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Greenwood J.1, McGregor A.2, Jones F.3, Grant R.3, Hurley M.3
1National Hospital for Neurology and Neurosurgery, London, United Kingdom, 2Imperial College London, London, United Kingdom, 3St George's University of London, London, United Kingdom
Background: Symptomatic degenerative lumbar disorders may be treated with lumbar fusion surgery (LFS). Unfortunately clinical outcomes following LFS are disappointing. Patients cite, ongoing back pain, restricted emotional, social and physical function [1]. Theoretically informed rehabilitation programmes following LFS may enhance outcome.
Purpose: We developed a theoretically informed, complex rehabilitation programme, REhabilitation after lumbar Fusion Surgery (REFS) [2] and are undertaking a feasibility study to evaluate this. Interim data are available from baseline to 6 months. We present;
· Engagement.
· Baseline data.
· Between group results at 6 months for Oswestry Disability Index (ODI), European Quality of Life Score 5 Domain (EQ-5D), Hospital Anxiety and Disability Score (HADS) and Pain Self-Efficacy Questionnaire (PSEQ).
· Engagement.
· Baseline data.
· Between group results at 6 months for Oswestry Disability Index (ODI), European Quality of Life Score 5 Domain (EQ-5D), Hospital Anxiety and Disability Score (HADS) and Pain Self-Efficacy Questionnaire (PSEQ).
Methods: A convenience sample (n=52), were randomised to either usual care or REFS programme, commenced 3 months after LFS.
REFS consisted of 10 consecutive weekly, small group (n 6) sessions (90 minutes duration) comprising education, individualised exercise and peer support. The education component consisted of the incremental delivery of clear and structured topics relevant to the recovery from LFS. The exercise component consisted of simple low-tech exercises, tailored to the abilities of the individual, and progressed. Peer support discussions concluded each session.
Between group differences at 6 months following LFS were calculated with a one-way ANOVA.
Results: Primary evaluation is related to feasibility aspects of the study particularly engagement. Participants will be considered to have engaged with the programme if they attend more than 50% of the offered sessions, record progressive exercise achievement and make regular weekly entries in their home exercise diaries.
Secondary evaluation via a cluster of quantitative measures including ODI, EQ-5D, HADS and PSEQ.
1. Participants (n=52) had a mean age of 54.15 (range 30-77), 69% female.
2. Mean and (95%, CI) at baseline for
a. ODI, 52.52 (47.87-57.26).
b. PSEQ, 25.9 (21.8-30.0).
c. EQ-5D, 47.0 (41.4-52.6).
d. HADS (anxiety subscale), 10.08 (8.84-11.31), and (depression subscale), 8.96 (7.68-10.24)
e. There was no significant difference between groups at baseline all measures.
3. Engagement has been positive, 95% (18/19) of participants engaging with the process.
4. Mean (SD) ODI at 6 months was 27.69 (21.73) and 45.11 (27.77) for rehabilitation/usual care groups respectively, (p>0.047).
5. Mean (SD) PSEQ at 6 months was 43 (15.83) and 29.25 (21.82) for rehabilitation/usual care groups respectively, (p>0.13).
6. Mean (SD) EQ-5D at 6 months was 74.1 (19.06) and 54.47 (28.32) for the rehabilitation/usual care groups respectively, (p>0.07).
7. Mean (SD) HADS (anxiety subscale) at 6 months was 7.18 (4.69) and 8.72 (5.58) for rehabilitation/usual care groups respectively, (p>0.448)
8. Mean (SD) HADS (depression subscale) at 6 months was 5.75 (5.21) and 6.82 (5.67) rehabilitation/usual care groups respectively (p>0.78).
Conclusion(s): The study to date has demonstrated high levels of engagement across a range of measures. There is evidence of short-term clinical benefit and statistically significant improvement in disability at 6 month following LFS.
Implications: This study informs the provision of rehabilitation following LFS. Suggesting that theoretically informed, complex rehabilitation has the potential to improve short-term clinical outcomes following LFS. Long-term follow up is planned.
Funding acknowledgements: National Institute for Health Research Clinical Doctoral Research Fellowship (NIHR, CDRF)
Topic: Musculoskeletal: spine
Ethics approval: National Research Ethics Service, 14/LO/0748
All authors, affiliations and abstracts have been published as submitted.
