels de la fusion lombaire: revue systématique et méta-analyse

Liedewij Bogaert (Leuven, Belgique), Tinne Thys (Leuven, Belgique), Bart Depreitere (Leuven, Belgique), Wim Dankaerts (Leuven, Belgique), Charlotte Amerijckx (Diepenbeek, Belgique), Peter Van Wambeke (Leuven, Belgique), Karel Jacobs (Leuven, Belgique), Helena Boonen (Leuven, Belgique), Simon Brumagne (Leuven, Belgique), Lieven Moke (Leuven, Belgique), Sebastiaan Schelfaut (Leuven, Belgique), Koen Peers (Leuven, Belgique), Thijs Swinnen (Leuven, Belgique), Lotte Janssens (Diepenbeek, Belgique)

Objective : Rehabilitation in the perioperative period of lumbar fusion surgery may be a window of opportunity to improve suboptimal functionality. Extensive variation in rehabilitation strategies necessitates an up-to-date overview of the evidence.
Therefore, we aimed to assess the effectiveness of perioperative rehabilitation strategies in patients undergoing lumbar fusion for degenerative conditions.

Material / Patients and Methods : Six electronic databases were systematically searched for randomized controlled trials (RCTs) evaluating the effect of perioperative rehabilitation (single modal or multimodal) on disability, pain, pain-related fear, and return-to-work. The estimated effect size was calculated for interventions with homogeneous content using a random-effects model. Certainty of evidence was assessed by GRADE. 

Results : In total, 18 RCTs, including 1402 unique patients, compared specific rehabilitation to other rehabilitation strategies or usual care. At short-term, low to very low evidence shows that multimodal rehabilitation was more effective in reducing disability and pain-related fear than exercise therapy alone (standardized mean difference [95% CI]: -0.80 [-1.56; -0.03] and -0.64 [-1.12; -0.14], respectively). Exercise therapy was more effective for reducing disability and pain than usual care (-0.41 [−0.71; −0.10] and -0.36 [−0.65; −0.08], respectively). Effects disappeared over the long term. Return-to-work showed a positive tendency in favor of rehabilitation (pooled relative risk [95% CI]: 1.30 [0,99-1.69]).  

Discussion - Conclusion : The current evidence on rehabilitation in the perioperative period of lumbar fusion suggests that exercise therapy is effective for reducing disability and pain, and when embedded in multimodal rehabilitation further reduces disability and fear-avoidance in short-term follow-up. This review will inform the development of a novel perioperative rehabilitation pathway of lumbar fusion.

Keywords : Lumbar fusion

Perioperative period

Low back pain