Rehabilitation after lumbar disc surgery

Background Several rehabilitation programmes are available for individuals after lumbar disc surgery. Objectives To determine whether active rehabilitation after lumbar disc surgery is more effective than no treatment, and to describe which type of active rehabilitation is most effective. This is the second update of a Cochrane Review first published in 2002. First, we clustered treatments according to the start of treatment. 1. Active rehabilitation that starts immediately postsurgery. 2. Active rehabilitation that starts four to six weeks postsurgery. 3. Active rehabilitation that starts longer than 12 months postsurgery. For every cluster, the following comparisons were investigated. A. Active rehabilitation versus no treatment, placebo or waiting list control. B. Active rehabilitation versus other kinds of active rehabilitation. C. Specific intervention in addition to active rehabilitation versus active rehabilitation alone. Search methods We searched CENTRAL (2013, Issue 4) and MEDLINE, EMBASE, CINAHL, PEDro and PsycINFO to May 2013. Selection criteria We included only randomised controlled trials (RCTs). Data collection and analysis Pairs of review authors independently assessed studies for eligibility and risk of bias. Meta‐analyses were performed if studies were clinically homogeneous. The GRADE approach was used to determine the overall quality of evidence. Main results In this update, we identified eight new studies, thereby including a total of 22 trials (2503 participants), 10 of which had a low risk of bias. Most rehabilitation programmes were assessed in only one study. Both men and women were included, and overall mean age was 41.4 years. All participants had received standard discectomy, microdiscectomy and in one study standard laminectomy and (micro)discectomy. Mean duration of the rehabilitation intervention was 12 weeks; eight studies assessed six to eight‐week exercise programmes, and eight studies assessed 12 to 13‐week exercise programmes. Programmes were provided in primary and secondary care facilities and were started immediately after surgery (n = 4) or four to six weeks (n = 16) or one year after surgery (n = 2). In general, the overall quality of the evidence is low to very low. Rehabilitation programmes that started immediately after surgery were not more effective than their control interventions, which included exercise. Low‐ to very low‐quality evidence suggests that there were no differences between specific rehabili