Individualized functional restoration as an adjunct to advice for lumbar disc herniation with associated radiculopathy. A pre-planned subgroup analysis of a randomized controlled trial

Abstract Background context Physical therapy is commonly sought by people with lumbar disc herniation and associated radiculopathy. It is unclear whether physical therapy is effective for this population. Purpose To determine the effectiveness of physical therapist delivered individualized functional restoration as an adjunct to guideline-based advice in people with lumbar disc herniation and associated radiculopathy. Design Pre-planned subgroup analysis of a multicenter parallel group randomized controlled trial. Patient sample Fifty-four participants with clinical features of radiculopathy (six-week to six-month duration) and imaging showing a lumbar disc herniation. Outcome measures Primary outcomes were activity limitation (Oswestry Disability Index), and separate 0-10 numerical pain rating scales for leg pain and back pain. Measures were taken at baseline and at 5, 10, 26 and 52-weeks. Methods Participants were randomly allocated to receive either individualized functional restoration incorporating advice (10 sessions) or guideline-based advice alone (2 sessions) over a 10-week period. Treatment was administered by 11 physical therapists at private clinics in Melbourne, Australia. Results Between-group differences for activity limitation favoured the addition of individualized functional restoration to advice alone at 10-weeks (7.7; 95% CI 0.3 to 15.1) and 52-weeks (8.2; 95% CI 0.7 to 15.6), as well as back pain at 10-weeks (1.4; 95% CI 0.2 to 2.7). There were no significant differences between groups for leg pain at any follow-up. Several secondary outcomes also favoured individualized functional restoration over advice. Conclusion In participants with lumbar disc herniation and associated radiculopathy, an individualized functional restoration program incorporating advice led to greater reduction in activity limitation at 10-week and 52-week follow-ups compared to guideline-based advice alone. Although back pain was significantly reduced at 10 weeks with individualized functional restoration, this effect was not maintained at later timepoints, and there were no significant effects on leg pain, relative to guideline-based advice.