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A Journal on Physical Medicine and Rehabilitation after Pathological Events

Official Journal of the Italian Society of Physical and Rehabilitation Medicine (SIMFER), European Society of Physical and Rehabilitation Medicine (ESPRM), European Union of Medical Specialists - Physical and Rehabilitation Medicine Section (UEMS-PRM), Mediterranean Forum of Physical and Rehabilitation Medicine (MFPRM), Hellenic Society of Physical and Rehabilitation Medicine (EEFIAP)
In association with International Society of Physical and Rehabilitation Medicine (ISPRM)
Indexed/Abstracted in: CINAHL, Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
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Europa Medicophysica 2003 December;39(4):171-9

language: English

Does failed spine surgery affect the outcomes from rehabilitation of chronic low back pain?

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.

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