This data audit aimed to provide quantitative insights into the optimal timing and delivery of rehabilitation for LD, to explore whether prehab is associated with better clinical outcomes in the long-term following LD surgery. The primary aim was to determine whether the timing of rehabilitation (pre- or postoperative) influenced the outcome following LD.
In order to fulfil the primary aim, outcomes from the Core Outcomes Index Score (COMI) were analysed. The COMI is a validated questionnaire which measures the impact of multiple key outcomes on those with back pain. Adults who had undergone first-time, single-level LD at Salford Royal Hospital between December 2016 and March 2019, and been invited to attend prehab, were identified. Relevant pseudonymised data (demographics and COMI scores) were extracted from the existing Spine Tango Registry. Baseline (pre-operative) data was compared with scores at 3- and 12-month (post-operative) follow up.
The study found no statistically significant differences in COMI score, back pain or leg pain between those who attended prehab and those who were invited but did not attend, at 3- and 12-month follow up. Other factors such as higher preoperative COMI, back pain, and leg pain scores were significantly associated with increased likelihood of achieving the minimal clinically relevant change (MCRC) in the COMI, at 12-month follow up. However, attending was linked to a greater likelihood of achieving MCRC at 12 months postoperatively.
Prehab is not significantly more effective than no prehab for LD, although it does have some benefits. This study was limited in its scope: future research could explore preoperative versus postoperative rehabilitation, as well as other preoperative factors associated with a positive LD outcome. A larger-scale study with a diverse population and not limited to a single site would increase generalisability to other settings and populations.
While this study did not find significant advantages to prehab based on available data, using an existing service was a unique opportunity to add to the evidence base regarding PR for LD. It is hoped that clinicians and researchers alike might use these results to aid decision-making and consider future areas for development.
Lumbar discectomy
Audit
