RESUMEN
A prospective 10-year follow-up study was conducted to determine the significance of the preoperative sense of coherence, with respect to the preoperative and 10-year clinical characteristics, among lumbar spinal stenosis patients ( N = 99). In addition, the predictive value of the preoperative sense of coherence regarding the 10-year surgery outcome was also evaluated. In a logistic regression analysis, a weak preoperative sense of coherence and low functional ability predicted the patients' functional ability 10 years after the surgery. Moreover, those patients with weak sense of coherence before surgery showed poorer functional ability 10 years after the surgery, but not preoperatively. A weak preoperative sense of coherence seems to associate with poorer long-term outcome after surgery; therefore, various rehabilitation strategies are discussed.
Asunto(s)
Vértebras Lumbares/cirugía , Sentido de Coherencia , Estenosis Espinal/cirugía , Actividades Cotidianas , Adulto , Anciano , Femenino , Estudios de Seguimiento , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Periodo Preoperatorio , Estudios Prospectivos , Recuperación de la Función , Estenosis Espinal/psicología , Estenosis Espinal/rehabilitación , Resultado del TratamientoRESUMEN
The aim was to study if postoperative rehabilitation improves functional outcome in lumbar spinal stenosis (LSS). Surgically treated LSS patients (n = 102) were randomized to rehabilitation-group (A) and "standard postoperative treatment"--group (B). Intervention for A-group started 3 months postoperatively, consisting of once a week outpatient visits for 12 weeks (1.5 h per visit; 1-6 patients per one physiotherapist). Physiotherapist guided stretching and strengthening exercises. A-group performed individually estimated exercises at those visits with guiding and at home up to 24-month postoperative follow-up. Physiotherapeutic guidance (12 times) was repeated after 12 months, in order to update exercises and motivate patients to keep training. For B-group, the "standard treatment" thus included normal postoperative treatment, or no treatment/self-management. Outcome measures were measured at the start and the end of the first physiotherapeutic intervention (3 and 6 months postoperatively), and at 12- and 24-month postoperative follow-ups. Oswestry Disability Index (ODI, 0-100%) was the main outcome measure. The other outcome measures were back- and leg pain separately (NRS-11); satisfaction (7-point scale) and treadmill test (0-1,000 m; not at 6 month). The intervention consisting of 12 + 12 physiotherapeutic sessions with further home exercises did not influence the course ODI in the 24-month postoperative follow-up (p = 0.95 for ODI; "as-rehabilitated" analysis). No influence on any other outcome measures was observed. After LSS surgery, routinely performed outpatient rehabilitation did not improve functional outcome compared to standard treatment. In addition, it had no impact on the back and leg pain, satisfaction and walking ability.
Asunto(s)
Terapia por Ejercicio/tendencias , Modalidades de Fisioterapia/tendencias , Estenosis Espinal/rehabilitación , Estenosis Espinal/cirugía , Espondilosis/rehabilitación , Espondilosis/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Dolor Crónico/fisiopatología , Dolor Crónico/rehabilitación , Dolor Crónico/cirugía , Evaluación de la Discapacidad , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Estenosis Espinal/fisiopatología , Espondilosis/fisiopatologíaRESUMEN
STUDY DESIGN: Systematic review. OBJECTIVE: To define preoperative factors predicting clinical outcome after lumbar spinal stenosis (LSS) surgery. SUMMARY OF BACKGROUND DATA: LSS is the most common reason requiring lumbar spine surgery in adults older than 65 years. There are no published systematic reviews on this topic. METHODS: A literature search was done until April 30, 2005. Included were randomized controlled or controlled trials or prospective studies dealing with operated LSS. The preoperative predictors had to be presented. Included articles were assessed as high-quality (HQ) and low-quality studies. The predictors in HQ studies were considered as the main results. RESULTS: A total of 21 articles were included. Depression and walking capacity were predictors according to 2 HQ studies. Predictors reported in 1 HQ study were cardiovascular/overall comorbidity, disorder influencing walking ability, self-rated health, income, severity of central stenosis, and scoliosis. CONCLUSION: Depression, cardiovascular comorbidity, disorder influencing walking ability, and scoliosis predicted poorer subjective outcome. Better walking ability, self-rated health, higher income, less overall comorbidity, and pronounced central stenosis predicted better subjective outcome. Male gender and younger age predicted better postoperative walking ability. The predictive value may be outcome specific; thus, the use of all relevant outcome measures is recommended when studying predictors of LSS.
Asunto(s)
Vértebras Lumbares/fisiopatología , Vértebras Lumbares/cirugía , Estenosis Espinal/fisiopatología , Estenosis Espinal/cirugía , Bases de Datos Factuales , Femenino , Humanos , Masculino , Valor Predictivo de las Pruebas , Pronóstico , Calidad de Vida , Ensayos Clínicos Controlados Aleatorios como Asunto , Estenosis Espinal/diagnóstico , Resultado del Tratamiento , CaminataRESUMEN
OBJECTIVE: To examine the intra- and intertester and intra- and interday reliability of hip passive range of motion (PROM) measurements and the effect of passive stretch on the reproducibility of PROM measurements. DESIGN: Reliability study. SETTING: Rehabilitation clinic at university hospital. PARTICIPANTS: Twenty volunteers (12 women, 8 men; age range, 18-45 y). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Two physical therapists made 2 PROM measurements on the first day and repeated them once after 2 days. The PROM in hip flexion, extension, and inner rotation and knee flexion were determined. The measurements of the hip flexion and inner rotation involved either 1 or 8 short-term passive stretches. The reproducibility was expressed as the intraclass correlation coefficient (ICC) and the coefficient of variation (CV) (in percent). RESULTS: The passive stretch increased significantly ( P <.05 to P <.001) the PROM of the hip joint. The reproducibility of the PROM measurement did not increase after repetitive passive stretch. The intra- and interday intra- and intertester ICC and CV of the PROM of the hip flexion and hip inner rotation ranged from .655 to .988 and 2.1% to 12.6%, respectively. The intra- and intertester intra- and interday ICC of the PROM of the hip extension ranged from .740 to .961, and the CV ranged from -85.5% to 242.6%. The intra- and intertester intra- and interday ICC of the PROM of the knee flexion ranged from .497 to .913, and the CV ranged from 2.5% to 9.9%. CONCLUSIONS: Repetitive stretching increased significantly the PROM in hip flexion and inner rotation, but the reproducibility of the PROM measurement did not improve. The hip flexion and the hip inner rotation PROM measurements had moderate to very high intra- and interday intra- and intertester reliabilities. The reliability of the PROM in hip extension and knee flexion was poor.