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Official Journal of the , , , ,
In association with
Indexed/Abstracted in: CINAHL, Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
Impact Factor 2,063
Online ISSN 1973-9095
Rainville J. 1, 2, Sobel J. 3, Hartigan C. 1, 2
1 The Spine Center New England Baptist Hospital, Boston, MA, USA
2 Department of Physical Medicine and Rehabilitation Medicine Harvard Medical School, Boston, MA, USA
3 Physiatry Medical Group, Menlo Park, CA, USA
Aim. The purpose of this study was to determine if a history of failed surgery affected physical impairments, self-reported disability, mood disturbance and pain intensity measured before and after spinal rehabilitation.
Methods. This prospective, observational study comparing multiple characteristics and outcomes between subjects with and without spine surgery undergoing rehabilitation in a hospital affiliated spine rehabilitation center. Back and leg pain were measured using visual analog scales, disability with the Oswestry disability scale and depression with the Beck’s depression inventory at evaluation, and at 3 and 12 months using mailed questionnaires. Physical measures of trunk flexibility, straight leg raising, back strength, lifting ability and lower extremity work performance were measured prior to and following rehabilitation. Aggressive quota-based exercises were used to address impairments in back function and were delivered in either group or individual physical therapy settings. χ2 and “t”-tests were used for statistical analyses. Attempts to control for differences in characteristics between groups were done using analyses of variance models.
Results. One-hundred and twenty-two consecutive chronic low back pain subjects completing spine rehabilitation. Eighty-four subjects did not have a history of prior spine surgery. They were compared to 38 with a prior surgical history including 15 with spinal fusions and 23 with decompressions. Prior surgery subjects presented with higher leg pain intensity and more frequently received workers’ compensation when compared to subjects without prior surgery. Most other characteristics were similar. Following rehabilitation, those with prior surgery demonstrated slightly less trunk flexion, otherwise similar improvements in physical measures were noted. Subjects without prior surgery demonstrated a reduction of pain symptoms at 3 and 12 month follow-up, but those with prior surgery did not. Depression improved equally in both groups. Disability also improved in both groups but less so in those with prior surgery. This difference in disability resulted from higher back pain levels in the prior surgery group.
Conclusion. Aggressive rehabilitation efforts improve impairments in back function, depression and disability in most subjects with chronic low back pain, but are less successful in reducing pain symptoms in those with failed prior spine surgery.