Unveiling Timetable for Physical Therapy after Single-Level Lumbar Surgery for Degenerative Disc Disease: Insights from a Systematic Review and Meta-Analysis

Abstract

Background: Postoperative physical therapy emerges as a pivotal element of the rehabilitation process, aimed at enhancing functional recovery, managing pain, and mitigating the risk of further complications. The debate concerning the optimal timing of physical therapy intervention post-surgery remains unresolved; in particular, whether to initiate physical therapy immediately or to wait weeks is of particular interest. The aim of this study is to review the available literature regarding the optimal timing of physical therapy initiation and the outcomes obtained. Methods: This review was carried out in accordance with the Preferential Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. This search was carried out in February 2024. Only peer-reviewed articles were considered for inclusion. Results: Fourteen studies were included. The primary outcomes assessed in the included studies were the following: 12-week and 12-month low back pain, return to work, function and disability, psychological status, patient satisfaction, and complications associated with early physical therapy. A meta-analysis was performed concerning low back pain after lumbar discectomy at 12 weeks and 12 months and complications after early physical therapy after lumbar discectomy and lumbar interbody fusion. A significant difference was found between early and standard physical therapy in terms of low back pain at 12-18 months (p = 0.0062); no significant differences were found in terms of complications, both for discectomy and arthrodesis. Conclusions: This review indicates that employing early rehabilitation strategies for intervertebral disc disease could enhance results in terms of pain and disability without an enhanced risk of complications.

Keywords: complications; early physical therapy; lumbar disc disease; outcomes; timing.

Figure 1

Prisma 2009 flow diagram of the included studies; LBP = low back pain; PT = physical therapy.

Figure 2

ROB 2.0 and ROBINS-I tools used for the included studies [8,9,14,15,16,17,18,19,20,21,22,23,24,25].

Figure 3

ROB2 tool plot summary.

Figure 4

Forrest plot representation of the meta-analysis for low back pain at 12–week follow-up after lumbar discectomy [8,14,16,19,22,23].

Figure 5

Forrest plot representation of the meta-analysis for low back pain at 12–18-month follow-up after lumbar discectomy [8,14,16].

Figure 6

Forrest plot representation of the meta–analysis for complications after lumbar interbody fusion and physical therapy [9,18,20,24].

Figure 7

Forrest plot representation of the meta–analysis for complications after lumbar discectomy and physical therapy [8,14,16,17,23].