PREPARE: presurgery physiotherapy for patients with degenerative lumbar spine disorder: a randomized controlled trial

Yvonne Lindbäck, Hans Tropp, Paul Enthoven, Allan Abbott, Birgitta Öberg

- Surgery due to disc herniation, or spinal stenosis results mostly in large improvement in the short-term, but mild to moderate improvements for pain and disability at long-term follow-up. Prehabilitation has been defined as augmenting functional capacity prior to surgery, which may have beneficial effect on outcome after surgery. - The aim was to study if pre-surgery physiotherapy improves function, pain and health in patients with degenerative lumbar spine disorder scheduled for surgery. - A single blinded, 2-arm, RCT. - 197 patients were consecutively included at a Spine Clinic. The inclusion criteria were; patients scheduled for surgery due to disc herniation, spinal stenosis, spondylolisthesis or DDD, 25 to 80 years of age. - Primary outcome was Oswestry Disability Index (ODI). Secondary outcomes were pain intensity, anxiety, depression, self-efficacy, fear avoidance, physical activity and treatment effect. - Patients were randomized to either - pre-surgery physiotherapy or standardized information, with follow-up after the pre-surgery intervention as well as 3 and 12 months post-surgery. The study was funded by regional research funds for US$77,342. No conflict of interest is declared. - The pre-surgery physiotherapy group had better ODI, VAS back pain, EQ-5D, EQ-VAS, FABQ-PA, SES and HADS depression scores and activity level compared to the waiting-list group after the pre-surgery intervention. The improvements were small, but larger than the study specific minimal clinical important change (MCIC) in VAS back and leg pain, EQ-5D and FABQ-PA and almost in line with MCIC in ODI and PCS in the physiotherapy-group. Post-surgery difference between groups only maintained for higher activity level in the physiotherapy-group. - Pre-surgery physiotherapy decreases pain, risk for avoidance behavior and worsening of psychological well-being and improves quality of life, and physical activity levels prior to surgery compared to waiting-list controls. These results were only maintained for activity levels post-surgery. Still, pre-surgery selection, content, dosage of exercises and importance of being active in a pre-surgery physiotherapy intervention is of interest to study further to improve long-term outcome.