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Meta-Analysis
. 2016 Feb;97(2):292-301.
doi: 10.1016/j.apmr.2015.09.003. Epub 2015 Sep 25.

Physiotherapy Commenced Within the First Four Weeks Post-Spinal Surgery Is Safe and Effective: A Systematic Review and Meta-Analysis

Megan Snowdon  1 , Casey L Peiris  2
Affiliations
Meta-Analysis

Physiotherapy Commenced Within the First Four Weeks Post-Spinal Surgery Is Safe and Effective: A Systematic Review and Meta-Analysis

Megan Snowdon et al. Arch Phys Med Rehabil. 2016 Feb.

Abstract

Objectives: To determine whether physiotherapy commenced within the first 4 weeks post-spinal surgery is safe and effective.

Data sources: Electronic databases CINAHL, MEDLINE, AMED, PubMed, Embase, and PEDro were searched from the earliest date possible through May 2015. An additional trial was identified through reference list scanning.

Study selection: Controlled trials evaluating comprehensive physiotherapy rehabilitation commenced within 4 weeks postoperatively compared with a control group receiving no physiotherapy, standard postoperative care, rest, less active physiotherapy, or sham physiotherapy after spinal surgery of a musculoskeletal etiology. Two reviewers independently applied inclusion and exclusion criteria, with disagreements discussed until consensus could be reached. Searching identified 3162 potentially relevant articles, of which 4 trials with 250 participants met the inclusion criteria.

Data extraction: Data were extracted using a predefined data extraction form. Methodological quality of trials was assessed independently by 2 reviewers using the Downs and Black checklist. Pooled analyses were performed using a random-effects model with inverse variance methods to calculate risk differences and 95% confidence intervals (CIs) (dichotomous outcomes), and standardized mean differences (SMDs) and 95% CIs (continuous outcomes).

Data synthesis: When compared with no or sham physiotherapy, early comprehensive physiotherapy did not increase the risk of adverse events (risk difference, -.01; 95% CI, -.07 to .05; I(2)=0%). In addition, there is moderate-quality evidence demonstrating a reduction in pain by a moderate and significant amount at 12 weeks (SMD=-.38; 95% CI, -.66 to -.10; I(2)=0%) and at 12+ months (SMD=-.30; 95% CI, -.59 to -.02; I(2)=0%).

Conclusions: Early comprehensive physiotherapy commenced within the first 4 weeks post-spinal surgery does not increase the potential for an adverse event and leads to a moderate, statistically significant reduction in pain when compared with a control group.

Keywords: Diskectomy; Laminectomy; Physical therapy modalities; Rehabilitation.

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